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The international decline of rheumatic fever, with incidence data from Denmark (1862-1963) and mortality data from the United States (1921-1970)

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Correlation: r = 0.928, r² = 0.81. Penicillin was introduced in 1943, in the United States and in Denmark. Both graphs changed from logarithmic to a linear scale. Note: Because of a discontinuity in the US data between 1948 and 1949, related to change of the ICD criteria for diagnosis, the data for mortality before 1949 were adjusted (by Alm) to attempt to compensate for this. (Source: [Alm 2020]. Data for Denmark were from [Steer 2015], and data for the United States are from [Massell et al 1988]. Both graphs changed from logarithmic to a linear scale.)

Note: Because of a discontinuity in the US data between 1948 and 1949, related to change of the ICD criteria for diagnosis, the data for mortality before 1949 were adjusted (by Alm) to attempt to compensate for this.

References cited:
Alm PA. Streptococcal infection as a major historical cause of stuttering: data, mechanisms, and current importance. Front Hum Neurosci 2020;14:569519.
Massell BF. Rheumatic Fever And Streptococcal Infection: Unraveling The Mysteries Of A Dread Disease. Boston, MA: Harvard University Press, 1997.
Steer AC. Historical aspects of rheumatic fever. J Paediatr Child Health 2015;51(1):21-7.