Effectiveness of Comprehensive-Care Programs in Preventing Rheumatic Fever

Four inner-city comprehensive-care programs in Baltimore were evaluated by study of their effect on incidence of rheumatic fever. Annual incidence of hospitalized first attacks was estimated for the black population five to 14 years old living in census tracts eligible for these programs in 1968–70. For comparison, incidence rates in three noneligible population groupings were calculated and compared with rates for 1960–64, before these programs were established. The rate of rheumatic fever for comprehensive-care tracts in 1968–70 was about 1/3 lower than for the rest of Baltimore. From 1960–64 to 1968–70 rheumatic fever decreased 60 per cent in comprehensive-care tracts but was unchanged in the rest of the city. The declining incidence in Baltimore resulted entirely from a reduction in preventable cases preceded by clinical respiratory infections although bacteriologic data were not available. The findings thus suggest that comprehensive-care programs have been the critical factor in reducing the incidence of rheumatic fever in the inner city. (N Engl J Med 289:331–335, 1973)