Abstract
Rheumatic heart disease accounts for up to 250 000 premature deaths every year worldwide and can be regarded as a physical manifestation of poverty and social inequality. We aimed to estimate the prevalence of rheumatic heart disease in endemic countries as assessed by different screening modalities and as a function of age. We searched Medline, Embase, the Latin American and Caribbean System on Health Sciences Information, African Journals Online, and the Cochrane Database of Systematic Reviews for population-based studies published between Jan 1, 1993, and June 30, 2014, that reported on prevalence of rheumatic heart disease among children and adolescents (≥ 5 years to <18 years). We assessed prevalence of clinically silent and clinically manifest rheumatic heart disease in random effects meta-analyses according to screening modality and geographical region. We assessed the association between social inequality and rheumatic heart disease with the Gini coefficient. We used Poisson regression to analyse the effect of age on prevalence of rheumatic heart disease and estimated the incidence of rheumatic heart disease from prevalence data. We included 37 populations in the systematic review and meta-analysis. The pooled prevalence of rheumatic heart disease detected by cardiac auscultation was 2·9 per 1000 people (95% CI 1·7-5·0) and by echocardiography it was 12·9 per 1000 people (8·9-18·6), with substantial heterogeneity between individual reports for both screening modalities (I² = 99·0% and 94·9%, respectively). We noted an association between social inequality expressed by the Gini coefficient and prevalence of rheumatic heart disease (p = 0·0002). The prevalence of clinically silent rheumatic heart disease (21·1 per 1000 people, 95% CI 14·1-31·4) was about seven to eight times higher than that of clinically manifest disease (2·7 per 1000 people, 1·6-4·4). Prevalence progressively increased with advancing age, from 4·7 per 1000 people (95% CI 0·0-11·2) at age 5 years to 21·0 per 1000 people (6·8-35·1) at 16 years. The estimated incidence was 1·6 per 1000 people (0·8-2·3) and remained constant across age categories (range 2·5, 95% CI 1·3-3·7 in 5-year-old children to 1·7, 0·0-5·1 in 15-year-old adolescents). We noted no sex-related differences in prevalence (p = 0·829).
Highlights
Rheumatic heart disease ranks among the leading causes of non-communicable diseases in low-income and middle-income countries and accounts for up to 250 000 premature deaths every year worldwide.[1]
Acute rheumatic fever and rheumatic heart disease can be regarded as physical manifestations of poverty and social inequality
Search strategy and selection criteria We searched Medline, Embase, the Latin-American and Caribbean System on Health Sciences Information, African Journals Online, and the Cochrane Database of Systematic Reviews on July 22, 2014, for populationbased studies on rheumatic heart disease published in English, French, Spanish, Dutch, or Portuguese between Jan 1, 1993, and June 30, 2014
Summary
Rheumatic heart disease ranks among the leading causes of non-communicable diseases in low-income and middle-income countries and accounts for up to 250 000 premature deaths every year worldwide.[1] Acute rheumatic fever and rheumatic heart disease can be regarded as physical manifestations of poverty and social inequality. Recurrent bouts of oligosymptomatic acute rheumatic fever can insidiously lead to clinically silent valvular disease through different morphological and functional stages, resulting in severe valvular damage and heart failure. Secondary antibiotic prophylaxis is the most effective therapeutic strategy for acute rheumatic fever and rheumatic heart disease in low-income and middle-income countries[2] and www.thelancet.com/lancetgh Vol 2 December 2014
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