IJE Advance Access published online on April 6, 2009
International Journal of Epidemiology, doi:10.1093/ije/dyp147
A systematic review of chronic fatigue, its syndromes and ethnicity: prevalence, severity, co-morbidity and coping
1Centre for Psychiatry, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
2Division of Epidemiology, Public Health and Primary Care, Imperial College London, London, UK.
3School of Social Sciences, University of Manchester, Manchester, UK.
4Department of Psychological Medicine and Psychiatry, Institute of Psychiatry, King's College London, London, UK.
*Corresponding author. Centre for Psychiatry, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London ECIM 6BQ, UK. E-mail: s.dinos{at}qmul.ac.uk
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Abstract |
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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 CFS [Odds Ratio (OR) 2.95, 95% confidence interval (CI): 0.69–10.4; OR = 11.5, CI: 1.1–56.4, respectively] and CF (OR = 1.56, CI: 1.03–2.24; OR = 3.28, CI: 1.63–5.88, respectively). Minority ethnic groups with CF and CFS experience more severe symptoms and may be more likely to use religion, denial and behavioural 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.
Keywords Chronic fatigue syndrome, CFS, chronic fatigue, CF, fatigue, ethnicity, meta-analysis, systematic review
Accepted 27 January 2009