The Temporospatial Epidemiology of Rheumatic Heart Disease in Far North Queensland (1997–2017)

Abstract

Background: Rheumatic heart disease (RHD) is still being diagnosed in Australia. It is essential to define the temporospatial epidemiology of the disease to inform strategies for its prevention. Methods: Individuals diagnosed with RHD in Far North Queensland (FNQ) between 1997 and 2017, were identified using the RHD register and public health system data. Results: There were 686 individuals diagnosed with RHD during the study period. Their median age at diagnosis was 29 (Interquartile range (IQR) 17–44) years; 458 (66.8%) were female; 616 (89.8%) identified as Indigenous Australians. The incidence of RHD increased in FNQ from 4.7/100000/year in 1997 to 49.4/100000/year in 2017 (p < 0.001). RHD incidence increased in both metropolitan and rural and remote locations, but it was significant higher in rural and remote locations (median (IQR) 44.6/100000/year (20.3–90.7) versus 5.9/100000/year (1.3–10.4), p < 0.001). There were 388 individuals with RHD receiving secondary prophylaxis (367 (94.6%) parenteral penicillin and 21 (5.4%) oral therapy). The median (IQR) adherence to parenteral secondary prophylaxis was only 41% (23–58%). The number of separate patients requiring valve surgery increased from 52 (41.9%) patients between 1997–2007 to 72 (58.1%) between 2008–2017 (p = 0.03). Conclusion: The incidence of RHD and incidence of RHD-related surgery continues to rise in FNQ. Although this is likely to be partly explained by increased disease recognition and enhanced service delivery, the incidence of the disease remains unacceptably high and is disproportionately borne by the Indigenous population. Optimisation of primary and secondary prophylaxis is urgently required to reduce the burden of this preventable disease.