Ethnic differences for developing rheumatic fever in a low-income group living in Hawaii.
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.
Kurahara
David K
DK
John A. Burns School of Medicine, University of Hawaii, 1319 Punahou Street, Room 734, Honolulu, HI 96826, USA. davidk@kapiolani.org
Grandinetti
Andrew
A
Galario
Judith
J
Reddy
D Venu
DV
Tokuda
Angela
A
Langan
Susan
S
Tanabe
Brian
B
Yamamoto
Kara S
KS
Yamaga
Karen M
KM
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