Epidemiology
Most cases of mitral stenosis are caused by rheumatic fever. While rheumatic fever is now very rare in high-income countries, it remains epidemic in much of the world. The greatest burden of acute rheumatic fever and rheumatic heart disease is in people in low- and middle-income countries and in populations of indigenous people living in poverty in high-income countries.[1] The highest prevalence and age-standardised mortality of rheumatic heart disease are in Oceania, South Asia, and central sub-Saharan Africa.[2][3] There is no clear sex predilection for acute rheumatic fever, although rheumatic heart disease is much more common in females. Acute rheumatic fever is most common in tropical countries with no seasonal variation. The highest rates of acute rheumatic fever have been documented in Aboriginal children in the Northern Territory of Australia and Pacific peoples, including those living in the US and New Zealand.[4] In the US, the annual national incidence of rheumatic fever is unknown, as it is no longer a nationally notifiable disease.[5]
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