RESUMO
OBJECTIVE: To investigate the postnatal risk of Kawasaki disease and coronary complications from a nationwide birth cohort in Taiwan, a country with the third-highest incidence of Kawasaki disease worldwide. STUDY DESIGN: We enrolled children born between 2000 and 2009 with complete postnatal medical care records for 2000-2014 in the Taiwan national database. RESULTS: Out of a total of 2 150 590 live births, we identified 6690 (62.6% boys) patients with Kawasaki disease. The onset was mostly (93.9%) within the first 5 years of life (median, 16 months; 38% during infancy), but was rare within the first 3 months of life. The overall cumulative incidence of Kawasaki disease by age 5 years was 2.78 (3.33 for boys and 2.17 for girls; P < .001) and exhibited an increasing trend with birth year (from 2.28 for 2000 to 3.67 for 2009). The incidence ratio was 1.535 in boys and 1.055 in each increasing year. Kawasaki disease recurred more often in younger patients (cumulative incidence, 2.3% in infants vs 1.7% in children aged 1-4 years). Coronary complications occurred in 16.2% of the patients, including 4 cases of acute myocardial infarction (3 occuring during the acute stage and 1 occurring 5 years later). The probability of a major cardiac event (infarction, undergoing percutaneous coronary intervention or coronary artery bypass grafting, or death) by adolescence was 1.9%. CONCLUSIONS: The postnatal risk of Kawasaki disease was 3-4 and increased with every birth year. Patients with Kawasaki disease are at substantial risk for a major cardiac events during childhood.
Assuntos
Síndrome de Linfonodos Mucocutâneos/epidemiologia , Pré-Escolar , Estudos de Coortes , Doença das Coronárias/epidemiologia , Doença das Coronárias/etiologia , Bases de Dados Factuais , Feminino , Humanos , Incidência , Lactente , Masculino , Síndrome de Linfonodos Mucocutâneos/complicações , Medição de Risco , TaiwanRESUMO
OBJECTIVE: To update the epidemiologic trend in Kawasaki disease (KD) and develop models for projection. STUDY DESIGN: From our national databases 2000-2010 and previous studies, we obtained the epidemiologic data to develop and validate system dynamics models. Population model incorporated birth rate and mortality. KD model incorporated the population at risk, incidence, and risk of coronary complications. RESULTS: The average annual incidence in age group <5, 5-10, 10-15, and 15-20 years was 67.3, 5.75, 0.79, and 0.26 per 100,000. The KD population was 23,349 and the model estimated 20,254 patients with KD, and 25% of these patients received medical care or continued surveillance in 2010. Projection up to 2030 suggests an average of 725 new patients with KD annually and a KD population of 35,006 by 2030. In 2030, 1469 patients with KD will need medical care for coronary complications. Simulation on the model modified to US data is also effective and suggests an average of 6200 new patients annually and KD population of 161,776 by 2030, and 5664 patients will need coronary care in 2030. By 2030, there will be 1 per 700 people in Taiwan and 1 per 1600 in the US with a history of KD. CONCLUSION: Simulations on our system dynamics models tailored to any epidemiologic and outcome variables and any changes with medical advance can dynamically project the futures.