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Valvular heart disease
Original research
Rheumatic heart disease mortality in Indigenous and non-Indigenous Australians between 2013 and 2017
  1. Ingrid Stacey1,
  2. Rebecca Seth2,
  3. Lee Nedkoff1,3,
  4. Joseph Hung4,
  5. Vicki Wade5,
  6. Emma Haynes6,
  7. Jonathan Carapetis7,
  8. Kevin Murray1,
  9. Dawn Bessarab6,
  10. Judith M Katzenellenbogen1,7
  1. 1School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
  2. 2School of Population Health, Curtin University, Perth, Western Australia, Australia
  3. 3Cardiology Population Health Laboratory, Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia
  4. 4School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
  5. 5RHD Australia, Menzies School of Health Research, Casuarina, New South Wales, Australia
  6. 6Centre for Aboriginal Medical and Dental Health, The University of Western Australia, Perth, Western Australia, Australia
  7. 7Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
  1. Correspondence to Ingrid Stacey, School of Population and Global Health, The University of Western Australia, Perth, WA 6009, Australia; ingrid.stacey{at}uwa.edu.au

Abstract

Objectives To generate contemporary age-specific mortality rates for Indigenous and non-Indigenous Australians aged <65 years who died from rheumatic heart disease (RHD) between 2013 and 2017, and to ascertain the underlying causes of death (COD) of a prevalent RHD cohort aged <65 years who died during the same period.

Methods For this retrospective, cross-sectional epidemiological study, Australian RHD deaths for 2013–2017 were investigated by first, mortality rates generated using Australian Bureau of Statistics death registrations where RHD was a coded COD, and second COD analyses of death records for a prevalent RHD cohort identified from RHD register and hospitalisations. All analyses were undertaken by Indigenous status and age group (0–24, 25–44, 45–64 years).

Results Age-specific RHD mortality rates per 100 000 were 0.32, 2.63 and 7.41 among Indigenous 0–24, 25–44 and 45–64 year olds, respectively, and the age-standardised mortality ratio (Indigenous vs non-Indigenous 0–64 year olds) was 14.0. Within the prevalent cohort who died (n=726), RHD was the underlying COD in 15.0% of all deaths, increasing to 24.6% when RHD was included as associated COD. However, other cardiovascular and non-cardiovascular conditions were the underlying COD in 34% and 43% respectively.

Conclusion Premature mortality in people with RHD aged <65 years has approximately halved in Australia since 1997–2005, most notably among younger Indigenous people. Mortality rates based solely on underlying COD potentially underestimates true RHD mortality burden. Further strategies are required to reduce the high Indigenous to non-Indigenous mortality rate disparity, in addition to optimising major comorbidities that contribute to non-RHD mortality.

  • epidemiology
  • heart valve diseases
  • global burden of disease
  • outcome assessment, health care
  • research design

Data availability statement

Data are available on reasonable request. The data underlying this article are based on sensitive health records, obtained from Australian health services by permission from data custodians. Data sharing is subject to rigorous conditions, including additional ethical and data custodian approvals.

https://doi.org/10.1136/heartjnl-2022-322146

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    Data availability statement

    Data are available on reasonable request. The data underlying this article are based on sensitive health records, obtained from Australian health services by permission from data custodians. Data sharing is subject to rigorous conditions, including additional ethical and data custodian approvals.

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    Footnotes

    • Twitter @ingrid_stacey

    • Correction notice This article has been corrected since it was first published to correct a typographical error in the title.

    • Contributors JMK is responsible for the overall content as guarantor. JMK, IS, RS, LN, JH, VW, JC and DB contributed to study design. IS and RS performed analyses with statistical supervision by KM, LN and JMK. IS drafted the manuscript including tables and figures. All coauthors interpreted results, generated content for discussion, critically reviewed manuscript and contributed to revisions.

    • Funding This work was supported by funding from the National Health and Medical Research Council through project grant (#114652) and seed funds from the End RHD Centre for Research Excellence and HeartKids. IS is supported by an NHMRC Postgraduate Scholarship Grant (#2005398) and an Ad Hoc Postgraduate Scholarship from The University of Western Australia. JMK and LN are supported by National Heart Foundation Future Leader Fellowships (#102043, #105038).

    • Map disclaimer The inclusion of any map (including the depiction of any boundaries therein), or of any geographic or locational reference, does not imply the expression of any opinion whatsoever on the part of BMJ concerning the legal status of any country, territory, jurisdiction or area or of its authorities. Any such expression remains solely that of the relevant source and is not endorsed by BMJ. Maps are provided without any warranty of any kind, either express or implied.

    • Competing interests None declared.

    • Patient and public involvement Coauthor Vicki Wade (RHD Australia) leads the culturally safe patient support programme ‘Champions4Change’, designed and led by Aboriginal and Torres Strait Islander peoples with lived experience of ARF/RHD. Consequently, framing of this research was conducted to benefit people living with ARF/RHD.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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