Two age peaks in the incidence of chronic fatigue syndrome/myalgic encephalomyelitis: a population-based registry study from Norway 2008-2012

Inger Johanne Bakken, Kari Tveito, Nina Gunnes, Sara Ghaderi, Camilla Stoltenberg, Lill Trogstad, Siri Eldevik Håberg, Per Magnus, Inger Johanne Bakken, Kari Tveito, Nina Gunnes, Sara Ghaderi, Camilla Stoltenberg, Lill Trogstad, Siri Eldevik Håberg, Per Magnus

Abstract

Background: The aim of the current study was to estimate sex- and age-specific incidence rates of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) using population-based registry data. CFS/ME is a debilitating condition with large impact on patients and their families. The etiology is unknown, and the distribution of the disease in the general population has not been well described.

Methods: Cases of CFS/ME were identified in the Norwegian Patient Register (NPR) for the years 2008 to 2012. The NPR is nationwide and contains diagnoses assigned by specialist health care services (hospitals and outpatient clinics). We estimated sex- and age-specific incidence rates by dividing the number of new cases of CFS/ME in each category by the number of person years at risk. Incidence rate ratios were estimated by Poisson regression with sex, age categories, and year of diagnosis as covariates.

Results: A total of 5,809 patients were registered with CFS/ME during 2008 to 2012. The overall incidence rate was 25.8 per 100,000 person years (95% confidence interval (CI): 25.2 to 26.5). The female to male incidence rate ratio of CFS/ME was 3.2 (95% CI: 3.0 to 3.4). The incidence rate varied strongly with age for both sexes, with a first peak in the age group 10 to 19 years and a second peak in the age group 30 to 39 years.

Conclusions: Early etiological clues can sometimes be gained from examination of disease patterns. The strong female preponderance and the two age peaks suggest that sex- and age-specific factors may modulate the risk of CFS/ME.

Figures

Figure 1
Figure 1
Observed number of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) cases by sex and one-year age groups (age in 2008). Data from the Norwegian Patient Register 2008 to 2012.
Figure 2
Figure 2
Number of yearly cases of CFS/ME by sex and five-year age groups estimated by Poisson regression analyses. CFS/ME, chronic fatigue syndrome/myalgic encephalomyelitis.
Figure 3
Figure 3
Estimated incidence rates of CFS/ME per 100,000 person years by sex and five-year age groups. CFS/ME, chronic fatigue syndrome/myalgic encephalomyelitis.

References

    1. Prins JB, van der Meer JW, Bleijenberg G. Chronic fatigue syndrome. Lancet. 2006;367:346–355. doi: 10.1016/S0140-6736(06)68073-2.
    1. Sosial- og helsedirektoratet: Sosial- og helsetjenester til pasienter med kronisk utmattelsessyndrom/myalgisk encefalopati (CFS/ME) (in Norwegian). Oslo, Norway; 2007.
    1. Wessely S. Old wine in new bottles: neurasthenia and ‘ME’. Psychol Med. 1990;20:35–53. doi: 10.1017/S0033291700013210.
    1. Fukuda K, Straus SE, Hickie I, Sharpe MC, Dobbins JG, Komaroff A. The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group. Ann Intern Med. 1994;121:953–959. doi: 10.7326/0003-4819-121-12-199412150-00009.
    1. Nacul LC, Lacerda EM, Campion P, Pheby D, Drachler ML, Leite JC, Poland F, Howe A, Fayyaz S, Molokhia M. The functional status and well being of people with myalgic encephalomyelitis/chronic fatigue syndrome and their carers. BMC Public Health. 2011;11:402. doi: 10.1186/1471-2458-11-402.
    1. Mørch K, Hanevik K, Rivenes AC, Bødtker JE, Næss H, Stubhaug B, Wensaas KA, Rortveit G, Eide GE, Hausken T, Langeland N. Chronic fatigue syndrome 5 years after giardiasis: differential diagnoses, characteristics and natural course. BMC Gastroenterol. 2013;13:28. doi: 10.1186/1471-230X-13-28.
    1. Fluge O, Bruland O, Risa K, Storstein A, Kristoffersen EK, Sapkota D, Næss H, Dahl O, Nyland H, Mella O. Benefit from B-lymphocyte depletion using the anti-CD20 antibody rituximab in chronic fatigue syndrome. A double-blind and placebo-controlled study. PLoS One. 2011;6:e26358. doi: 10.1371/journal.pone.0026358.
    1. Dinos S, Khoshaba B, Ashby D, White PD, Nazroo J, Wessely S, Bhui KS. A systematic review of chronic fatigue, its syndromes and ethnicity: prevalence, severity, co-morbidity and coping. Int J Epidemiol. 2009;38:1554–1570. doi: 10.1093/ije/dyp147.
    1. Bakken IJ, Suren P, Haberg SE, Cappelen I, Stoltenberg C. Norsk pasientregister - en viktig kilde for forskning (in Norwegian) Tidsskr Nor Laegeforen. 2014;134:12–13. doi: 10.4045/tidsskr.13.1417.
    1. Bhui KS, Dinos S, Ashby D, Nazroo J, Wessely S, White PD. Chronic fatigue syndrome in an ethnically diverse population: the influence of psychosocial adversity and physical inactivity. BMC Med. 2011;9:26. doi: 10.1186/1741-7015-9-26.
    1. Hamaguchi M, Kawahito Y, Takeda N, Kato T, Kojima T. Characteristics of chronic fatigue syndrome in a Japanese community population: chronic fatigue syndrome in Japan. Clin Rheumatol. 2011;30:895–906. doi: 10.1007/s10067-011-1702-9.
    1. Kingma EM, Rosmalen JG, White PD, Stansfeld SA, Clark C. The prospective association between childhood cognitive ability and somatic symptoms and syndromes in adulthood: the British birth cohort. J Epidemiol Community Health. 2013;67:1047–1053. doi: 10.1136/jech-2013-202850.
    1. Lindal E, Stefansson JG, Bergmann S. The prevalence of chronic fatigue syndrome in Iceland - a national comparison by gender drawing on four different criteria. Nord J Psychiatry. 2002;56:273–277. doi: 10.1080/08039480260242769.
    1. Nacul LC, Lacerda EM, Pheby D, Campion P, Molokhia M, Fayyaz S, Leite JC, Poland F, Howe A, Drachler ML. Prevalence of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) in three regions of England: a repeated cross-sectional study in primary care. BMC Med. 2011;9:91. doi: 10.1186/1741-7015-9-91.
    1. Vincent A, Brimmer DJ, Whipple MO, Jones JF, Boneva R, Lahr BD, Maloney E, St Sauver JL, Reeves WC. Prevalence, incidence, and classification of chronic fatigue syndrome in Olmsted County, Minnesota, as estimated using the Rochester Epidemiology Project. Mayo Clin Proc. 2012;87:1145–1152. doi: 10.1016/j.mayocp.2012.08.015.
    1. Gallagher AM, Thomas JM, Hamilton WT, White PD. Incidence of fatigue symptoms and diagnoses presenting in UK primary care from 1990 to 2001. J R Soc Med. 2004;97:571–575. doi: 10.1258/jrsm.97.12.571.
    1. Reyes M, Nisenbaum R, Hoaglin DC, Unger ER, Emmons C, Randall B, Stewart JA, Abbey S, Jones JF, Gantz N, Minden S, Reeves WC. Prevalence and incidence of chronic fatigue syndrome in Wichita, Kansas. Arch Intern Med. 2003;163:1530–1536. doi: 10.1001/archinte.163.13.1530.
    1. Carruthers BM, Jain AK, De MeirLeir KL, Peterson DL, Klimas NG, Lerner AM, Bested AC, Flor-Henry P, Joshi P, Powles AC, Sherkey JA, van de Sande MI. Myalgic encephalomyelitis/chronic fatigue syndrome: clinical working case definition, diagnostic and treatment protocols. J Chronic Fatigue Syndr. 2003;11:7–97. doi: 10.1300/J092v11n01_02.
    1. Lippestad JW, Kurtze N, Bjerkan AM: Status for helse- og omsorgstilbudet til pasienter med CFS/ME i Norge (in Norwegian). 2013. SINTEF report A17571. []
    1. Wyller VB. Kronisk utmattelsessyndrom/myalgisk encefalopatio (CFS/ME) hos barn og ungdommer (in Norwegian) Oslo: Norsk barnelegeforening; 2009.
    1. World Health Organization: International statistical classification of diseases and related health problems: ICD-10..
    1. Cairns R, Hotopf M. A systematic review describing the prognosis of chronic fatigue syndrome. Occup Med (Lond) 2005;55:20–31. doi: 10.1093/occmed/kqi013.
    1. Joyce J, Hotopf M, Wessely S. The prognosis of chronic fatigue and chronic fatigue syndrome: a systematic review. QJM. 1997;90:223–233. doi: 10.1093/qjmed/90.3.223.
    1. Katz BZ, Shiraishi Y, Mears CJ, Binns HJ, Taylor R. Chronic fatigue syndrome after infectious mononucleosis in adolescents. Pediatrics. 2009;124:189–193. doi: 10.1542/peds.2008-1879.
    1. Watt T, Groenvold M, Bjorner JB, Noerholm V, Rasmussen NA, Bech P. Fatigue in the Danish general population. Influence of sociodemographic factors and disease. J Epidemiol Community Health. 2000;54:827–833. doi: 10.1136/jech.54.11.827.
    1. Loge JH, Ekeberg O, Kaasa S. Fatigue in the general Norwegian population: normative data and associations. J Psychosom Res. 1998;45:53–65. doi: 10.1016/S0022-3999(97)00291-2.
    1. Costello EJ, Copeland W, Angold A. Trends in psychopathology across the adolescent years: what changes when children become adolescents, and when adolescents become adults? J Child Psychol Psychiatry. 2011;52:1015–1025. doi: 10.1111/j.1469-7610.2011.02446.x.
    1. Lipton RB, Bigal ME, Diamond M, Freitag F, Reed ML, Stewart WF. Migraine prevalence, disease burden, and the need for preventive therapy. Neurology. 2007;68:343–349. doi: 10.1212/01.wnl.0000252808.97649.21.
    1. Sacco S, Ricci S, Degan D, Carolei A. Migraine in women: the role of hormones and their impact on vascular diseases. J Headache Pain. 2012;13:177–189. doi: 10.1007/s10194-012-0424-y.
    1. Rayhan RU, Ravindran MK, Baraniuk JN. Migraine in gulf war illness and chronic fatigue syndrome: prevalence, potential mechanisms, and evaluation. Front Physiol. 2013;4:181. doi: 10.3389/fphys.2013.00181.
    1. Aloisi AM. Gonadal hormones and sex differences in pain reactivity. Clin J Pain. 2003;19:168–174. doi: 10.1097/00002508-200305000-00004.
    1. Martin VT, Behbehani M. Ovarian hormones and migraine headache: understanding mechanisms and pathogenesis–part 2. Headache. 2006;46:365–386. doi: 10.1111/j.1526-4610.2006.00370.x.
    1. Foerster BR, Petrou M, Edden RA, Sundgren PC, Schmidt-Wilcke T, Lowe SE, Harte SE, Clauw DJ, Harris RE. Reduced insular gamma-aminobutyric acid in fibromyalgia. Arthritis Rheum. 2012;64:579–583. doi: 10.1002/art.33339.
    1. Morris G, Maes M. Myalgic encephalomyelitis/chronic fatigue syndrome and encephalomyelitis disseminata/multiple sclerosis show remarkable levels of similarity in phenomenology and neuroimmune characteristics. BMC Med. 2013;11:205. doi: 10.1186/1741-7015-11-205.
    1. Haeri S, Baker AM, Boggess KA. Prevalence of Epstein-Barr virus reactivation in pregnancy. Am J Perinatol. 2010;27:715–719. doi: 10.1055/s-0030-1253098.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться