Pediatric Cardiology

, Volume 26, Issue 6, pp 775–781

The Epidemiology of Kawasaki Disease in an Urban Hospital: Does African American Race Protect Against Coronary Artery Aneurysms?

  • A.R. Porcalla
  • C.A. Sable
  • K.M. Patel
  • G.R. Martin
  • N. Singh


The etiology and pathogenesis of Kawasaki disease (KD) is largely unknown. Certain demographic factors and laboratory findings are predictive of the development of coronary artery (CA) aneurysms. The objectives of this study were to determine the epidemiology of KD patients in an urban hospital and determine risk factors associated with their development of CA abnormalities. A longitudinal case series of KD patients admitted to Children’s National Medical Center from 1990 to 2002 was examined. Age, sex, ethnic background, duration of fever prior to diagnosis, address, month diagnosed, and CA abnormalities (ectasia or aneurysms) on echocardiography were recorded. Median household income was obtained from the U.S. Census Bureau Web site. The Student t-test, logistic regression analyses, and the Kruskal–Wallis test were used, with significance assumed at p < 0.05. A total of 302 patients were evaluated. CA abnormalties were found in 27 patients (9%), with aneurysms identified in 13 patients (4%). Age was 2.9 ± 2.4 years (range, 2 months to 14 years). A total of 51 patients (16%) were ≤1 year and 35 patients (12%) were ≥5 years. Ethnic distribution was 54% (164) African American, 24% (72) Caucasian, 9% (29) Asian/Pacific Islander, 8% (23) Hispanic, and 5% (14) Middle Eastern. Only 2/164 (1.2%) African Americans developed CA aneurysms. Neighborhood median income of the cohort was $45,400 ± $21,200 ($52,200 ±$25,800 for patients with aneurysms). A total of 28% of cases clustered between December and January. Cases doubled annually in 1999–2001 compared to 1990–1998 (39 vs 19). Multivariate logistic regression found age between 1 and 5 years [p = 0.045; odds ratio, 0.31; 95% confidence interval (CI), 0.10–0.97] and African American race (p = 0.014; odds ratio, 0.15; 95% CI, 0.03–0.68) to be independently protective against CA aneurysms. Duration of fever prior to diagnosis, considered in 210 patients, was different between patients with and without aneurysms (11 ± 5.3 vs 6.5 ± 3.8 days, respectively, p = 0.0007). Multivariate logistic regression found fever longer than 5 days to be the only predictive factor associated with the development of aneurysms and any abnormality. African Americans had a shorter duration of fever than the rest of the cohort (6.03 vs 7.31 days), (p = 0.0087). The epidemiology of KD at our hospital is similar to that at other centers except for the predominance of African Americans with a shorter duration of fever prior to diagnosis and a decreased incidence of CA aneurysms compared to other ethnicities. The protective nature of African American ethnicity against the development of CA aneurysms raises speculation about the role of genetics and its interaction with immunity in the pathogenesis of KD.

Key words

Kawasaki disease Epidemiology African-American ethnicity Coronary arteries 


  1. 1.
    Anderson MS, Burns J, Treadwell TA, Pietra BA, Glode MP (2001) Erythrocyte sedimentation rate and C-reactive protein discrepancy and high prevalence of coronary artery abnormalities in Kawasaki disease. Pediatr Infect Dis J 20:698–702PubMedGoogle Scholar
  2. 2.
    Belay ED, Holman RC, Clarke MJ, et al (2000) The incidence of Kawasaki syndrome in West Coast health maintenance organizations. Pediatr Infect Dis J 19:828–832PubMedGoogle Scholar
  3. 3.
    Bonacini M, Groshen MD, Yu MC, Govindarajan S, Lindsay KL (2001) Chronic hepatitis C in ethnic minority patients evaluated in Los Angeles County. Am J Gastroenterol 96:2438–2441CrossRefPubMedGoogle Scholar
  4. 4.
    Brogger J, Eagan T, Eide GE, Bakke P, Gulsvik A (2004) Bias in retrospective studies of trends in asthma incidence. Eur Respir J 23:281–286CrossRefPubMedGoogle Scholar
  5. 5.
    Bronstein DE, Dille AN, Austin JP, et al (2000) Relationship of climate, ethnicity and socioeconomic status to Kawasaki disease in San Diego County, 1994 through 1998. Pediatr Infect Dis J 19:1087–1091PubMedGoogle Scholar
  6. 6.
    Burns JC, Kushner HI, Bastian JF, et al (2000) Kawasaki disease: a brief history. Pediatrics 106:E27CrossRefPubMedGoogle Scholar
  7. 7.
    Curtis N, Zheng R, Lamb JR, Levin M (1995) Evidence for a superantigen mediated process in Kawasaki disease. Arch Dis Child 72:308–311PubMedGoogle Scholar
  8. 8.
    Fernandes Filho JA, Vedeler CA, Myhr KM, Nyland H, Pandey JP (2002) TNF-alpha and -beta gene polymorphisms in multiple sclerosis: a highly significant role for determinants in the first intron of the TNF-beta gene. Autoimmunity 35:377–380CrossRefPubMedGoogle Scholar
  9. 9.
    Fleckenstein J (2004) Chronic hepatitis C in African Americans and other minority groups. Curr Gastroenterol Rep 6:66–70PubMedGoogle Scholar
  10. 10.
    Fukunishi M, Kikkawa M, Hamana K, et al. (2000) Prediction of nonresponsiveness to intravenous high-dose gamma-globulin therapy in patients with Kawasaki disease at onset. J Pediatr 137:172–176PubMedGoogle Scholar
  11. 11.
    Gupta M, Noel GJ, Schaefer M, et al. (2001) Cytokine modulation with immune gamma-globulin in peripheral blood of normal children and its implications in Kawasaki disease treatment. J Clin Immunol 21:193–199CrossRefPubMedGoogle Scholar
  12. 12.
    Han RK, Sinclair B, Newman A, et al. (2000) Recognition and management of Kawasaki disease. Cmaj 162:807–812PubMedGoogle Scholar
  13. 13.
    Holman RC, Curns AT, Belay ED, Steiner CA, Schonberger LB (2003) Kawasaki syndrome hospitalizations in the United States, 1997 and 2000, Pediatrics 112:495–501CrossRefPubMedGoogle Scholar
  14. 14.
    Honkanen VE, McCrindle BW, Laxer RM, et al (2003) Clinical relevance of the risk factors for coronary artery inflammation in Kawasaki disease. Pediatr Cordial 24:122–126Google Scholar
  15. 15.
    Jiao F, Yang L, Li Y, et al (2001) Epidemiologic and clinical characteristics of Kawasaki disease in Shaanxi Province. China, 1993–1997, J Trop Pediatr 47:54–56PubMedGoogle Scholar
  16. 16.
    Krieger N, Chen JT, Selby JV (1999) Comparing individual-based and household-based measures of social class to assess class inequalities in women’s health: a methodological study of 684 US women. J Epidemiol Community Health 53:612–623PubMedGoogle Scholar
  17. 17.
    Krieger N, Williams DR, Moss NE (1997) Measuring social class in US public health research: concepts, methodologies, and guidelines. Annu Rev Public Health 18:341–378CrossRefPubMedGoogle Scholar
  18. 18.
    Laupland KB, Dele Davies H (1999) Epidemiology, etiology, and management of Kawasaki disease: state of the art. Pediatr Cardiol 20:177–183CrossRefPubMedGoogle Scholar
  19. 19.
    Lazarus R, Klimecki WT, Palmer LJ, et al (2002) Single-nucleotide polymorphisms in the interleukin-10 gene: differences in frequencies, linkage disequilibrium patterns, and haplotypes in three United States ethnic groups. Genomics 80:223–228CrossRefPubMedGoogle Scholar
  20. 20.
    Leung DY, Meissner HC, Fulton DR, Quimby F, Schlievert PM (1995) Superantigens in Kawasaki syndrome. Clin Immunol Immunopathol 77:119–126CrossRefPubMedGoogle Scholar
  21. 21.
    Meissner HC, Leung DY (2003) Kawasaki syndrome: where are the answers? Pediatrics 112:672–676PubMedGoogle Scholar
  22. 22.
    Nakamura Y, Yashiro M, Uehara R, et al (2003) Case–control study of giant coronary aneurysms due to Kawasaki disease. Pediatr Int 45:410–413CrossRefPubMedGoogle Scholar
  23. 23.
    Nakamura Y, Yashiro M, Uehara R, et al (2004) Use of laboratory data to identify risk factors of giant coronary aneurysms due to Kawasaki disease. Pediatr Int 46:33–38CrossRefPubMedGoogle Scholar
  24. 24.
    Newburger JW, Takahashi M, Burns JC, et al (1986) The treatment of Kawasaki syndrome with intravenous gamma globulin. N Engl J Med 315:341–347PubMedGoogle Scholar
  25. 25.
    Nomura Y, Yoshinaga M, Masuda K, Takei S, Miyata K (2002) Maternal antibody against toxic shock syndrome toxin-1 may protect infants younger than 6 months of age from developing Kawasaki syndrome. J Infect Dis 185:1677–1680CrossRefPubMedGoogle Scholar
  26. 26.
    Pandey JP, Frederick M (2002) TNF-alpha, IL1-beta, and immunoglobulin (GM and KM) gene polymorphisms in sarcoidosis. Hum Immunol 63:485–491CrossRefPubMedGoogle Scholar
  27. 27.
    Rauch AM, Glode MP, Wiggins JW Jr, et al (1991) Outbreak of Kawasaki syndrome in Denver, Colorado: association with rug and carpet cleaning. Pediatrics 87:663–669PubMedGoogle Scholar
  28. 28.
    Shulman ST, McAuley JB, Pachman LM, Miller ML, Ruschhaupt DG (1987) Risk of coronary abnormalities due to Kawasaki disease in urban area with small Asian population. Am J Pis Child. 141:420–425Google Scholar
  29. 29.
    Shulman ST, Melish M, Inoue O, Kato H, Tomita S (1993) Immunoglobulin allotypic markers in Kawasaki disease. J Pediatr 122:84–86PubMedGoogle Scholar
  30. 30.
    Sohn MH, Noh SY, Chang W, Shin KM, Kim DS (2003) Circulating interleukin 17 is increased in the acute stage of Kawasaki disease, Scand J Rheumatol 32:364–366PubMedGoogle Scholar
  31. 31.
    Stockheim JA, Innocentini N, Shulman ST (2000) Kawasaki disease in older children and adolescents. J Pediatr 137:250–252PubMedGoogle Scholar
  32. 32.
    Sugimoto K, Stadanlick J, Ikeda F, et al (2003) Influence of ethnicity in the outcome of hepatitis C virus infection and cellular immune response. Hepatology 37:590–599CrossRefPubMedGoogle Scholar
  33. 33.
    Treadwell TA, Maddox RA, Holman RC, et al (2002) Investigation of Kawasaki syndrome risk factors in Colorado. Pediatr Infect Dis J 21:976–978CrossRefPubMedGoogle Scholar
  34. 34.
    Tzen KT, Wu MH, Wang JK, et al (1997) Prognosis of coronary arterial lesions in Kawasaki disease treated without intravenous immunoglobulin. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi 38:32–37PubMedGoogle Scholar
  35. 35.
    Yanagawa H, Nakamura Y, Yashiro M, et al (2001) Incidence survey of Kawasaki disease in 1997 and 1998 in Japan. Pediatrics 107:E33CrossRefPubMedGoogle Scholar
  36. 36.
    Yoshioka T, Matsutani T, Toyosaki-Maeda T, et al (2003) Relation of streptococcal pyrogenic exotoxin C as a causative superantigen for Kawasaki disease. Pediatr Res 53:403–410CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2005

Authors and Affiliations

  • A.R. Porcalla
    • 1
    • 2
  • C.A. Sable
    • 3
  • K.M. Patel
    • 4
  • G.R. Martin
    • 3
  • N. Singh
    • 1
  1. 1.Division of Infectious DiseaseChildren’s National Medical Center/George Washington UniversityWashingtonUSA
  2. 2.University Hospitals and Clinics–Holmes County, Medical University of Mississippi Medical CenterLexingtonUSA
  3. 3.Division of CardiologyChildren’s National Medical Center/George Washington UniversityWashingtonUSA
  4. 4.Division of Health Services and Community Medical ResearchChildren’s National Medical Center/George WashingtonUniversityWashingtonUSA

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