fulltext- http://www.biomedcentral.com/content/pdf/1741-7015-9-91.pdf
Prevalence of myalgic encephalomyelitis/chronic fatigue syndrome
(ME/CFS) in three regions of England: a repeated cross-sectional study
in primary care
Luis C Nacul, Eliana M Lacerda, Derek Pheby, Peter Campion, Mariam
Molokhia, Shagufta Fayyaz, Jose CDC Leite, Fiona Poland, Amanda Howe
and Maria L Drachler
BMC Medicine 2011, 9:91doi:10.1186/1741-7015-9-91
Published: 28 July 2011
Abstract (provisional)
Background
ME/CFS or chronic fatigue syndrome (CFS) has been used to name a range
of chronic conditions characterized by extreme fatigue and other
disabling symptoms. Attempts to estimate the burden of disease have
been limited by selection bias, and by lack of diagnostic biomarkers
and of agreed reproducible case definitions. We estimated the
prevalence and incidence of ME/CFS in three regions in England, and
discussed the implications of frequency statistics and the use of
different case definitions for health and social care planning and for
research.
Methods
We compared the clinical presentation, prevalence and incidence of
ME/CFS based in a sample of 143,000 individuals aged 18 to 64 years,
covered by primary care services in 3 regions of England. Case
ascertainment involved: i) electronic search for chronic fatigue
cases; ii) direct questioning of general practitioners (GPs) on cases
not previously identified by the search; iii) clinical review of
identified cases according to CDC-1994, Canadian and Epidemiological
Case (ECD) Definitions. This enabled the identification of cases with
high validity.
Results
The estimated minimum prevalence rate of ME/CFS was 0.2% for cases
meeting any of the study case definitions, 0.19% for the CDC-1994
definition, 0.11% for the Canadian definition and 0.03% for the ECD.
The overall estimated minimal yearly incidence was 0.015%. The highest
rates were found in London and the lowest in East Yorkshire. All cases
conforming to the Canadian criteria also met the CDC-1994 criteria but
presented higher prevalence and severity of symptoms.
Conclusions
ME/CFS is not uncommon in England and represents a significant burden
to patients and society. The number of people with chronic fatigue who
do not meet specific criteria for ME/CFS is higher still. Both groups
have high levels of need for service provision, including health and
social care. We suggest combining the use of both the CDC-1994 and
Canadian criteria for ascertainment of ME/CFS cases, alongside careful
clinical phenotyping of study participants. This combination if used
systematically will enable international comparisons, minimisation of
bias, and the identification and investigation of distinct sub-groups
of patients with possibly distinct aetiologies and pathophysiologies,
standing a better chance of translation into effective specific
treatments.
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