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A systematic review of chronic fatigue, its syndromes and ethnicity: Prevalence, severity, co-morbidity and coping – Source: International Journal of Epidemiology, Apr 6, 2009

  [ 16 votes ]   [ Discuss This Article ]
By Sokratis Dinos, et al. • • April 9, 2009

Background: Chronic Fatigue Syndrome (CFS) is characterized by unexplained fatigue that lasts for at least 6 months alongside a constellation of other symptoms. CFS was historically thought to be most common among White women of higher socio-economic status.

However, some recent studies in the USA suggest that the prevalence is actually higher in some minority ethnic groups. If there are convincing differences in prevalence and risk factors across all or some ethnic groups, investigating the causes of these can help unravel the pathophysiology of CFS.

Methods: A systematic review was conducted to explore the relationship between fatigue, chronic fatigue (CF-fatigue lasting for 6 months), CFS and ethnicity. Studies were population-based and health service-based. Meta-analysis was also conducted to examine the population prevalence of CF and CFS across ethnic groups.

Results: Meta-analysis showed that, compared with the White American majority, African Americans and Native Americans have:

• A higher risk of chronic fatigue syndrome [Odds Ratio (OR) 2.95, 95% confidence interval (CI): 0.69-10.4; OR = 11.5, CI: 1.1-56.4, respectively]
[Note: an odds ratio of 1.0 would denote no difference in average risk for the two groups. An odds ratio of 2.95 would seem to indicate risk almost three times as great.]

• And chronic fatigue (OR = 1.56, CI: 1.03-2.24; OR = 3.28, CI: 1.63-5.88, respectively).

Minority ethnic groups with chronic fatigue (CF) and chronic fatigue syndrome (CFS) experience more severe symptoms and may be more likely to use religion, denial and behavioral disengagement to cope with their condition compared with the White majority.

Conclusions: Although available studies and data are limited, it does appear that some ethnic minority groups are more likely to suffer from CF and CFS compared with White people. Ethnic minority status alone is insufficient to explain ethnic variation of prevalence.

Psychosocial risk factors found in high-risk groups and ethnicity warrant further investigation to improve our understanding of aetiology and the management of this complex condition.

Source: International Journal of Epidemiology, Apr 6, 2009. PMID: 19349479, by Dinos S, Khoshaba B, Ashby D, White PD, Nazroo J, Wessely S, Bhui KS. Centre for Psychiatry, Barts and the London School of Medicine and Dentistry, Queen Mary University of London; Division of Epidemiology, Public Health and Primary Care, Imperial College London; School of Social Sciences, University of Manchester; Department of Psychological Medicine and Psychiatry, Institute of Psychiatry, King's College London, UK. [E-mail:]

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