Steele, L, Dobbins, J G, Fukuda, K et al. · The American journal of medicine · 1998 · DOI
Researchers surveyed nearly 17,000 people in San Francisco to understand how common ME/CFS and related chronic fatigue conditions are. They found that about 2% of adults reported unexplained chronic fatigue, with only 0.2% meeting criteria for ME/CFS-like illness. The conditions were more common in women, people with lower incomes, and certain racial groups, but did not run in families.
This is one of the few large-scale population studies examining ME/CFS prevalence in a diverse urban community, providing evidence that these conditions affect approximately 0.2% of the general adult population. Understanding demographic patterns of disease distribution helps identify vulnerable populations and informs public health planning for ME/CFS.
This cross-sectional survey cannot establish causation for why certain demographic groups are more affected, nor can it determine whether observed associations reflect true biological differences, healthcare access disparities, occupational exposures, or reporting biases. The reliance on self-reported symptoms without clinical confirmation means some respondents classified as CFS-like may not have met rigorous diagnostic criteria upon medical evaluation.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Steele, L, Dobbins, J G, Fukuda, K, Reyes, M, Randall, B, Koppelman, M, et al. (1998). The epidemiology of chronic fatigue in San Francisco.. The American journal of medicine. https://doi.org/10.1016/s0002-9343(98)00158-2
BibTeX
@article{mecfsatlas-steele-1998-epidemiology-chronic,
author = {Steele, L and Dobbins, J G and Fukuda, K and Reyes, M and Randall, B and Koppelman, M and Reeves, W C},
title = {The epidemiology of chronic fatigue in San Francisco.},
journal = {The American journal of medicine},
year = {1998},
doi = {10.1016/s0002-9343(98)00158-2},
note = {PubMed: 9790487},
url = {https://www.mecfsatlas.com/evidence/steele-1998-epidemiology-chronic},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-28. https://www.mecfsatlas.com/evidence/steele-1998-epidemiology-chronic
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