Rheumatic Heart Disease-Attributable Mortality at Ages 5–69 Years in Fiji: A Five-Year, National, Population-Based Record-Linkage Cohort Study

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.

Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association

“…In a study from Fiji of 2619 people followed up during 2008 to 2012, the age-standardized death rate was 9.9 (95% CI, 9.8–10.0) per 100 000, or over twice the GBD 2013 estimate. 8a …”

Screening-detected rheumatic heart disease can progress to severe disease

“…Fiji has a very high burden of RHD, with a prevalence of definite RHD of 7–8 per 1000 on echocardiographic screening of school-aged children 14 15. RHD is one of the leading causes of mortality in children and young adults 16. The Fiji Ministry of Health and Medical Services operates a register-based RHD control programme.…”

Rheumatic fever with severe carditis: still prevalent in the South West Pacific

“…Another country in Oceania with a high RHD prevalence is Fiji; a recent study of RHD-associated deaths there found that RHD is responsible for a significant premature loss of human life 10. The 50% RHD mortality under 40 years in Fiji directly affects economic productivity in young adulthood,10 the age group on which economies thrive.…”

“…The 50% RHD mortality under 40 years in Fiji directly affects economic productivity in young adulthood,10 the age group on which economies thrive. A particularly poignant case by Steer et al 11 indicates the importance of healthcare professional training to recognise RHD in Fiji.…”