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ME Epidemiology - prevalence and peak ages of onset
- Thread starter Simon M
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In the case of the Norway Patient Register study that Snow Leopard linked to, the database has data from Norwegian hospitals and outpatient clinics (not GP clinics).
Given some of the ME/CFS criteria require children only need be ill for 3 months to be diagnosed and given the Norwegian children seem to be diagnosed in a hospital clinic, they are more likely to have shown up in the NPR (hospital) database quickly. In contrast, the adults need to have been ill for 6 months before diagnosis and then they can be diagnosed by a GP. They might undergo some evaluations in the hospital but might not be given a diagnosis there. Therefore they may take much longer to show up in the NPR database with a diagnosis of ME/CFS. Some of those adults may recover from their post-viral fatigue illness and never be recorded in the Norway Patient register as having ME/CFS, whereas the children who recover quickly probably are recorded.
Therefore, the database may be over-representing the number of people being diagnosed in the 10 to 19 age range relative to those diagnosed at later ages. Just possibly, for some women with ME/CFS being cared for by their GP, the first time their illness is recorded in the NPR might be when they are pregnant (edit - or are thinking about starting a family).
Here's a possibility to explain a higher rate of ME/CFS in women post-Giardia infection - higher rates of Giardia infection in young women.
Demographics of Giardia infection in Bergen, Norway, subsequent to a waterborne outbreak, 2008, Robertson et al
I'm not saying these things absolutely have affected the reported male:female ratios and age ratios, just that maybe biology (as in hormones or immune system) isn't the only reason for the reported patterns.
Given some of the ME/CFS criteria require children only need be ill for 3 months to be diagnosed and given the Norwegian children seem to be diagnosed in a hospital clinic, they are more likely to have shown up in the NPR (hospital) database quickly. In contrast, the adults need to have been ill for 6 months before diagnosis and then they can be diagnosed by a GP. They might undergo some evaluations in the hospital but might not be given a diagnosis there. Therefore they may take much longer to show up in the NPR database with a diagnosis of ME/CFS. Some of those adults may recover from their post-viral fatigue illness and never be recorded in the Norway Patient register as having ME/CFS, whereas the children who recover quickly probably are recorded.
Therefore, the database may be over-representing the number of people being diagnosed in the 10 to 19 age range relative to those diagnosed at later ages. Just possibly, for some women with ME/CFS being cared for by their GP, the first time their illness is recorded in the NPR might be when they are pregnant (edit - or are thinking about starting a family).
Here's a possibility to explain a higher rate of ME/CFS in women post-Giardia infection - higher rates of Giardia infection in young women.
Demographics of Giardia infection in Bergen, Norway, subsequent to a waterborne outbreak, 2008, Robertson et al
I'm not saying these things absolutely have affected the reported male:female ratios and age ratios, just that maybe biology (as in hormones or immune system) isn't the only reason for the reported patterns.
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rvallee
Senior Member (Voting Rights)
I would think that being the largest effort of its kind, the IOM report would likely be the most accurate.
Which does not mean it is entirely accurate but likely the most. There is consistency around those numbers as well so if they are off it's likely to not be by much in %.
I think IOM is generally pretty good but there are some gotchas to watch for.
It reports an ME/CFS prevalence of 836,000 to 2.5M. But the supporting reference for that upper prevalence is a publication by Jason which includes this statement...
The CDC currently estimates there are up to 900,000 Americans with CFS and another 2.5 million with CFS-like illness.
CDC has defined "CFS-like" illness to be be 6 months of fatigue but not meeting the 4 out of the other 8 symptoms required by Fukuda. It's certainly not ME. So IMO, that 2.5M upper prevalence for ME/CFS appears to be an error in the report.
ME/CFS Skeptic
Senior Member (Voting Rights)
I agree. I never fully understood where those prevalence figures came from. The article of Jason that is referenced is just a short overview of CFS prevalence in the CFIDS Chronicle.
There are some (rather misleading) studies such as the CDC Georgia study and Wessely's prevalence study in the UK that reported a much higher prevalence of 2,5%. But given that there are approximately 300 million Americans, that would lead to an estimated higher bound of 7,5 million. So that can't be where the 2,5 million came from. I also don't see how it could refer to the CFS-like patients in the 1999 Chicago study. Anyone else has a clue from which study the 2,5 million figure comes?
Even the lower bound of 836.000 is strange. It's the figure the Chicago study reported. But that was in 1999, there are approximately 500.000 Americans more now. Also this prevalence study gave a figure of 0,42% which is higher than the 0,23% (Reyes et al. 2003) or 0,19% (Nacul et al. 2011)study reported, so why should it be used as a lower boundary?
In my view, they should have said that ME/CFS has an estimated prevalence of 0,2%-0,4% and then calculated how many Americans that would be for the current US population (the prevalences are for adult populations only, If I'm not mistaken).
adambeyoncelowe
Senior Member (Voting Rights)
Isn't 2.5 million equivalent to the 0.82% (or thereabouts) from the 'CFS-like' figure?
ME/CFS Skeptic
Senior Member (Voting Rights)
Where does the 0,82% figure come from?
Yes - In the IOM report, the source of the 2.5M is CDC's report of "CFS-like" illness.
The Georgia study used the overly broad Reeves criteria that included "unwellness" and more mental illness and as a result inflated prevalence 10 fold over CDC's own previous estimates.
The Wessely study from 1997 reported 2.6% for Fukuda but only 0.5% when they excluded comorbid psychiatric illness.
The Nacul study reported 0.19% for Fukuda but only 0.11% for Canadian so perhaps the lower range should be even lower. In reality, we have no idea because much of the epi research is so flawed. In the meantime and at least in the US, the 0.42% estimate from Jason's study has tended to be the most accepted estimate.
ME/CFS Skeptic
Senior Member (Voting Rights)
Ok, but where does that figure come from, which study is it based on?
adambeyoncelowe
Senior Member (Voting Rights)
I can't remember. I thought it was due to a doubling of one of other numbers as a guesstimate.
The prevalence rates are estimates from studies in adults so 2.5M would equate to about .99% of the current adult US population. There are few studies in children but the prevalence estimates are much lower, particularly in children under 10-12.
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To my knowledge, there isn't one. I dont know of any study that reported a prevalence of 2.5M (.99% by today's population) in adults and I think the estimates of "CFS-like" illness were much higher than 2.5M. So even if "CFS-like" illness is accepted as a valid thing, that number is still strange.
The upper limit in the IOM appears to be based simply on the CDC statement that there are 2.5M people with CFS-like illness. I can't see anything else in the cited reference that would support the 2.5M prevalence estimate - even ignoring that its for CFS-like illness and not ME
Back to the original point - I think the IOM stats are generally good and accurately reflect the underlying studies but there's a few places like this that appear to be screwed up.
Jonathan Edwards
Senior Member (Voting Rights)
According to figure 1 they do.
Read on. Not sure what the adjustment for population figures was.
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Daisybell
Senior Member (Voting Rights)
Maybe the way to think about the incidence in women is to consider that there’s a dip in incidence in your 20s, rather than two peaks, one in your teens and one in your thirties....
So perhaps there is something protective going on in your 20s, when you are ‘in your prime’? And if you are genetically susceptible, then you will mostly have succumbed by your forties....?
So perhaps there is something protective going on in your 20s, when you are ‘in your prime’? And if you are genetically susceptible, then you will mostly have succumbed by your forties....?
andypants
Senior Member (Voting Rights)
I think my story is a pretty common one. I first got sick at 19 but it took 10 years for it to become so serious I was diagnosed with ME. So officially my onset was at age 29, but in reality it was (probably) at 19. So I was pretty sick through all of my 20s, but since I managed to stay in school and didn’t have a diagnosis on paper I was healthy.
I don’t think we can say much about the second age peak for sure until people are more accurately and promptly diagnosed.
beverlyhills
Established Member (Voting Rights)
The first spike correlates with the age of first sexual contact by females in Norway.
The second spike correlates with the mean age of first-time mothers in Norway.
Males and females have the same age of sexual initiation usually so it is why the spikes are the same, and why the second one is not. Even a non-significant rise in males should be expected because the increased presumed stress of novel fatherhood.
This study potentially delineates two separate etiologies: progesterone mediated autoimmune shift and infectious onset, and shows the two syndromes should be isolated.
The second spike correlates with the mean age of first-time mothers in Norway.
Males and females have the same age of sexual initiation usually so it is why the spikes are the same, and why the second one is not. Even a non-significant rise in males should be expected because the increased presumed stress of novel fatherhood.
This study potentially delineates two separate etiologies: progesterone mediated autoimmune shift and infectious onset, and shows the two syndromes should be isolated.
Snow Leopard
Senior Member (Voting Rights)
Another 2.4 year prospective study. (mean baseline age of entire population was 44.9, 57% women)
https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3427300
New onset 0.08%/year, mean age of 48.0. 56% of new cases were women.
"Lifetime diagnosis at baseline" was 1.3%. (note this was self-reported)
https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3427300
New onset 0.08%/year, mean age of 48.0. 56% of new cases were women.
"Lifetime diagnosis at baseline" was 1.3%. (note this was self-reported)
beverlyhills
Established Member (Voting Rights)
Study was cohort participatory and not observational and generally reflects who participates in these studies uncompensated. I do not have any comments on it directly other than the context I posited above.