Prevalence survey for chronic rheumatic heart disease and rheumatic fever in northern India.

A house-to-house survey of a random sample of 33,36I subjects, comprising one-third of the total population of a town in northern India, shows the prevalence of chronic rheumatic heart disease and rheumatic fever to be .23/1i000 among male and 2 07/1I000 among female subjects. Of the 48 cases of rheumatic heart disease, 62 per cent gave a history suggestive of rheumatic fever in the past. Six of these had rheumatic activity. No cases were seen below the age of 5 years and above the age of 50. One-quarter of the cases of mitral stenosis and half the cases of mitral incompetence in both sexes were below the age of 20 years All the women and 84 per cent of the men with rheumatic heart disease had mitral valve involvement, while the aortic valve was involved in 42 per cent of men and 14 per cent of women. Mitral stenosis and mitral incompetence were equally common, singly or mixed, while aortic incompetence was the usual aortic lesion. Pure mitral stenosis was 321 times commoner and mitral incompetence twice as common in female than in male subjects. Among women, mitral stenosis developed earlier in many and was more often complicated by pulmonary hypertension. Previous published data, based on hospitalfigures alone, have given rise to the mistaken belief that it is less common among women in India and other Eastern coun- tries. It is probable that many of the other peculiarities of the disease like infrequency of chorea, subcutaneous nodules, lone mitral incompetence, and rheumatic fever as compared to rheumatic heart disease are also due to dependence on figures from teaching hospitals and specialized units which are biased by preselection.