Prevalence of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) in three regions of England: a repeated cross-sectional study in primary care
Prevalence of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) in three regions of England: a repeated cross-sectional study in primary care
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DOI：
10.1186/1741-7015-9-91
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发表时间：
2011-07-28
期刊：
影响因子：
9.3
通讯作者：
Drachler, Maria L.
中科院分区：
文献类型：
--
作者：
Nacul, Luis C.;Lacerda, Eliana M.;Drachler, Maria L.
背景资料：肌痛性脑脊髓炎/慢性疲劳综合征（ME/CFS）或慢性疲劳综合征（CFS）已被用来命名一系列慢性疾病，其特征是极度疲劳和其他致残症状。估计疾病负担的尝试受到选择偏倚、缺乏诊断生物标志物和商定的可重复病例定义的限制。我们估计了英格兰三个地区ME/CFS的患病率和发病率，并讨论了频率统计的意义以及不同病例定义在卫生和社会保健规划和研究中的应用。方法：我们比较了ME/CFS的临床表现，患病率和发病率，基于143，000名年龄在18至64岁之间的个体的样本，在英格兰的三个地区提供初级保健服务。案件查明涉及：1）电子搜索慢性疲劳病例; 2）对以前未通过搜索确定的病例直接询问全科医生（GP）; 3）根据CDC-1994，加拿大和流行病学病例（ECD）定义对确定的病例进行临床审查。这使得识别的情况下，具有较高的validity.Results：ME/CFS的估计最低患病率为0.2%的情况下，满足任何研究的情况下的定义，0.19%的CDC-1994年的定义，0.11%的加拿大的定义和0.03%的ECD。总体估计最低年发生率为0.015%。伦敦的发病率最高，东约克郡的发病率最低。除了一个符合加拿大标准的情况下，也符合CDC-1994年的标准，但提出了更高的患病率和严重程度的symptoms.Conclusions：ME/CFS是在英格兰并不罕见，并代表着一个显着的负担，病人和社会。不符合ME/CFS特定标准的慢性疲劳患者人数仍然较高。这两个群体都非常需要提供服务，包括保健和社会护理。我们建议结合使用CDC-1994和加拿大标准来确定ME/CFS病例，同时对研究参与者进行仔细的临床表型分析。如果系统地使用这种组合，将能够进行国际比较，最大限度地减少偏倚，并识别和研究可能具有不同病因和病理生理学的不同患者亚组，更有可能转化为有效的特定治疗。
Background: Myalgic encephalomyelitis/chronic fatigue syndrome (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 on a sample of 143,000 individuals aged 18 to 64 years, covered by primary care services in three regions of England. Case ascertainment involved: 1) electronic search for chronic fatigue cases; 2) direct questioning of general practitioners (GPs) on cases not previously identified by the search; and 3) 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 but one of the cases conforming to the Canadian criteria also met the CDC-1994 criteria, however 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, minimization 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.