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A Retrospective Linked Data Analysis of Acute Rheumatic Fever and Rheumatic Heart Disease Diagnoses in Children Aged
Jamie Cransberg1, Judith Katzenellenbogen1, Bo Remenyi2
1Cardiovascular Epidemiology Research Centre, School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia.
Insights
Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are diagnosed in Australian children under 5 years. Early diagnosis and increased clinician awareness are crucial for this high-risk group.
Area of Science:
- Paediatric epidemiology
- Cardiovascular disease research
- Public health surveillance
Background:
- Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are significant public health concerns, particularly in Indigenous Australian populations.
- While ARF/RHD primarily affects older children, understanding diagnoses in younger age groups is essential for early intervention.
Purpose of the Study:
- To characterize the clinical and demographic profile of Australian children under 5 years diagnosed with ARF or RHD.
- To compare this profile with children aged 5-14 years diagnosed with ARF/RHD.
Main Methods:
- Retrospective analysis of linked administrative data (emergency departments, hospitalisations, RHD registers, death records) from 2001-2017.
- Inclusion criteria: Children under 15 years with a first diagnosis of ARF or RHD in Northern Territory, South Australia, Queensland, and Western Australia.
- Analysis stratified by 5-year age groups, focusing on disease severity, notification status, and prior healthcare interactions.
Main Results:
- 180 (7.6%) of 2382 children diagnosed with ARF/RHD were under 5 years old.
- 30.6% of this younger cohort were not notified to RHD registers.
- 49 children under 5 were diagnosed with RHD, with varying disease severity (mild, moderate, severe); high hospitalisation for injury noted in the first year of life.
Conclusions:
- This study provides the first comprehensive Australian evidence of ARF and RHD diagnoses in children under 5 years.
- Increased clinician awareness is vital for recognizing ARF/RHD in this young, high-risk demographic.
- Further research into early-life risk factors and healthcare interactions is warranted.
Objective:
To describe the clinical and demographic profile of Australian children first diagnosed with acute rheumatic fever (ARF) or rheumatic heart disease (RHD) before the age of 5 years, with comparison to children aged 5-14 years.
Methods:
Linked emergency department, hospitalisation, RHD register and death records from the End RHD in Australia: Study of Epidemiology were used to identify first ARF/RHD diagnosis occurring in < 15-year-olds. Demographic/clinical profiles and pre-diagnosis healthcare interactions were analysed with stratification into 5-year age groups.
Design:
Retrospective cross-sectional linked administrative data analysis.
Setting:
Northern Territory, South Australia, Queensland and Western Australia.
Participants:
Children aged < 15 years at first hospitalisation or notification for ARF or RHD, 2001-2017.
Main Outcome Measures:
Disease stage and severity at diagnosis, register notification status, clinical history prior to ARF or RHD diagnosis.
Results:
Of 2382 children diagnosed with ARF/RHD aged < 15 years, 180 (7.6%) were aged under 5 years. Among under 5-year-olds with ARF or RHD, 30.6% had not been notified to RHD registers. A total 49 under 5-year-olds were diagnosed with RHD; with 22 (44.9%) classified as having mild disease, 16 (32.7%) moderate and 6 (12.2%) severe. High hospitalisation rates for injury in the first year of life were observed for the < 5-year-old cohort with ARF/RHD.
Conclusions:
We present the first comprehensive Australian evidence that ARF and RHD diagnoses are occurring in Australian children aged under 5 years. Greater awareness among clinicians is needed regarding ARF/RHD as a potential diagnosis in this young, high risk age group.
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