Abstract
BackgroundRheumatic heart disease (RHD) is considered a major public health problem in developing countries, although scarce data are available to substantiate this. Here we quantify mortality from RHD in Fiji during 2008–2012 in people aged 5–69 years.Methods and FindingsUsing 1,773,999 records derived from multiple sources of routine clinical and administrative data, we used probabilistic record-linkage to define a cohort of 2,619 persons diagnosed with RHD, observed for all-cause mortality over 11,538 person-years. Using relative survival methods, we estimated there were 378 RHD-attributable deaths, almost half of which occurred before age 40 years. Using census data as the denominator, we calculated there were 9.9 deaths (95% CI 9.8–10.0) and 331 years of life-lost (YLL, 95% CI 330.4–331.5) due to RHD per 100,000 person-years, standardised to the portion of the WHO World Standard Population aged 0–69 years. Valuing life using Fiji’s per-capita gross domestic product, we estimated these deaths cost United States Dollar $6,077,431 annually. Compared to vital registration data for 2011–2012, we calculated there were 1.6-times more RHD-attributable deaths than the number reported, and found our estimate of RHD mortality exceeded all but the five leading reported causes of premature death, based on collapsed underlying cause-of-death diagnoses.ConclusionsRheumatic heart disease is a leading cause of premature death as well as an important economic burden in this setting. Age-standardised death rates are more than twice those reported in current global estimates. Linkage of routine data provides an efficient tool to better define the epidemiology of neglected diseases.
Highlights
With few current data [10], the only available data were those from urban populations living in the UK, USA and Japan in the early to mid-twentieth century and socially disadvantaged indigenous populations living in Australia and New Zealand today
The cohort data were expanded into thirteen five-year age categories and standardised mortality ratios (SMR) and relative survival rates were calculated by applying the background age category, gender and ethnicity specific death rates to the cohort
Links were identified in the patient information system for 87.1% of control programme records, 85.3% of echocardiography clinic records and 66.0% of death certificates (S3 Table)
Summary
[1] This process, which may manifest clinically as heart failure, stroke and early death, [2] remains a major public health problem in developing countries. [4, 7] In 2005, a WHO report found mortality estimates based on either vital registration data or verbal autopsy techniques to be unreliable, largely because of the difficulty distinguishing RHD-attributable death from other causes of cardiac death. [9] We sought to measure RHD-attributable mortality in Fiji, a developing nation in the Western Pacific, where a high prevalence of RHD has consistently been reported. Rheumatic heart disease (RHD) is considered a major public health problem in developing countries, scarce data are available to substantiate this. We quantify mortality from RHD in Fiji during 2008–2012 in people aged 5–69 years
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