Clinical Relevance: CE/MFS is more common than many experts think

  • A new CDC report estimates 1.3 percent of US adults live with chronic fatigue syndrome (ME/CFS).
  • Women and older adults have higher prevalence rates of ME/CFS, with disparities in race and income levels.
  • ME/CFS, historically misunderstood, is now recognized as a serious multisystem illness by healthcare professionals.

New data from the Centers for Disease Control and Prevention (CDC) paints a clearer picture of the prevalence of chronic fatigue in the United States. The report estimates that 1.3 percent of adults, or roughly 3.3 million Americans, live with this debilitating condition.

Chronic fatigue syndrome – or more accurately  myalgic encephalomyelitis (ME/CFS) – has a long and complex history. Although its precise cause still remains a bit of a question mark, doctors have been describing its symptoms for centuries. 

For example, in the 1930s, it gained recognition as “postinfectious neuromyasthenia”, a condition scientists at the time linked to outbreaks of a polio-like disease. Then, in the 1950s, a mystery illness emerged at a London hospital which was eventually labeled ME. Around the same time, the Epstein-Barr virus was discovered, further complicating the diagnosis. 

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Until recently, many experts treated it as a psychosomatic syndrome and dubbed it “the Yuppie flu.” Today, healthcare takes it more seriously. Clinicians define ME/CFS as a multisystem illness characterized by debilitating lack of energy that doesn’t improve with rest and gets worse after any activity, be it physical or mental. This persistent exhaustion often comes with other symptoms like sleep problems, pain, brain fog, and dizziness.

Critical Insights

Researchers analyzed two years of data from the National Health Interview Survey (NHIS), a nationally representative survey of over 57,000 U.S. adults, to understand the prevalence of ME/CFS. While most NHIS interviews are conducted in person, some were done over the phone during the height of the pandemic.

The new report found that ME/CFS is far less rare than many clinicians realize. Among its key findings:

  • In 2021–2022, 1.3 percent of adults had a diagnosis of ME/CFS.
  • The percentage of adults who had ME/CFS increased with age until the age of 69, then declined among those aged 70 and older.
  • Women were more likely than men to have ME/CFS, with 1.7 percent of women and 0.9 percent of men being affected, respectively.
  • Among ethnic groups, 1.5 percent of White non-Hispanic people had ME/CFS. This is higher than the average, compared to 0.7 percent of Asian, non-Hispanic and 0.8 percent of Hispanic adults.
  • The likelihood of the diagnosis was higher among those living in poverty. Two percent of adults with a family income less than 100 percent of the federal poverty level reported having ME/CFS.
  • People living in rural communities were more likely to be diagnosed with the condition compared to their urban counterparts. 

Why Some Are At Greater Risk

Scientists are still investigating why ME/CFS affects more women than men, but several theories stand out. Hormones like estrogen and progesterone might make women more susceptible to the condition by influencing their immune system and brain function. Additionally, women’s immune systems may respond differently, increasing their vulnerability to inflammation. Beyond biology, chronic stress, lack of social support, and even differences in pain perception, could contribute to ME/CFS development. 

The fact that income level, race, and place of residence all play a role in ME/CFS occurrence suggest a complex interplay between social, economic, and environmental factors. Lower income individuals might face greater stress, less access to healthcare, and environmental exposures that increase their susceptibility. Racial disparities might also stem from healthcare access limitations, socioeconomic disadvantages, and potential genetic predispositions. As for location, rural communities tend to have more limited healthcare resources and potentially higher exposure to environmental toxins. 

The authors said that the report certainly dispels the notion of chronic fatigue as an exclusively “rich white woman’s” illness. Although women and white people are indeed diagnosed at a higher rate, the gap is much smaller than previous research has suggested. And, while the data collection relied on patients’ memories rather than verified medical records, many experts believe that ME/CFS is unreported and is often mis- or under-diagnosed. The authors said that Long COVID cases may also be included in their results.

Clinicians are still working on effective treatments for ME/CFS. Cognitive behavior therapy helps shift negative thinking patterns that worsen fatigue. Gradually increasing physical activity helps patients build endurance. Certain medications, like antidepressants or pain relievers, help manage specific symptoms. Experts also recommend prioritizing sleep, healthy eating, and stress management. While full recovery isn’t guaranteed, many people experience significant improvement over time.


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