title: Prevalence of chronic fatigue syndrome in metropolitan, urban, and rural Georgia.
abstract: BACKGROUND
  Chronic fatigue syndrome (CFS) is a debilitating illness with no known cause or effective therapy. Population-based epidemiologic data on CFS prevalence are critical to put CFS in a realistic context for public health officials and others responsible for allocating resources.
  
  
  METHODS
  Based on a random-digit dialing survey we ascertained CFS cases and controls to estimate the prevalence of CFS in metropolitan, urban, and rural populations of Georgia. This report focuses on the 5,623 of 19,381 respondents ages 18 to 59 years old. Fatigued (2,438), randomly selected unwell not fatigued (1,429) and randomly selected well (1,756) respondents completed telephone questionnaires concerning fatigue, other symptoms, and medical history. Subsets of those identified by interview as having CFS-like illness (292), chronic unwellness which was not CFS-like (268 - randomly selected), and well subjects (223, matched to those with CFS-like illness on sex, race, and age) completed a clinical evaluation.
  
  
  RESULTS
  We estimated that 2.54% of persons 18 to 59 years of age suffered from CFS. There were no significant differences in prevalence of CFS between metropolitan, urban or rural populations or between white and black residents of the three regions. However, there were significant differences in female-to-male ratios of prevalence across the strata (metropolitan female: male 11.2 : 1, urban 1.7 : 1, rural 0.8 : 1).
  
  
  CONCLUSIONS
  We estimated that 2.54% of the Georgia population suffers from CFS, which is 6- to 10-fold higher than previous population-based estimates in other geographic areas. These differences may reflect broader screening criteria and differences in the application of the case definition. However, we cannot exclude the possibility that CFS prevalence may be higher in Georgia than other areas where it has been measured. Although the study did not identify differences in overall prevalence between metropolitan, urban, and rural Georgia populations, it did suggest the need for additional stratified analyses by geographic strata.
authors.affiliation: Chronic Viral Diseases Branch, Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA. wcr1@cdc.gov
authors.forename: William C
authors.initials: WC
authors.lastname: Reeves
authors.forename: James F
authors.initials: JF
authors.lastname: Jones
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Maloney
authors.forename: Christine
authors.initials: C
authors.lastname: Heim
authors.forename: David C
authors.initials: DC
authors.lastname: Hoaglin
authors.forename: Roumiana S
authors.initials: RS
authors.lastname: Boneva
authors.forename: Marjorie
authors.initials: M
authors.lastname: Morrissey
authors.forename: Rebecca
authors.initials: R
authors.lastname: Devlin