Bronstein D E, Dille A N, Austin J P, Williams C M, Palinkas L A, Burns J C
Department of Pediatrics, University of California, San Diego, USA.
Pediatr Infect Dis J. 2000 Nov;19(11):1087-91. doi: 10.1097/00006454-200011000-00012.
Kawasaki disease (KD) is the most common cause of acquired heart disease in children in the United States. By monitoring trends in patient numbers and demographics during a 5-year period, we were able to explore the relationship between climate, ethnicity, socioeconomic status and susceptibility to KD.
We conducted active surveillance for all patients hospitalized with KD in San Diego County from 1994 through 1998. Data on seasonal variation in monthly rainfall and temperature were obtained from the US Meteorological Service. Patient sex, age, date of admission and self-reported ethnicity were identified from patient medical records. Socioeconomic status was assessed on the basis of insurance status among patients hospitalized at a single institution.
During the 5-year period there were 169 cases of KD in San Diego County. The overall annual incidence of KD in children < 5 years of age ranged from 8.0 to 15.4/100 000. KD incidence was inversely associated with average monthly temperature (r = -0.47, P < 0.001) and positively associated with average monthly precipitation (r = -0.52, P < 0.001). Asian/Pacific Islanders < 5 years of age were 2.7 times as likely and Hispanics were one-third as likely to be hospitalized for KD than children from all other ethnic groups combined. Children with private or military insurance in all ethnic groups were more likely to have a diagnosis of KD than children with government assistance or no insurance. After controlling for insurance status, only Asian/Pacific Islanders remained at increased risk (rate ratio, 2.14) for KD relative to all other ethnic groups combined.
KD is a common childhood vasculitis of unknown etiology. The skewed ethnic distribution and seasonality are consistent with the hypothesis that KD is an infectious disease that is influenced by environmental and genetic factors.
川崎病（KD）是美国儿童后天性心脏病的最常见病因。通过监测5年期间的患者数量和人口统计学趋势，我们得以探究气候、种族、社会经济地位与KD易感性之间的关系。
我们对1994年至1998年在圣地亚哥县因KD住院的所有患者进行了主动监测。每月降雨量和温度的季节变化数据来自美国气象服务局。患者的性别、年龄、入院日期和自我报告的种族信息从患者病历中获取。社会经济地位根据在单一机构住院患者的保险状况进行评估。
在这5年期间，圣地亚哥县有169例KD病例。5岁以下儿童KD的总体年发病率在8.0至15.4/10万之间。KD发病率与月平均温度呈负相关（r = -0.47，P < 0.001），与月平均降水量呈正相关（r = -0.52，P < 0.001）。5岁以下的亚裔/太平洋岛民因KD住院的可能性是所有其他种族儿童总和的2.7倍，而西班牙裔则是其三分之一。所有种族中拥有私人或军事保险的儿童比有政府援助或无保险的儿童更有可能被诊断为KD。在控制保险状况后，相对于所有其他种族的总和，只有亚裔/太平洋岛民患KD的风险仍然增加（率比，2.14）。
KD是一种病因不明的常见儿童血管炎。种族分布不均和季节性与KD是一种受环境和遗传因素影响的传染病这一假设一致。
