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April 1987

Risk of Coronary Abnormalities due to Kawasaki Disease in Urban Area With Small Asian Population

Author Affiliations

From the Department of Pediatrics, Northwestern University Medical School and The Children's Memorial Hospital, Chicago (Drs Shulman, Pachman, and Miller), and the Department of Pediatrics, University of Chicago (Drs McAuley and Ruschhaupt). Dr Miller is now with the University of Texas, San Antonio.

Am J Dis Child. 1987;141(4):420-425. doi:10.1001/archpedi.1987.04460040078020

• The epidemiology of Kawasaki disease in the six-county Chicago metropolitan area (total population, >7 100 000 inhabitants) was characterized by identifying cases, with onset occurring from 1979 to 1983, inclusively, that had been studied by echocardiography. A retrospective survey of the records from pediatric echocardiographic laboratories and pediatric cardiologists at teaching hospitals, as well as a random sample survey of nonteaching hospitals with pediatric beds in the metropolitan area, was carried out. A total of 190 cases were identified, yielding an annual mean minimum Incidence of 5.95 per 100000 children less than 5 years old. Cases occurred endemically with superimposed spring clusters in 1980 and 1983. As seen in other studies, the male-female ratio was 1.58:1, and the peak incidence occurred in children between 1 and 2 years old, with 85% of cases occurring in children under 5 years of age. The racial distribution of cases was as follows: whites, including Hispanics, 62%; blacks, 32%; Asians, 5%; and half-white/half-Asian, 1%. Asians were slightly overrepresented in that they made up only 1.7% of the study area population. The annual minimum incidence for Asian Americans was 24.4 per 100000 children less than 5 years old; this rate was significantly greater than those for the other racial groups. Although few cases were observed in Japanese-American children, the calculated annual minimum incidence in this small group was approximately 44 per 100000 children less than 5 years old. The highest incidence was observed in several suburban Chicago zip code areas, where annual rates as high as 84.7 per 100000 children less than 5 years old were documented. Coronary artery abnormalities were diagnosed by echocardiography in 30 (16%) of 190 cases; the male-female ratio of patients with such abnormalities was 2.75:1. Whites and children under 1 year of age demonstrated the highest Incidence of coronary artery abnormalities. White children under 1 year of age appeared to be at particularly high risk for development of coronary abnormalities, with 11 (41%) of 27 white infants manifesting such findings by echocardiography. These infants may represent a subgroup of patients who would benefit particularly from therapy with intravenous gamma globulin for prevention of coronary abnormalities and who require particularly close follow-up care.

(AJDC 1987;141:420-425)