title: Comorbidities treated in primary care in children with chronic fatigue syndrome / myalgic encephalomyelitis: A nationwide registry linkage study from Norway.
abstract: Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a complex condition. Causal factors are not established, although underlying psychological or immunological susceptibility has been proposed. We studied primary care diagnoses for children with CFS/ME, with children with another hospital diagnosis (type 1 diabetes mellitus [T1DM]) and the general child population as comparison groups.
  
  
  
  All Norwegian children born 1992-2012 constituted the study sample. Children with CFS/ME (n = 1670) or T1DM (n = 4937) were identified in the Norwegian Patient Register (NPR) (2008-2014). Children without either diagnosis constituted the general child population comparison group (n = 1337508). We obtained information on primary care diagnoses from the Norwegian Directorate of Health. For each primary care diagnosis, the proportion and 99 % confidence interval (CI) within the three groups was calculated, adjusted for sex and age by direct standardization.
  
  
  
  Children with CFS/ME were more often registered with a primary care diagnosis of weakness/general tiredness (89.9 % [99 % CI 88.0 to 91.8 %]) than children in either comparison group (T1DM: 14.5 % [99 % CI: 13.1 to 16.0 %], general child population: 11.1 % [99 % CI: 11.0 to 11.2 %]). Also, depressive disorder and anxiety disorder were more common in the CFS/ME group, as were migraine, muscle pain, and infections. In the 2 year period prior to the diagnoses, infectious mononucleosis was registered for 11.1 % (99 % CI 9.1 to 13.1 %) of children with CFS/ME and for 0.5 % (99 % CI (0.2 to 0.8 %) of children with T1DM. Of children with CFS/ME, 74.6 % (1292/1670) were registered with a prior primary care diagnosis of weakness / general tiredness. The time span from the first primary care diagnosis of weakness / general tiredness to the specialist health care diagnosis of CFS/ME was 1 year or longer for 47.8 %.
  
  
  
  This large nationwide registry linkage study confirms that the clinical picture in CFS/ME is complex. Children with CFS/ME were frequently diagnosed with infections, supporting the hypothesis that infections may be involved in the causal pathway. The long time span often observed from the first diagnosis of weakness / general tiredness to the diagnosis of CFS/ME might indicate that the treatment of these patients is sometimes not optimal.
authors: Norwegian Institute of Public Health, PO Box 4404, Nydalen, Oslo, 0403, Norway. inger.johanne.bakken@fhi.no.
authors: Inger J
authors: 0000-0002-4176-8257
authors: IJ
authors: Bakken
authors: Norwegian Institute of Public Health, PO Box 4404, Nydalen, Oslo, 0403, Norway.
authors: Kari
authors: K
authors: Tveito
authors: Norwegian Institute of Public Health, PO Box 4404, Nydalen, Oslo, 0403, Norway.|The National Center for Epilepsy, Oslo University Hospital, Oslo, Norway.
authors: Kari M
authors: KM
authors: Aaberg
authors: Norwegian Institute of Public Health, PO Box 4404, Nydalen, Oslo, 0403, Norway.
authors: Sara
authors: S
authors: Ghaderi
authors: Norwegian Institute of Public Health, PO Box 4404, Nydalen, Oslo, 0403, Norway.
authors: Nina
authors: N
authors: Gunnes
authors: Norwegian Institute of Public Health, PO Box 4404, Nydalen, Oslo, 0403, Norway.
authors: Lill
authors: L
authors: Trogstad
authors: Norwegian Institute of Public Health, PO Box 4404, Nydalen, Oslo, 0403, Norway.
authors: Per
authors: P
authors: Magnus
authors: Norwegian Institute of Public Health, PO Box 4404, Nydalen, Oslo, 0403, Norway.|Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
authors: Camilla
authors: C
authors: Stoltenberg
authors: Norwegian Institute of Public Health, PO Box 4404, Nydalen, Oslo, 0403, Norway.
authors: Siri E
authors: SE
authors: Håberg
mesh_terms: D000293:Adolescent; D001008:Anxiety Disorders / Q000453:epidemiology / Q000628:therapy; D002648:Child; D015897:Comorbidity; D057210:Delayed Diagnosis; D003866:Depressive Disorder / Q000453:epidemiology / Q000628:therapy; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology*; D020031:Epstein-Barr Virus Infections / Q000453:epidemiology* / Q000628:therapy; D005221:Fatigue / Q000453:epidemiology* / Q000628:therapy; D015673:Fatigue Syndrome, Chronic / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008881:Migraine Disorders / Q000453:epidemiology / Q000628:therapy; D018908:Muscle Weakness / Q000453:epidemiology* / Q000628:therapy; D063806:Myalgia / Q000453:epidemiology / Q000628:therapy; D009664:Norway / Q000453:epidemiology; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012042:Registries
keywords: Adolescents; Children; Chronic fatigue syndrome; Diabetes; Epidemiology; Infections diseases; Multimorbidity; Primary care