Rheumatic Heart Disease Epidemiology

Abstract

After epidemiologic data had suggested the existence of a high-risk rheumatic fever (RF) region in Colorado, examination of 3,737 children in a careful prevalence study in that region, the San Luis Valley yielded 14 cases of rheumatic heart disease (RHD) for a prevalence rate of 3.7/1,000. This rate was significantly higher than the rate of 1.7/1,000 among Denver children of the same age screened by a similar method and followed for a similar period for ascertainment of diagnoses. Although the current high RHD risk in the San Luis Valley had been thought to be due to the relative impoverishment of this part of the state, the RHD and history-of-RF prevalence rates did not correlate with socioeconomic indices by county within the Valley as expected. An ethnic difference in RHD prevalence seen in Denver did not exist in the San Luis Valley, which led to speculation about (1) patterns of school attendance in small towns versus urban areas, and (2) the probability that the influence of poverty as an RHD-risk factor operates on a community rather than on a family or individual level.