title: Ethnic differences for developing rheumatic fever in a low-income group living in Hawaii.
abstract: The risk factors responsible for acute rheumatic fever (ARF) are complex, in part, because group A streptococcus (GAS) infection is a prerequisite for this disease. We attempted to differentiate socioeconomic from genetic risk factors by studying subjects in a Hawaii pediatric cardiology clinic who qualified for Medicaid. This ethnically diverse group was unique because they maintained a low socioeconomic but generally healthy lifestyle with more limited risks than those living in extremely impoverished conditions.
  
  
  METHODS
  Questionnaires were administered to consenting subjects in the clinic, who were divided into those diagnosed with ARF (n = 26) and those with other (primarily congenital) heart diseases (n = 41).
  
  
  RESULTS
  The socioeconomic status of the ARF and non-ARF groups was lower than that of the Hawaii population in general, and little differences were noted between the groups. The ARF group, however, had slightly larger household sizes and more children than the non-ARF group. The greatest difference was in ethnicity. By the Fisher exact test, the number of Polynesians belonging to the ARF group was significantly greater than all other ethnicities (P = .005). Polynesians had an odds ratio > 4.80 of developing ARF, which increased to 6.33 when number of children per household was considered.
  
  
  CONCLUSIONS
  The potential contribution of genetic predisposing factors for developing ARF was analyzed in subjects living in a homogeneously low socioeconomic level relative to the general Hawaii population. Polynesians were at highest risk when compared to other ethnicities living in similar socioeconomic conditions.
authors.affiliation: John A. Burns School of Medicine, University of Hawaii, 1319 Punahou Street, Room 734, Honolulu, HI 96826, USA. davidk@kapiolani.org
authors.forename: David K
authors.initials: DK
authors.lastname: Kurahara
authors.forename: Andrew
authors.initials: A
authors.lastname: Grandinetti
authors.forename: Judith
authors.initials: J
authors.lastname: Galario
authors.forename: D Venu
authors.initials: DV
authors.lastname: Reddy
authors.forename: Angela
authors.initials: A
authors.lastname: Tokuda
authors.forename: Susan
authors.initials: S
authors.lastname: Langan
authors.forename: Brian
authors.initials: B
authors.lastname: Tanabe
authors.forename: Kara S
authors.initials: KS
authors.lastname: Yamamoto
authors.forename: Karen M
authors.initials: KM
authors.lastname: Yamaga
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D002648:Child; D005006:Ethnicity; D005260:Female; D020022:Genetic Predisposition to Disease; D006254:Hawaii / Q000453:epidemiology; D006801:Humans; D008297:Male; D016017:Odds Ratio; D011203:Poverty; D012213:Rheumatic Fever / Q000453:epidemiology / Q000235:genetics*; D011795:Surveys and Questionnaires