Kawasaki disease in England: Ethnicity, deprivation, and respiratory pathogens
Harnden A., Mayon-White R., Perera R., Yeates D., Goldacre M., Burgner D.
BACKGROUND:: Kawasaki disease is now the commonest cause of acquired heart disease in children in the United Kingdom. Its incidence has increased in recent years. Epidemiologic analyses have provided insights into the possible etiology, but European data are scarce. METHODS:: We analyzed linked England-wide hospital admission data for Kawasaki disease in people younger than 18 years of age, during a 5-year period (1998-2003), relating incidence to geographic location, urbanization, deprivation, ethnicity, and to laboratory reports of respiratory virus infection. RESULTS:: There were 2432 admissions with Kawasaki disease in the study period for 1704 individuals. One thousand twenty-eight (60%) of the 1704 were male and 1228 (72%) were younger than 5 years of age. The annual age-specific incidence rate in those younger than 5 years was 8.39/100,000. Incidence rates in different areas of residence were significantly and independently related to both the degree of deprivation of the area and the proportion of the population in each area who were Chinese. After adjusting for the winter peaks in both the incidence of Kawasaki disease and respiratory virus infections, there was no correlation between Kawasaki disease and specific viruses. INTERPRETATION:: The previously reported increase in Kawasaki disease incidence in England has reached a plateau. These data support the concept of an infectious trigger in a genetically susceptible population, but known respiratory viral pathogens are unlikely to be the specific etiologic agents.