THE INCIDENCE OF RHEUMATIC FEVER IN METROPOLITAN NASHVILLE, 1963–1969

An intensive survey of the incidence of rheumatic fever in Metropolitan Nashville, Tennessee, during the period 1963–1969 revealed 324 cases which came under medical care. Only 151 cases had been reported to the official health agency. The crude annual incidence of rheumatic fever ranged from a high of 14.9 cases to a low of 6.4 cases per 100,000 population. Age, race, and sex-specific rates revealed the incidence to be twice as high among blacks than whites. The rates were strikingly higher in the 5- to 19-year age groups with a high age-specific incidence rate of 55.5 cases per 100,000 in the 10- to 14-year old black group. Among the 324 cases, 260 (80%) were initial attacks and 60 (19%) were recurrences. Eighty-six (27%) of the cases were not hospitalized. There appeared to be little overdiagnosis. Eighty-eight per cent of the cases either met the Jones criteria or were considered “definite” by the attending physician. Carditis was present in 42% of the cases with a significantly higher rate occurring among blacks. There were 97 cases (31%) for whom no history of a preceding infection could be elicited.