The Prevalence and Characteristics of Fibromyalgia in the 2012 National Health Interview Survey

BackgroundMost knowledge of fibromyalgia comes from the clinical setting, where healthcare-seeking behavior and selection issues influence study results. The characteristics of fibromyalgia in the general population have not been studied in detail.MethodsWe developed and tested surrogate study specific criteria for fibromyalgia in rheumatology practices using variables from the US National Health Interview Survey (NHIS) and the modification (for surveys) of the 2010 American College of Rheumatology (ACR) preliminary fibromyalgia criteria. The surrogate criteria were applied to the 2012 NHIS and identified persons who satisfied criteria from symptom data. The NHIS weighted sample of 8446 persons represents 225.7 million US adults.ResultsFibromyalgia was identified in 1.75% (95% CI 1.42, 2.07), or 3.94 million persons. However, 73% of identified cases self-reported a physician’s diagnosis other than fibromyalgia. Identified cases had high levels of self-reported pain, non-pain symptoms, comorbidity, psychological distress, medical costs, Social Security and work disability. Caseness was associated with gender, education, ethnicity, citizenship and unhealthy behaviors. Demographics, behaviors, and comorbidity were predictive of case status. Examination of the surrogate polysymptomatic distress scale (PSD) of the 2010 ACR criteria found fibromyalgia symptoms extending through the full length of the scale.ConclusionsPersons identified with criteria-based fibromyalgia have severe symptoms, but most (73%) have not received a clinical diagnosis of fibromyalgia. The association of fibromyalgia-like symptoms over the full length of the PSD scale with physiological as well as mental stressors suggests PSD may be a universal response variable rather than one restricted to fibromyalgia.

背景：目前学界对纤维肌痛（fibromyalgia）的认知大多源自临床场景，而就医行为与选择偏倚会对研究结果产生影响；目前尚未针对普通人群中的纤维肌痛特征开展详尽研究。方法：本研究借助美国国家健康访谈调查（National Health Interview Survey, NHIS）的变量数据，结合2010年美国风湿病学会（American College of Rheumatology, ACR）纤维肌痛初步诊断标准的调研适配修订版，开发并验证了风湿病临床场景下的纤维肌痛研究专用替代诊断标准。将该替代标准应用于2012年NHIS数据集，基于症状数据筛选出符合标准的受试者；本次NHIS加权样本涵盖8446名个体，对应美国2.257亿成年人口。结果：研究共筛出1.75%（95%置信区间[1.42, 2.07]）的受试者符合纤维肌痛诊断标准，对应约394万美国成年人；但其中73%的受试者自述曾被医师诊断为其他疾病，而非纤维肌痛。符合标准的受试者自述存在重度疼痛、非疼痛症状、共病情况、心理困扰、医疗支出、社会保障相关需求与工作残疾情况。纤维肌痛确诊病例与性别、受教育程度、种族、公民身份及不健康行为显著相关。人口学特征、行为习惯与共病情况可有效预测受试者是否符合纤维肌痛诊断标准。对2010年ACR标准中的多症状困扰量表（polysymptomatic distress scale, PSD）进行分析后发现，纤维肌痛相关症状覆盖该量表的全部维度。结论：经标准筛选出的纤维肌痛受试者症状严重，但其中73%并未获得临床纤维肌痛诊断。覆盖PSD量表全维度的类纤维肌痛症状与生理及心理应激因素存在关联，这提示PSD或许是一种通用的反应变量，而非仅局限于纤维肌痛的评估指标。