Using preceding hospital admissions to identify children at risk of developing acute rheumatic fever

Area of Science:

• Public Health
• Epidemiology
• Pediatrics

Background:

• New Zealand (NZ) Māori and Pacific children experience high rates of acute rheumatic fever (ARF), a significant public health concern.
• National ARF prevention programs include housing improvement initiatives, necessitating effective tools for targeting high-risk populations.
• Identifying children at risk for ARF is crucial for maximizing the benefits of housing interventions.

Purpose of the Study:

• To evaluate the effectiveness of using hospitalizations as a tool to identify children at risk of developing ARF.
• To compare the sensitivity and efficiency of different potentially avoidable hospitalization (PAH) groups in detecting future ARF cases.

Main Methods:

• Analysis of NZ public hospital discharge data from 2000-2014.
• Investigation of three PAH groups: PAH conditions associated with the housing environment (PAHHE), Crowding, and Ministry of Health (MoH) conditions.
• Calculation of ARF prevalence within each PAH group to estimate sensitivity and number needed to screen (NNS) for efficiency.

Main Results:

• Approximately one-third of ARF patients had a prior PAH as children.
• Sensitivity for detecting future ARF varied significantly across groups, ranging from <5% (MoH) to 27% (PAHHE).
• The number needed to screen (NNS) to identify one ARF case was more efficient for the PAHHE group (502.4) compared to the MoH group (707.5).

Conclusions:

• Hospitalizations alone are not highly efficient for targeting ARF prevention due to the condition's relative rarity.
• The PAHHE group demonstrates potential utility in identifying children who may benefit from housing interventions.
• The hospital setting remains valuable for identifying at-risk children for broader health improvement programs, particularly those addressing housing-related conditions.