The Demographics of Menière's Disease: Selection Bias or Differential Susceptibility?

Abstract

ObjectiveTo clarify whether the reported lack of racial and ethnic diversity among Menière's disease (MD) patients is representative of selection bias or disease susceptibility.Study DesignRetrospective medical record review and population-level analyses.SettingTertiary referral center.PatientsCohort of 1091 patients diagnosed with MD by the tertiary otology service.Main Outcome MeasureDemographic and population-level characteristics (age, sex, race, insurance status, ZIP code, median income, education level) compared with local, regional, health system, and otolaryngology clinic demographics.ResultsPatients seen for MD were significantly older than those seen throughout the otolaryngology clinic (median, 65.0 versus 58.8 yr) or health system (65.0 versus 50.8 yr). A majority of patients with MD were of White race (92%), compared with 2.7% Black race and 0.5% Asian. Using population-level data, median income and having medical insurance were significantly correlated with care for MD. A disproportionate rate of care for MD was seen in ZIP codes outside urban areas as compared with other otologic and otolaryngologic conditions seen in the same clinic.ConclusionPatients with MD are of older age, more likely to be of White race, and disproportionately from rural locales. The demographic profile of patients diagnosed with MD by tertiary otology is better explained by differential susceptibility to MD than by selection bias.

An Update on the Epidemiology and Clinicodemographic Features of Meniere's Disease

“…Although 806 patients were identified by ICD‐10 codes, we found that only ~60% of those patients had MD according to the current AAO‐HNS guidelines, with only ~20% meeting diagnostic criteria for definite MD. This further justifies and provides the impetus for this study, given that many prior epidemiologic studies of MD rely purely upon diagnostic codes within clinical records or national records systems, and few have applied strict MD diagnostic criteria 2,10–18 . The construct validity of such studies must thus be called into question due to their inclusion of conditions with overlapping symptomatology—such as vestibular migraine—among cohorts of “MD” 6–9 .…”

“…This further justifies and provides the impetus for this study, given that many prior epidemiologic studies of MD rely purely upon diagnostic codes within clinical records or national records systems, and few have applied strict MD diagnostic criteria. 2,[10][11][12][13][14][15][16][17][18] The construct validity of such studies must thus be called into question due to their inclusion of conditions with overlapping symptomatology-such as vestibular migraine-among cohorts of "MD". [6][7][8][9] As an illustrative example, in the highly cited 1984 study by Wladislavosky-Waserman et al from the Mayo Clinic, up to one-third of the included patients had recurrent vertigo without any cochlear symptoms, and thus would not meet current diagnostic criteria for MD.…”

“…Such studies may furthermore be biased by the application of outdated diagnostic criteria and the inclusion of non-MD diagnoses with overlapping clinical features, such as vestibular migraine. 2,[11][12][13][14][15][16][17][18] As such, any estimates of the disease's prevalence or epidemiologic features drawn from these studies must be interpreted with caution.…”

“…Many studies on the epidemiology of MD are limited by small sample sizes 10 or were conducted prior to the establishment of widely accepted diagnostic criteria. Such studies may furthermore be biased by the application of outdated diagnostic criteria and the inclusion of non‐MD diagnoses with overlapping clinical features, such as vestibular migraine 2,11–18 . As such, any estimates of the disease's prevalence or epidemiologic features drawn from these studies must be interpreted with caution.…”

Epidemiology and genetics of Meniere's disease

“…However, some more recent studies have noted similar frequencies among men and women. A study in United States suggests that Meniere's disease susceptibility is highest in older populations, white race, from higher income and rural areas, with a female to male ratio of only 1.25 [7]. The population-based study in Taiwan also showed higher prevalence in rural areas, with a female to male ratio of 1.84 [5].…”