Underlying disease risk among patients with fatigue: a population-based cohort study in primary care
White B., Zakkak N., Renzi C., Rafiq M., Gonzalez-Izquierdo A., Denaxas S., Nicholson BD., Lyratzopoulos G., Barclay ME.
Background Method Presenting to primary care with fatigue The excess short-term incidence of is associated with a wide range of 237 diseases in patients who presented conditions, including cancer, although with fatigue compared with those who their relative likelihood is unknown. did not present with fatigue is described. Disease-specific 12-month risk by sex Aim was modelled and the age-adjusted risk To quantify associations between calculated. new-onset fatigue presentation and subsequent diagnosis of various diseases, Results including cancer. The study included 304 914 people in the fatigue group and 423 671 in Design and setting the non-fatigue group. In total, 127 A cohort study of patients presenting of 237 diseases studied were more in English primary care with new-onset common in men who presented with fatigue during 2007–2017 (the fatigue fatigue than in men who did not, and group) compared with patients 151 were more common in women who who presented without fatigue (the presented with fatigue. Diseases that non-fatigue group), using Clinical were most strongly associated with Practice Research Datalink data linked fatigue included: depression; respiratory to hospital episodes and national cancer tract infections; insomnia and sleep registration data. disturbances; and hypo/hyperthyroidism (women only). By age 80 years, cancer was the third most common disease and had the fourth highest absolute excess risk in men who presented with fatigue (fatigue group: 7.01%, 95% confidence interval [CI] = 6.54 to 7.51; non-fatigue group: 3.36%, 95% CI = 3.08 to 3.67; absolute excess risk 3.65%). In women, cancer remained relatively infrequent; by age 80 years it had the thirteenth highest excess risk in patients who presented with fatigue. Conclusion This study ranked the likelihood of possible diagnoses in patients who presented with fatigue, to inform diagnostic guidelines and doctors’ decisions. Age-specific findings support recommendations to prioritise cancer investigation in older men (aged ≥70 years) with fatigue, but not in women at any age, based solely on the presence of fatigue.