No More "Yuppie Flu"
New Study Debunks CFIDS Myths, Reveals Greater
By Renee Brehio
In the 1980s, chronic fatigue and immune dysfunction syndrome(CFIDS)
was portrayed as the "Yuppie flu," a relatively rare
condition that affected mostly upper middle class white professionals.
Now a group of researchers has shattered that image. A study
published in the October 11 issue of Archives of Internal Medicine
reports that as many as 800,000 people nationwide may suffer
from CFIDS, twice the number previously estimated by the Centers
for Disease Control and Prevention (CDC). And the majority of
sufferers are not "yuppies."
In fact, the highest levels of CFIDS were consistently found
among minority groups and individuals with lower levels of education
and occupational status, such as blue-collar workers. Unfortunately,
these populations are also the least likely to have access to
"For years, CFIDS has been marginalized and misunderstood,"
says Kim Kenney, CFIDS Association Executive Director. "This
crucial piece of research will help change the misperceptions
about the illness and send a wake-up call to the medical and
research community that it is a public health problem that needs
to be addressed."
Working under a grant from the National Institutes of Health
(NIH), researchers from DePaul University, University of Illinois
at Chicago, Northwestern University Medical School, Michael Reese
Hospital and Medical Center and Northern Illinois University
conducted telephone screenings with a random sample of28,673
adults in eight communities in Chicago. This was the first major
CFIDS prevalence study to draw its participants from an ethnically
and socio-economically diverse inner city area.
Those individuals who indicated during the screening that
they suffered from unexplained, persistent or relapsing chronic
fatigue for at least six months and had symptoms consistent with
the CDC's criteria for CFIDS, without another possible medical
explanation, were classified as having a chronic fatigue-like
This group then participated in the second phase of the study,
in which they were medically evaluated. Self-report questionnaires,
complete medical examinations with laboratory testing and psychiatric
evaluations were used to rule out other conditions. A team of
four physicians and a psychiatrist made the final diagnoses.
What the researchers found was a very different picture of CFIDS
than that presented by previous studies. One reason may be that
by targeting a diverse urban area, they uncovered a hidden population
of sufferers. The CDC, which conducted its studies mostly in
upper-middle class, white communities, previously estimated 238
adults per100,000 in the United States have CFIDS; the Chicago
study puts the number at 422 out of every 100,000,nearly double
"Previous studies that relied on referrals from physicians
and medical clinics have underestimated prevalence because many
low-income individuals lack access to the health care system
and therefore didn't show up in the numbers," says Dr. Leonard
Jason, the DePaul University psychology professor who led the
research team. "And many patients with fatigue drop out
of the system, so it is difficult to get an accurate number by
only sampling those in treatment."
Study authors speculate that relying on referrals and sampling
mostly white, middle-to-upper class communities, as the CDC's
initial studies did, also resulted in the labeling of CFIDS as
a "yuppie" disease as they do not account for ethnic
minorities and the medically underserved.
What is clear is that most of the CFIDS prevalence studies
to date are problematic and do not present a complete picture
of the illness. Examining the DePaul findings reveals some startling
new pieces of information in addition to con- firming some previously
Low rate of diagnosis.
The researchers found that less than 10% of individuals with
CFIDS had been diagnosed, which is lower than the CDC's estimate
of 16%. This indicates that most individuals who have CFIDS are
not receiving treatment, perhaps because they are not financially
able or aware that they should do so. "Many are probably
coping with their symptoms with- out having any idea that they
might have a medical condition," says Dr. Jason, "which
argues for more education about the illness, both among physicians
and the general public."
In the community-based study, Latinos demonstrated the highest
prevalence of CFIDS at 726 cases per 100,000-twice that of whites,
at 310 per 100,000. African Americans, also previously considered
to be far less afflicted than whites, had a prevalence rate of
337 per100,000. The study authors speculate that elevated rates
of CFIDS in Latinos and African Americans may be attributable
to poor or deteriorating health status among underserved ethnic
groups. Factors contributing to poorer health status may include
psychological and social stress, behavioral risk factors, poor
nutrition, inadequate health care, more hazardous occupations
and environmental exposures.
High rate in women.
The relationship of gender to CFIDS has raised some controversy
in the past. This study confirmed that women have a much higher
rate of the illness than men, with 522women afflicted per 100,000,
com-pared to 291 men per 100,000.CFIDS is 15 times more prevalent
in women than lung cancer (33/100,000) or breast cancer (26/100,000)
and more than 40 times as common in women as AIDS (12/100,000).
These numbers should classify CFIDS as a major women's health
Baby boomers at risk.
Individuals in the 40-49 year-old age range exhibited the highest
rates of CFIDS, which belies the common perception that it is
mostly younger professionals (especially women of childbearing
age) who "bum out" and develop CFIDS. Interestingly,
prevalence rates are as high for individuals who are 50-59 as
for those in the 30-39 year-old range.
Class isn't a large factor.
With respect to social and educational status, many previous
studies described individuals with CFIDS as well-educated, with
middle or upper incomes and professional occupations. In contrast,
the study found that prevalence was highest among skilled workers
(craftsmen, clerical and sales workers), second highest among
unskilled laborers, machine operators and semiskilled workers
and lowest among professionals.
It's not all in your head.
In addition to medical examinations, study participants were
screened for psychiatric symptoms. A significant subgroup had
never experienced a psychiatric illness and almost 60% had never
experienced a psychiatric illness such as depression before the
onset of their CFIDS. These statistics help strengthen the argument
that CFIDS cannot be entirely attributable to psychological factors.
Creating greater awareness
These findings provide us with ammunition to change the image
of CFIDS in the minds of legislators, researchers, the medical
community and the general public and help get the illness recognized
as a priority for redoubled research and education efforts by
government and academic institutions.
In addition to its advocacy efforts, The CFIDS Association
of America is using the study as a springboard to launch a media
relations effort to change perceptions. Reporters at top newspapers,
women's magazines, television and radio stations are being called
to inform them about the study and educate them about the illness.
You can obtain a copy of the study by visiting the Archives of
Internal Medicine's web site at www.archinternmed.com or by contacting
the Association for a reprint at 1-800-44-CFIDS.
Source: The CFIDS Chronicle, November/December 1999. This
article was reprinted with permission from the CFIDS Association