Virtual Poster 21st Lancefield International Symposium for Streptococci and Streptococcal Diseases 2022

Ethnically Disparate Disease Progression and Outcomes among Acute Rheumatic Fever Patients in New Zealand, 1989–2015 (#222)

Jane Oliver 1 2 , Oliver Robertson 3 , Jane Zhang 3 , Brooke L Marsters 3 , Dianne Sika-Paotonu 3 4 5 6 , Susan Jack 5 7 , Julie Bennett 3 , Deborah A Williamson 1 , Nigel Wilson 4 8 , Nevil Pierse 3 , Michael G Baker 9
  1. Infectious Diseases, University of Melbourne, Melbourne, Victoria, Australia
  2. Tropical Diseases, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
  3. Public Health, University of Otago wellington, Wellington, New Zealand
  4. University of Auckland, Auckland, New Zealand
  5. University of Otago, Dunedin , New Zealand
  6. Telethon Kids Institute, Perth, Western Australia, Australia
  7. Southern District Health Board, Dunedin, New Zealand
  8. Starship Child Health, Auckland, New Zealand
  9. Public Health, University of Otago Wellington, Wellington, New Zealand

Background

The occurrence of acute rheumatic fever (ARF) and it’s complication rheumatic heart disease (RHD) declined sharply in many high-income countries since the 1960s. In New Zealand, ethnic inequities are striking, with Māori and Pasifika children experiencing among the highest ARF rates in the world. We investigated outcomes for patients hospitalised with an initial occurrence of ARF. Secondly, we investigated what proportion of people aged <40 years-old who were hospitalised for the first time with RHD had been previously hospitalised with ARF.

Methods

Data from the National Minimum Dataset and the National Mortality Collection were obtained. We included patients born after 1983 who were hospitalised with initial ARF during 1989–2012. ARF progression outcome data (recurrent ARF hospitalisation, RHD hospitalisation, death from circulatory causes) during 1989–2015 were linked to the initial ARF hospitalisation.

A retrospective analysis identified initial RHD patients <40 years of age hospitalised during 2010–2015 and any preceding hospitalisation(s) for ARF.

Results

Most (86.4%) of 2,182 initial ARF patients did not experience disease progression by 31/12/2015. The probability of progression after 26.8 years of theoretical follow-up was 24.0%; the probability of death was 1.0%. Progression was more rapid and around 2-times more likely for Māori and Pasifika patients. Of 435 initial RHD patients, 82.2% had not been previously hospitalised for ARF.

Conclusions

This young cohort demonstrated low mortality but considerable illness, especially among underserved Māori and Pasifika populations.  A national patient register could help monitor and reduce ARF progression.