Socio‐economic deprivation associated with acute rheumatic fever. A hospital‐based case‐control study in Bangladesh

Abstract

There are few studies on the relationship between socio-economic factors and rheumatic fever (RF) in the populations where the burden of both socio-economic deprivation and RF is still very high. The aim of this study is to assess the association between some socio-economic factors and RF by examining data available from a RF hospital in Bangladesh. We have reviewed the medical records of patients presenting with manifestations suggestive of RF during a 1-year period. From the patients who showed group A beta-haemolytic streptococcal upper respiratory infection (ABHS infection), 44 RF cases defined by the Jones criteria and 86 control subjects, who did not satisfy the criteria, were identified for analysis. The median age was 12 years and 60% were female. RF was significantly associated with low income (odds ratio [OR] 2.37; P = 0.04); poor living conditions: substandard (kacha) house (OR 2.93, P = 0.02); and poor nutritional status: low height for age (OR 2.68, P = 0.02). Multiple logistic regression analysis revealed an increased OR for kacha house (OR 3.18, P = 0.02) but the same estimate for low height for age (OR 2.68; P = 0.04). Our analysis shows that, among the patients presenting to the RF hospital with proven ABHS infection, acute RF is associated with socio-economic deprivation.

Rheumatic fever

“…Low income, poor living, and substandard housing (especially crowding) are risk factors associated with outbreaks of the disease [3]. Climatic factors such as cold and humidity are implicated in the incidence of acute rheumatic fever, which may be important in the spread of the infection with Streptococcus.…”

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

“…[7][8][9][10][11] This view is supported by research showing that ARF is associated with socio-economic and living conditions. 12,13 Previous studies have identified associations between ARF/RHD and poor housing conditions, [14][15][16][17] sometimes including home crowding. 12,13,18,19 It is possible that cold, damp living conditions promote GAS infection by weakening immune and respiratory defences.…”

The primary prevention of rheumatic fever

“…Poverty may feed indirectly into other factors that may impact on RF, such as crowding, housing, nutrition, parental unemployment and poor access to health care. [12][13][14][17][18][19]21,23,24,26,33,36,37,[39][40][41] Since the publication of the guideline, the New Zealand Child & Youth Epidemiology Service in its Indicator Handbook have linked the risk of RF to high levels of deprivation using the New Zealand Deprivation Index (see earlier), which is based on household income, access to telephone and car, education level and housing. 3…”

“…Many published studies were found on the association between crowding and RF. 12,[15][16][17][18][19][20][22][23][24][25][26][27][29][30][31][32][34][35][36][37]39,[41][42][43][44][45][46][47][48] There is evidence from comparative studies of a link between crowding in the home and RF information on household crowding is available by region in NZ with considerable geographic variation. Auckland is the most crowded region.…”