Methods: A population based cohort of 18,101 men and women aged 40-79 years who completed a measure of fatigue (SF-36-VT) in addition to providing information on possible confounding factors (age, sex, body mass index, marital status, smoking, education level, alcohol consumption, social class, depression, bodily pain, diabetes, use of β blockers, physical activity and diet) and mechanisms (haemoglobin, CRP, thyroid function) were followed up prospectively for up to 20 years. Mortality from all causes, cancer and cardiovascular disease (CVD) was ascertained using death certification linkage with the UK Office of National Statistics.
Results: During 300,322 person years of follow-up (mean 16.6 years), 4397 deaths occurred. After adjusting for confounders, the hazard ratios (HR) for all-cause mortality were 1.40 (1.25-1.56) for those reporting the highest fatigue (bottom SF36-VT quartile) compared with those reporting the lowest fatigue (top SF-36-VT quartile). This significant association was specifically observed for those deaths related to CVD (HR 1.45, 1.18-1.78) but not cancer (HR 1.09, 0.90-1.32). Of the considered mechanisms, thyroid function was most notable for attenuating this association. The risk of all-cause mortality however remained significant even after considering all putative confounders and mechanisms (HR 1.26, 1.10-1.45).
Conclusion: High levels of fatigue are associated with excess mortality in the general population. . This commonly dismissed symptom demands greater evaluation and should not automatically be considered benign.
We gratefully thank the participants of the EPIC-Norfolk study. We also thank
the collaborating general practices, staff of the EPIC-Norfolk and our funders.
This work was supported by programme grants from the Medical Research
Council G1000143 and the Cancer Research UK 8257. Funders had no role in
study design, analysis or interpretation of the findings.
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- School of Medicine, Medical Sciences & Nutrition, Applied Health Sciences - Clinical Chair in Epidemiology
- School of Medicine, Medical Sciences & Nutrition, MRC/Versus Arthritis Centre for Musculoskeletal Health and Work
- School of Medicine, Medical Sciences & Nutrition, Aberdeen Centre for Arthritis and Musculoskeletal Health (ACAMH)
- School of Medicine, Medical Sciences & Nutrition, Epidemiology Group
Person: Clinical Academic
- School of Medicine, Medical Sciences & Nutrition, Aberdeen Cardiovascular and Diabetes Centre
- School of Medicine, Medical Sciences & Nutrition, Applied Health Sciences - Chair in Old Age Medicine (Clinical)
- Institute of Applied Health Sciences
Person: Clinical Academic