The temporospatial epidemiology of rheumatic heart disease in Far North Queensland, tropical Australia 1997–2017; impact of socioeconomic status on disease burden, severity and access to care

Abstract

Background The incidence of rheumatic heart disease (RHD) among Indigenous Australians remains one of the highest in the world. Many studies have highlighted the relationship between the social determinants of health and RHD, but few have used registry data to link socioeconomic disadvantage to the delivery of patient care and long-term outcomes. Methods A retrospective study of individuals living with RHD in Far North Queensland (FNQ), Australia between 1997 and 2017. Patients were identified using the Queensland state RHD register. The Socio-Economic Indexes for Areas (SEIFA) Score–a measure of socioeconomic disadvantage–was correlated with RHD prevalence, disease severity and measures of RHD care. Results Of the 686 individuals, 622 (90.7%) were Indigenous Australians. RHD incidence increased in the region from 4.7/100,000/year in 1997 to 49.4/100,000/year in 2017 (p<0.001). In 2017, the prevalence of RHD was 12/1000 in the Indigenous population and 2/1000 in the non-Indigenous population (p<0.001). There was an inverse correlation between an area’s SEIFA score and its RHD prevalence (rho = -0.77, p = 0.005). 249 (36.2%) individuals in the cohort had 593 RHD-related hospitalisations; the number of RHD-related hospitalisations increased during the study period (p<0.001). In 2017, 293 (42.7%) patients met criteria for secondary prophylaxis, but only 73 (24.9%) had good adherence. Overall, 119/686 (17.3%) required valve surgery; the number of individuals having surgery increased over the study period (p = 0.02). During the study 39/686 (5.7%) died. Non-Indigenous patients were more likely to die than Indigenous patients (9/64 (14%) versus 30/622 (5%), p = 0.002), but Indigenous patients died at a younger age (median (IQR): 52 (35–67) versus 73 (62–77) p = 0.013). RHD-related deaths occurred at a younger age in Indigenous individuals than non-Indigenous individuals (median (IQR) age: 29 (12–58) versus 77 (64–78), p = 0.007). Conclusions The incidence of RHD, RHD-related hospitalisations and RHD-related surgery continues to rise in FNQ. Whilst this is partly explained by increased disease recognition and improved delivery of care, the burden of RHD remains unacceptably high and is disproportionately borne by the socioeconomically disadvantaged Indigenous population.

Melioidosis–a disease of socioeconomic disadvantage

“…This current study's data lead to the greater truth that while almost all the patients in this cohort presented PLOS NEGLECTED TROPICAL DISEASES acutely, their clinical presentation and death from melioidosis was, in many cases, decades in the making. Despite Australia's universal health system, this finding is not unique to melioidosis; an association with socioeconomic disadvantage is seen in a variety of infectious diseases and non-communicable diseases seen in the region [13,[26][27][28][29][30][31][32].…”

“…However, the local incidence of melioidosis is rising and a more integrated approach to disease prevention and management is clearly necessary. Whilst a hub and spoke model has worked well in delivering specialist medical assessment and treatment in FNQ [29,39], providing interventions that prevent melioidosis in the geographically dispersed population is more complicated. Public health strategies that focus on human behaviour and aim to prevent exposure to B. pseudomallei are challenging to implement [40,41].…”

Echocardiographic Screening Detects a Significant Burden of Rheumatic Heart Disease in Australian Torres Strait Islander Children and Missed Opportunities for its Prevention

“…21 The SEIFA score has been shown to have a strong inverse correlation with the prevalence of RHD in the region. 22 This study has many limitations. The small sample size increases the risk of type 2 statistical errors, and its retrospective design increases the likelihood of incomplete or inaccurate data.…”

Medium‐term outcomes from mitral valve surgery for rheumatic heart disease in young adults in Aotearoa New Zealand: a cohort study

“…For example, a recent report by Kang and colleagues showed that the mean age of death of Australian Aboriginal patients with RHD was only 29 years. 5 However, there is a sparsity of literature published on rheumatic surgery in the New Zealand indigenous population, with limited reports particularly from the 21st century. 6 Furthermore, there is a paucity of global data on rheumatic surgery in young adults; most studies investigate outcomes in the paediatric population or older patient population.…”

“…Without access to timely cardiac valvular surgery, patients with RHD have a significantly reduced lifespan. For example, a recent report by Kang and colleagues showed that the mean age of death of Australian Aboriginal patients with RHD was only 29 years 5 . However, there is a sparsity of literature published on rheumatic surgery in the New Zealand indigenous population, with limited reports particularly from the 21st century 6 .…”