Table 1.
Summary statistics from meta-analyses of prevalence studies on rheumatic heart disease.
| RHD definition | Criteria details | N Studies | N Participants | Prevalence, per 1000 (95%CI) | Prediction interval | I² (95%CI) | H (95%CI) | p heterogeneity | p Egger test | p difference criteria |
|---|---|---|---|---|---|---|---|---|---|---|
| Overall | ||||||||||
| Criteria | ||||||||||
| - WHF | 32 | 148719 | 26.1 (19.2–33.1) | 0.5–86.0 | 98.6 (98.4–98.8) | 8.6 (8.0–9.2) | < 0.0001 | 0.961 | < 0.0001 | |
| - WHO | 39 | 378003 | 11.3 (7.2–16.2) | 0.0–50.1 | 99.3 (99.2–99.3) | 11.4 (10.7–12.1) | < 0.0001 | < 0.0001 | ||
| - Others | 21 | 564070 | 5.2 (3.0–8.0) | 0.0–24.4 | 99.3 (99.1–99.4) | 11.6 (10.8–12.5) | < 0.0001 | 0.021 | ||
| Diagnostic procedure | ||||||||||
| - A > E | 31 | 774073 | 6.4 (4.0–9.2) | 0.0–30.0 | 99.4 (99.4–99.5) | 13.3 (12.6–14.0) | < 0.0001 | 0.0009 | < 0.0001 | |
| - E > E | 46 | 296909 | 21.2 (15.3–28.1) | 0.0–88.0 | 99.3 (99.2–99.3) | 11.8 (11.2–12.3) | < 0.0001 | 0.006 | ||
| - E > N | 5 | 19810 | 15.6 (5.8–30.0) | 0.0–95.2 | 97.1 (95.2–98.2) | 5.8 (4.6–7.5) | < 0.0001 | 0.898 | ||
| Overall, low risk of bias studies | ||||||||||
| Criteria | ||||||||||
| - WHF | 21 | 116602 | 30.6 (20.8–42.2) | 0.3–104.0 | 99.0 (98.8–99.1) | 10.0 (9.2–10.8) | < 0.0001 | 0.787 | 0.0008 | |
| - WHO | 21 | 349486 | 11.7 (7.1–17.4) | 0.0–50.2 | 99.3 (99.2–99.4) | 12.3 (11.5–13.2) | < 0.0001 | < 0.0001 | ||
| - Others | 9 | 186116 | 9.2 (3.0–18.7) | 0.0–61.8 | 99.5 (99.4–99.6) | 14.3 (12.9–15.7) | < 0.0001 | 0.092 | ||
| Diagnostic procedure | ||||||||||
| - A > E | 16 | 436227 | 9.3 (4.7–15.5) | 0.0–48.3 | 99.6 (99.6–99.7) | 16.8 (15.7–17.9) | < 0.0001 | 0.003 | 0.0014 | |
| - E > E | 31 | 197282 | 23.1 (15.7–31.8) | 0.0–92.2 | 99.2 (99.1–99.3) | 11.4 (10.7–12.1) | < 0.0001 | 0.177 | ||
| - E > N | 4 | 18695 | 20.3 (7.8–12.8) | 0.0–153.5 | 97.5 (95.6–98.5) | 6.3 (4.8–8.2) | < 0.0001 | 0.668 | ||
| Definite | ||||||||||
| Criteria | ||||||||||
| - WHF | 32 | 148719 | 11.4 (6.7–17.2) | 0.0–61.6 | 98.8 (98.6–98.9) | 9.1 (8.5–9.7) | < 0.0001 | 0.083 | 0.008 | |
| - WHO | 29 | 378003 | 6.4 (3.9–9.6) | 0.0–30.7 | 98.9 (98.7–99.0) | 9.4 (8.8–10.1) | < 0.0001 | < 0.0001 | ||
| - Others | 21 | 564070 | 3.7 (1.9–6.0) | 0.0–19.4 | 99.2 (99.0–99.3) | 11.0 (10.2–11.8) | < 0.0001 | 0.054 | ||
| Diagnostic procedure | ||||||||||
| - A > E | 31 | 774073 | 4.6 (2.8–6.8) | 0.0–21.8 | 99.2 (99.2–99.3) | 11.5 (10.9–12.2) | < 0.0001 | 0.003 | 0.031 | |
| - E > E | 46 | 296909 | 9.3 (5.7–13.7) | 0.0–56.1 | 99.1 (99.1–99.2) | 10.8 (10.3–11.3) | < 0.0001 | 0.291 | ||
| - E > N | 5 | 19810 | 9.7 (4.3–17.2) | 0.0–48.7 | 93.4 (87.5–96.5) | 3.9 (2.8–5.3) | < 0.0001 | 0.822 | ||
| Borderline/Probable | ||||||||||
| Criteria | ||||||||||
| - WHF (Borderline) | 28 | 93059 | 15.2 (10.5–20.7) | 0.0–37.8 | 97.4 (96.8–97.8) | 6.2 (5.6–6.8) | < 0.0001 | 0.278 | 0.0004 | |
| - WHO (Probable) | 10 | 56331 | 5.6 (2.3–10.4) | 0.9–12.5 | 97.3 (96.3–98.1) | 6.1 (5.2–7.2) | < 0.0001 | 0.011 | ||
| - Others (Probable) | 2 | 2689 | 5.9 (1.0–14.5) | NA | 74.2 (0.0–94.2) | 2.0 | 0.049 | NA | ||
| Diagnostic procedure | ||||||||||
| - A > E | 7 | 52537 | 5.8 (0.8–15.3) | 0.0–61.9 | 99.1 (98.8–99.3) | 10.6 (9.3–12.2) | < 0.0001 | 0.233 | 0.279 | |
| - E > E | 30 | 86287 | 13.7 (9.5–18.6) | 0.0–51.2 | 96.9 (96.2–97.4) | 5.6 (5.1–6.2) | < 0.0001 | 0.024 | ||
| - E > N | 3 | 13255 | 11.7 (5.8–19.6) | 0.0–216.2 | 79.8 (36.1–93.6) | 2.2 (1.2–4.0) | 0.007 | 0.345 | ||
| Clinically Manifest | ||||||||||
| Criteria | ||||||||||
| - WHF | 10 | 67933 | 4.7 (1.9–8.8) | 0.0–24.9 | 96.1 (94.5–97.3) | 5.1 (4.2–6.1) | < 0.0001 | 0.613 | 0.100 | |
| - WHO | 18 | 124940 | 1.7 (1.0–2.6) | 0.0–6.2 | 86.2 (79.6–90.6) | 2.7 (2.2–3.3) | < 0.0001 | 0.006 | ||
| - Others | 6 | 21396 | 2.6 (0.1–7.7) | 0.0–33.6 | 96.0 (93.4–97.5) | 5.0 (3.9–6.4) | < 0.0001 | 0.402 | ||
| Diagnostic procedure | ||||||||||
| - A > E | 12 | 72912 | 1.9 (0.7–3.5) | 0.0–11.0 | 94.0 (91.2–95.9) | 4.1 (3.8–4.9) | < 0.0001 | 0.103 | 0.303 | |
| - E > E | 20 | 139408 | 3.3 (1.8–5.1) | 0.0–14.4 | 94.8 (93.2–96.1) | 4.4 (3.8–5.0) | < 0.0001 | 0.150 | ||
| - E > N | 2 | 1949 | 2.0 (0.3–4.7) | 0.3–4.7 | 0.0 | 1.0 | 0.538 | NA | ||
| Clinically Silent | ||||||||||
| Criteria | ||||||||||
| - WHF | 9 | 67099 | 11.6 (5.2–17.8) | 0.0–93.6 | 99.3 (99.1–99.4) | 11.8 (10.5–13.2) | < 0.0001 | 0.1548 | 0.302 | |
| - WHO | 16 | 74246 | 10.6 (5.2–17.8) | 0.0–55.8 | 98.5 (98.1–98.8) | 8.1 (7.3–9.0) | < 0.0001 | 0.004 | ||
| - Others | 4 | 14246 | 3.8 (0.1–11.8) | 3.5–6.7 | 95.8 (92.0–97.8) | 4.9 (3.5–6.7) | < 0.0001 | 0.098 | ||
| Diagnostic procedure | ||||||||||
| - A > E | 10 | 65113 | 2.6 (0.6–6.0) | 0.0–22.6 | 97.6 (96.7–98.2) | 6.4 (5.5–7.5) | < 0.0001 | 0.113 | 0.0003 | |
| - E > E | 19 | 90478 | 15.5 (8.7–24.2) | 0.0–71.7 | 98.6 (98.3–98.8) | 8.5 (7.7–9.3) | < 0.0001 | 0.108 | ||
| - E > N | 0 | 0 | NA | NA | NA | NA | NA | NA | ||
NA: not applicable; WHF: World Heart Federation; WHO: World Heart Organization; A > E = Auscultation only for screening followed with echography confirmation; E > E: Echography +/− auscultation for screening followed with echography for confirmation; E > N: Echography only for screening without echography confirmation; CI = confidence interval.