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Incidence and short-term outcomes of Kawasaki disease

Abstract

Objective

Kawasaki disease (KD) is a childhood vasculitis with conflicting reported North American trends in incidence and patient characteristics. Objectives: (1) determine KD incidence between 1995 and 2017; (2) compare patient characteristics by era and age group; (3) determine complication and cardiovascular follow-up rates.

Methods

We used population-based health administrative data to identify children (0–18 yr) hospitalized with KD in Ontario, Canada between 1995 and 2017. We excluded children with prior KD diagnosis or incomplete records. We determined the annualized incidence and follow-up trends.

Results

KD was diagnosed in 4,346 children between 1995 and 2017. Annual KD incidence was 22.0 (<5 yr), 6.1 (5–9 yr), and 0.6 (10–18 yr) per 100,000 children. KD incidence increased significantly for all age groups, including from 18.4 to 25.0 cases per 100,000 children <5 yr. Ninety-day mortality occurred in ≤5 children (≤0.1%). Coronary artery aneurysm (CAA) occurred in 106 children (2.4%, 95% confidence interval 2.0–2.9) during admission and 151 (3.5%, 95% confidence interval 3.0–4.1) during 11-year median follow-up. Children 10–18 yr had longer hospitalizations (4.3 vs. 3.5 days, p = 0.003) and more CAA (7.4% vs. 3.4%, p = 0.007). By 1-year post-diagnosis, 3970 (91.3%) and 2576 (59.3%) children had echocardiography and cardiology follow-up, respectively.

Conclusions

KD incidence is increasing in Ontario, with greater healthcare utilization from hospitalizations and subsequent follow-up.

Impact

  • 4346 children were hospitalized for Kawasaki disease over 22 years in Ontario, and Kawasaki disease incidence increased significantly for all age groups, males and females.

  • Older children (10–18 years) had longer hospital length of stay, more PICU admissions and more frequent coronary artery aneurysms.

  • Nearly all children with Kawasaki disease had follow-up echocardiography within 1 year.

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Fig. 1: Incidence of Kawasaki disease among children in Ontario from 1995 to 2017.
Fig. 2: Incidence of Kawasaki disease among all Ontario children from 1995 to 2017, by age.
Fig. 3: Seasonal variation in Kawasaki disease cases, by index admission era versus all pediatric hospitalizations in Ontario.

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Acknowledgements

This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care. This study received funding from institutional grants from Hamilton Health Sciences and McMaster University Department of Pediatrics. Parts of this material are based on data and/or information compiled and provided by CIHI. However, the analyses, conclusions, opinions, and statements expressed in the material are those of the authors, and not necessarily those of CIHI. We thank the ICES McMaster and Ottawa teams, including Richard Perez for his dedicated work planning and supervising analysis for this study, as well as Erin O’Leary for project coordination. M.B. was supported by a New Investigator Fund from Hamilton Health Sciences. C.R. was supported by Resident Research Award funding from the Department of Pediatrics, McMaster University. E.I.B. was supported by a New Investigator Award from the Canadian Institutes of Health Research, Canadian Association of Gastroenterology, and Crohn’s and Colitis Canada. E.I.B. was also supported by the Career Enhancement Program of the Canadian Child Health Clinician Scientist Program.

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Authors

Contributions

C.R., R.C., and M.B. conceptualized and designed the study, coordinated and supervised data collection and analysis, drafted the initial manuscript, and reviewed and revised the manuscript. H.S., E.D., and E.I.B. conceptualized and designed the study, coordinated and supervised data collection and analysis, and reviewed and revised the manuscript. S.B., C.D., T.M., R.P., J.K., B.K., E.K., C.J.-R., and R.W. reviewed and revised the proposed study design, reviewed data analyses, assisted with data interpretation, and reviewed and revised the manuscript. A.G. conceptualized and designed the study, was primarily responsible for data collection and analysis, and reviewed and revised the manuscript. All authors have approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Michelle Batthish.

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The authors declare no competing interests.

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Deidentified individual participant data will not be made available.

Ethical approval

The use of data in this project was authorized under section 45 of Ontario’s Personal Health Information Protection Act and was approved by Hamilton Integrated Research Ethics Board.

Patient consent

ICES is an independent, non-profit research institute whose legal status under Ontario’s health information privacy law allows it to collect and analyze healthcare and demographic data, without consent, for health system evaluation and improvement.

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Robinson, C., Chanchlani, R., Gayowsky, A. et al. Incidence and short-term outcomes of Kawasaki disease. Pediatr Res (2021). https://doi.org/10.1038/s41390-021-01496-5

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