I read with great interest the recent article by Simo et al. and applaud their efforts to further elucidate the descriptive epidemiology of Meniere’s disease. Although not perfect, large administrative databases offer the most cost effective way to attempt to define the disease burden in relatively rare diseases.

However, I am concerned that the abstract of this study might be misleading to the casual reader. The abstract gives an estimate of “Meniere’s prevalence in the U.S. population”. However, in my opinion the methodology used does not provide a good estimate of prevalence in the general population. The study reports the proportion of patients who had an inpatient hospital admission with a recorded diagnosis of Meniere’s. The population of patients admitted to the hospital differs significantly from the general population with regards to many demographics, especially age and comorbidities. Therefore using the total number of hospital admissions as the denominator for the prevalence calculation limits the application to an understanding of the epidemiology of Meniere’s in the general population. For example, in 2012 patients age 65 and older accounted for 34.9% of U.S. hospital inpatient admissions , yet this age group only makes up 13.7% of the general population . Because the prevalence of Meniere’s increases with increasing age, the overall prevalence estimate in the article will be skewed with regards to the general population. The same will be true for any of the socioeconomic, ethnic, or geographic demographics analyzed if there are differences in rates of Meniere’s and in rates of all-cause admissions.

As briefly implied by the authors, the use of inpatient data only for the numerator is also problematic for several reasons. First of all, treatment of Meniere’s disease in the U.S. rarely involves inpatient admission. The majority of patients are exclusively treated as outpatients, and such patients are not captured in the National Inpatient Survey. Furthermore, it seems quite likely that a patient with chronic Meniere’s admitted to the hospital for another reason (such as a myocardial infarction or hip replacement) might not have their Meniere’s recorded as a discharge diagnosis.

Although it may be useful to know the prevalence of Meniere’s amongst patients admitted to the hospital, it should be noted that the values reported by Simo et al. cannot easily be compared to other studies that estimate the prevalence in the general population.

Regards,