RHD burden estimates in countries with high 2015 human development indices, 1980–2017
| Study author, publication year | Country (coverage) | Study period | Data source | Study population | Metric | Burden estimates |
|---|---|---|---|---|---|---|
| China | ||||||
| Xuan et al, 198019 Epidemiology and community control of rheumatic heart disease in Panyu County | China (subnational - Panyu County) | 1972-1978 | Community screening RHD: Clinical plus investigations | 159 782 people aged over 15 years in a total population of 328256 | RHD prevalence in general population | 2.52% (male 2.0%, female 2.9%). |
| Self-referral for investigation | People aged over 15 years in another population of 123 034 | RHD prevalence in general population | 1.7% | |||
| Mass survey of cardiovascular diseases | 11909 people of all ages including 4476 children aged 0-14 years | RHD prevalence in general population | All age groups: 0.3% 0–14 year olds: 0.6% | |||
| Zhimin et al, 200620 Prevalence of chronic rheumatic heart disease in Chinese adults | China (subnational – 9 suburban and urban communities) | Oct 2001–Feb 2002 | Population-based screening (questionnaire, physical exam, echocardiography – diagnostic criteria described in paper) | General population, ages 18–74 years 9124 participants interviewed, 8652 completed questionnaires, 8080 completed echocardiographic exam | RHD prevalence in general population | 186 per 100 000 (n=15) 40% (n=6) diagnosed with RHD for first time, that is, screen detected |
| Kang et al, 201521 Prevalence and clinical significance of cardiac murmurs in schoolchildren | China (subnational – Dongguan City) | Nov 2011 – Nov 2012 | School screening study – questionnaire plus clinical plus echocardiography in those with a murmur (echo criteria not stated) | School students attending 32 elementary schools in Dongguan (age 5–13 years); 81 213 of 81 231 school children screened (99.98%) | RHD prevalence in school children | 2193 children had a murmur, underwent echocardiography – 5 had RHD. 5/81 213=6.2 per 100 000 |
| Chen et al, 199922 Changing pattern of heart disease in Shanghai from the 1950s to 1980s | China (Two facilities, Shanghai) | 1980–1989 | Medical inpatient data | 30 516 adult medical admissions, 7159 of which were cardiac cases | RHD as a percentage of all medical admissions with heart disease | 1980–89: 24.23% (n=1743) Reduction compared with earlier study for period 1948–1957, when RHD comprised 50.3% (n=1901) |
| Cheng, 200923 How much of the recent decline in rheumatic heart disease in China can be explained by changes in cardiovascular risk factors? | China (facility, Shanghai) | 1948–2005 | Hospital admissions data | Total cardiac admissions | RHD frequency among total cardiac admissions | 1948–57: 50% 1958–68: 44% 1969–79: 30% 1980–89: 24% 1990–99: 10% 2000–05: 2% |
| Liu et al, 201424 Five-year epidemiological survey of valvular heart disease: changes in morbidity, etiological spectrum and management in a cardiovascular centre of Southern China | China (facility, Guangdong) | 2009–2013 | Medical records / inpatient echo database | 19 428 consecutive inpatients with abnormal valve structure/function who underwent echocardiography | RHD as a percentage of total echocardiographs | RHD as a percentage of total valvular disease: 2009: 42.8% (n=1268) 2013: 32.8% (n=1680) Age-specific estimates <15 years: 7.7% 15-25 years: 28.9% 25–35 years: 60% 35–45 years: 73.6% 45–55 years: 71.8% 55–65 years: 60.2% 65–75 years: 32.0% 75–85 years: 14% 85+ years:2.9% |
| Lu et al, 201625 Trends in the prevalence of heart diseases over a ten-year period from single-centre observations based on a large echocardiographic database | China (facility, Shanghai) | 2003–2012 | Outpatient echo database (echo diagnosis based on American Society of Echocardiography recommendations) | 385,682 outpatients who underwent transthoracic echocardiography, age ≥18 years | RHD as a percentage of total echocardiographs | 2003: 4.04% 2012: 3.06% 2003–2007: 3.87% 2008–2012: 3.04% |
| Hu et al, 201726 A hospital-based survey of patients with severe valvular heart disease in China | China (facility, Zhejiang) | 2010-2015 | Echocardiography database (2014 AHA/ ACC guidelines and EAE/ ASE recommendations) | 139 496 consecutive patients (inpatients and outpatients), age ≥18 years | RHD prevalence among hospital patients | 1.56% (n=2179) |
| Wang et al, 201127 Cardiopulmonary bypass techniques and clinical outcomes in Beijing Fuwai Hospital: a brief clinical review | China (facility, Beijing) | 2008 | Cardiac surgery database | 7606 cardiac surgery cases | RHD frequency among total cardiac surgery cases | 19.45% (n=1479 cases) |
| Liu et al, 201028 Pregnancy outcomes in women with heart disease | China (facility, Shanghai) | 1993-2007 | Clinical record data | 20 983 patients delivering during study period, 1142 of whom had heart disease | RHD prevalence in obstetric population | 99 women with RHD among 20 983 women delivering =0.47% (RHD 8.7% of all cases with heart disease) |
| Zhou and Hu, 200829 An epidemiological study on the prevalence of atrial fibrillation in the Chinese population of Mainland China | China (subnational, 13 provinces) | Not stated | Population-based screening (RHD: history +/- examination and echocardiography if self-reported RHD) | 29 079 subjects, age ≥30 years | RHD prevalence in general population | 91 of 29 079 subjects (0.3%) |
| Malaysia | ||||||
| Khoo et al, 199130 Cardiovascular mortality in Peninsular Malaysia: 1950-1989 | Malaysia (subnational) | 1950-1989 | Mortality data from Registrar of Births and Deaths (1950-1960) and Department of Statistics (1965 onwards) For 1965-1989 only used data for medically certified deaths | General population | RHD as a percentage of cardiovascular deaths | 1965: 4.51% 1989: 1.70% 1975–89: 2.58% |
| RHD as a percentage of total deaths | 1965: 0.41% 1989: 0.5% 1975–89: 0.66% | |||||
Where multiple estimates were reported, for temporal trends the earliest and latest data were extracted; age-specific or sex-specific estimates are presented for the most recent year.
Not all published papers noted which diagnostic criteria were used. Where specified, the following abbreviations are provided in the table: AHA, American Heart Association, ACC, American College of Cardiology, ASE, American Society of Echocardiography; EAE, European Association of Echocardiography; RHD, rheumatic heart disease.