Epidemiologic studies on cardiovascular-renal diseases: I. Analysis of mortality by age-race-sex-occupation☆

A decline in the incidence and severity of rheumatic fever has been reported from several centers in the past 2 decades. 1-11 It is the purpose of this report to document this trend as it has occurred on the Children's Cardiac Service at Bellevue Hospital over a 24-year period from 1935 through 1958. Case Material and Methods A total of 792 initial attacks of acute rheumatic fever form the basis for this study. The patients, ranging in age from 2 to 15 years, fulfill the following requirements: (1) They were hospitalized at Bellevue during their first attack, and (2) a definite diagnosis of acute rheumatic fever was made in each. Cases in which the diagnosis of acute rheumatic fever was considered to be questionable at the time of review for the study were not included. A definite diagnosis required at least one of the major criteria of Jones 12,13 (arthritis,

Declining Severity of First Attack of Rheumatic Fever

Certain facets of the epidemiology of rheumatic fever are not clear. The correlation of group A beta hemolytic streptococcal infections and rheumatic fever is established; in all probability this is the specific etiologic agent in rheumatic fever. The latter then may prove to be a clinical manifestation of a certain phase (nonsuppurative and late) of streptococcal infection, rather than a disease entity in itself. In numerous respects the epidemiology of rheumatic fever mimics that of streptococcal infections. Some conditioning of tissue by infection, especially through antigen-antibody interaction or hypersensitivity, is probably involved in the basic pathogenesis of rheumatic fever. 1,48,49 Most group A streptococci very likely furnish the antigenic stimuli concerned in the development of this pathologic process and this may prove to be their rheumatogenic property. The response of the immunologic mechanisms of the host governs in some way the initiation and progression of the histopathologic changes which occur. Alterations in the immune response are probably precursors to the evolution of events in the pathogenesis of rheumatic fever. Other factors may play an important part in the epidemiology of this disease. The inherited susceptibility to rheumatic fever has been emphasized. The influence of age on the attack rate of rheumatic fever may reflect only the stage of maturity of the immune mechanism of the host. Environmental factors appear to affect primarily the epidemiology of rheumatic fever only as they influence conditions which enhance the spread of streptococcal infections, particularly in streptococcal epidemics. The variability of host factors involving susceptibility and resistance to streptococci, most of which may prove to be "rheumatogenic," make it exceedingly difficult to clarify the role of these factors in the epidemiology and pathogenesis of rheumatic fever. However, to set the stage for the possible development of rheumatic fever a susceptible individual must have been challenged by one of the various strains of group A streptococci. Whether or not a sequence of events follows which leads to rheumatic fever is dependent upon a number of variable and unknown factors.

Epidemiology of rheumatic fever.

Most physicians and epidemiologists agree that rheumatic heart disease is not distributed uniformly throughout the United States. Thoroughly reliable data on this problem may not become available until the development of some specific diagnostic test that would permit detection of mild or subclinical cases. In the meantime efforts have been made to estimate the distribution of this disease by ( a ) the use of rheumatic heart disease mortality statistics 1 and ( b ) conclusions drawn from morbidity studies in certain segments of the population, such as school children 2 or military personnel. 3 Attempts to check the findings of one method by those of the other, for any given locality, have not been reported, but on one point there seems to be general agreement between the results of the various mortality studies and morbidity reports for this disease, namely, that the Rocky Mountain states have an undue amount of rheumatic fever. The

Incidence of heart disease among Colorado school children; a state-wide study.

THEHOUSE OF THE GOOD SAMARITAN, now a division of the Children's Hospital Medical Center in Boston, was one of the first institutions in the US to specialize in the problem of rheumatic fever and rheumatic heart disease ( RHD). Patients with these conditions were accepted for care almost from the time the hospital opened its doors in 1861. By 1921 several wards were devoted entirely to patients with rheumatic fever, chorea, and rheumatic heart disease and in 1931 the entire hospital was given over to the treatment and study of rheumatic fever and related diseases. Buried in the records of the hospital is a vast store of clinical information. Some of it has already been used, but much remains to be analyzed and evaluated. In order to utilize the available material as effectively as possible, we began to apply to this problem some of the newer data processing methods and

Evolving Picture of Rheumatic Fever: Data from 40 Years at the House of the Good Samaritan

The importance of rheumatic fever and its after-effects as a cause of mortality in childhood has been stressed more and more in discussions from all parts of the world, particularly the United States. A statistical survey has recently been issued by the Children's Bureau 1 to shed more light on the differences in mortality from rheumatic fever and heart diseases in the United States, its sections and the individual states. In order to diminish chance fluctuations, which necessarily become large in individual states when the total is split into the respective age, race and sex groups, three year averages of the mortality data, 1939-1941, have been taken and centered on the population of the census of 1940. Exact data on population in the individual states by age, race and sex are available only for the years of census enumerations. However, for the United States as a whole additional data are

Death toll from rheumatic fever in childhood.

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Death toll from rheumatic fever in childhood.