Balance Disorders in Young and Middle‐Aged Adults: <scp>NHANES</scp> , 2001–2004 and 2021–2023

ABSTRACT Objectives To estimate the prevalence of balance disorders in young and middle‐aged adults, examine associations with risk factors, and changes over the past 20 years. Methods The National Health and Nutrition Examination Survey (NHANES) is a cross‐sectional complex random sample of the civilian, non‐institutionalized United States population. In 2001–2004 and 2021–2023, NHANES included questions about balance, dizziness, and falls in the past 12 months. The modified Romberg test (MRT) was used to examine vestibular balance function. Logistic regression models were used to assess risk factor associations with balance disorders. Results Among 4525 middle‐aged adults 40–69 years in 2001–2004, 21.5% (95% confidence interval [CI]: 19.1%, 23.9%) reported difficulty with balance and dizziness, and 29.7% (27.3%, 32.1%) failed to pass four MRT (MRT‐4) conditions. Among 3986 middle‐aged adults in 2021–2023, 36.2% (34.5%, 37.8%) reported specific balance and dizziness problems (BDP), and 25.9% (23.2%, 28.6%) failed the MRT‐4. An enhanced MRT with a fifth condition (MRT‐5) increased the discrimination of adults at risk of balance problems and falls. Risk factors for vestibular balance disorders, including age, education, income, cigarette smoking, physical activity, hypertension, diabetes, trouble hearing, and severe headaches/migraines, remained consistent. Reported functional disabilities (hearing, mobility, and vision) were significantly associated with BDP and MRT. In 2021–2023, comparisons of 2084 young adults 20–39 years with middle‐aged adults showed increased age‐specific prevalences of BDP and falls. Conclusion Middle‐age‐specific MRT‐4 results in 2021–2023 improved. Balance disorders are associated with other health conditions, increased risk of falls, and need for medical services. Level of Evidence 3.