Table 3

RHD burden estimates in countries with high 2015 human development indices, 1980–2017

Study author, publication yearCountry (coverage)Study periodData sourceStudy populationMetricBurden estimates
Xuan et al, 198019
Epidemiology and community control of rheumatic heart disease in Panyu County
(subnational -  Panyu County)
1972-1978Community screening
RHD: Clinical plus investigations
159 782 people aged over 15 years in a total population of 328256RHD prevalence in general population2.52%
(male 2.0%, female 2.9%).
Self-referral for investigationPeople aged over 15 years in another population of 123 034RHD prevalence in general population1.7%
Mass survey of cardiovascular diseases11909 people of all ages including 4476 children aged 0-14 yearsRHD prevalence in general populationAll age groups: 0.3%
0–14 year olds: 0.6%
Zhimin et al,  200620
Prevalence of chronic rheumatic heart disease in Chinese adults
(subnational – 9 suburban and urban communities)
Oct 2001–Feb 2002Population-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 population186 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
(subnational – Dongguan City)
Nov 2011 – Nov 2012School 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 children2193 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
(Two facilities, Shanghai)
1980–1989Medical inpatient data30 516 adult medical admissions, 7159 of which were cardiac casesRHD as a percentage of all medical admissions with heart disease1980–89: 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?
(facility, Shanghai)
1948–2005Hospital admissions dataTotal cardiac admissionsRHD frequency among total cardiac admissions1948–57: 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
(facility, Guangdong)
2009–2013Medical records / inpatient echo database19 428 consecutive inpatients with abnormal valve structure/function who underwent echocardiographyRHD as a percentage of total echocardiographsRHD 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
(facility, Shanghai)
2003–2012Outpatient echo database (echo diagnosis based on American Society of Echocardiography recommendations)385,682 outpatients who underwent transthoracic echocardiography, age ≥18 yearsRHD as a percentage of total echocardiographs2003: 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
(facility, Zhejiang)
2010-2015Echocardiography database (2014 AHA/ ACC guidelines and EAE/ ASE recommendations)139 496 consecutive patients (inpatients and outpatients),
age ≥18 years
RHD prevalence among hospital patients1.56% (n=2179)
Wang et al, 201127
Cardiopulmonary bypass techniques and clinical outcomes in Beijing Fuwai Hospital: a brief clinical review
(facility, Beijing)
2008Cardiac surgery database7606 cardiac surgery casesRHD frequency among total cardiac surgery cases19.45% (n=1479 cases)
Liu et al, 201028
Pregnancy outcomes in women with heart disease
(facility, Shanghai)
1993-2007Clinical record data20 983 patients delivering during study period, 1142 of whom had heart diseaseRHD prevalence in obstetric population99 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
(subnational, 13 provinces)
Not statedPopulation-based screening (RHD: history +/- examination and echocardiography if self-reported RHD)29 079 subjects, age ≥30 yearsRHD prevalence in general population91 of 29 079 subjects (0.3%)
Khoo et al, 199130
Cardiovascular mortality in Peninsular Malaysia: 1950-1989
1950-1989Mortality 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 populationRHD as a percentage of cardiovascular deaths1965: 4.51%
1989: 1.70%
1975–89: 2.58%
RHD as a percentage of total deaths1965: 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.