Burden of Disease
The global burden of rheumatic fever and rheumatic heart disease declined dramatically during the 20th century, mainly due to improved living conditions and better access to health services. The introduction of penicillin in the 1950s and 1960s also meant that people could be treated effectively for streptococcal infections, thus reducing the potential for rheumatic fever.
The burden of these conditions is now predominantly confined to developing countries. It is estimated that at least 15.6 million people worldwide are currently living with rheumatic heart disease and another 1.9 million have had rheumatic fever with no rheumatic heart disease. There are approximately 470,000 new cases of rheumatic fever diagnosed and over 230,000 deaths due to rheumatic heart disease each year. In industrialised countries, rheumatic fever is now rare, and rheumatic heart disease is seen mostly in the older, pre-penicillin population.
In Australia, rheumatic fever and rheumatic heart disease are still common in many Aboriginal and Torres Strait Islander communities. However, estimating the national burden of ARF and RHD is difficult because information is largely state and territory-specific. To date, most of the published data in Australia has been provided by the Northern Territory.
Almost all cases of rheumatic fever recorded in the Northern Territory (NT) between 2005 and 2010 were for Aboriginal and Torres Strait Islander people (98%).(1) Aboriginal people are 69 times more likely than non-Aboriginal people to develop rheumatic fever and 64 times more likely to have rheumatic heart disease. Overall 2% of NT Aboriginal people have rheumatic heart disease, including 3% of young adults. Between 2007 and 2009, 897 deaths were attributed to rheumatic heart disease.(2)
Young people in the NT aged 5 – 14 years are at highest risk of a first episode of rheumatic fever. Between 2005 and 2010, 58% of cases of rheumatic fever were in children aged 5-14(1, 2), and rheumatic heart disease is most commonly seen in adolescents and young adults, with the highest rates of rheumatic heart disease in adults aged 35-39.
Aboriginal and Torres Strait Islander people are up to eight times more likely than other Australians to be hospitalised for rheumatic fever and rheumatic heart disease. (3) While these conditions account for only 7% of potentially preventable hospitalisations in the NT, the impact on the hospital system in terms of length of stay is greater than for most other chronic conditions (4).
In 2006, the Australian Institute of Health and Welfare reported the mortality rate for rheumatic and other valvular disease was 19.1 times higher among Aboriginal and Torres Strait Islander people than non-Indigenous Australians. This disparity was greater than other chronic diseases such as nephritis and nephrosis (18.2), diabetes (18.1) and ischaemic heart disease (4.3). According to this report, Aboriginal and Torres Strait Islander people were 3. 9 times more likely than non-Indigenous Australians to die from these chronic conditions. An Indigenous person living in the Northern Territory is 54.8 times as likely to die from the complications of rheumatic heart disease than a non-Indigenous person.(5)
It is unlikely that such a stark contrast between two populations living within the same national barriers exists for any other disease or on any other continent (5)
- Parnaby M, Carapetis J. ‘Rheumatic fever in Indigenous Australian children. Journal of Paediatrics and Child Health. 2010;46:pp. 527-33.
- Australian Institute of Health and Welfare. Rheumatic heart disease and acute rheumatic fever in Australia: 1996 – 2012, Cardiovascular Disease Series. Cat. no. CVD 60. Canberra: AIHW, 2013.
- RHDAustralia. Health Worker Modules: Module 1 – Acute Rheumatic Fever and Rheumatic Heart Disease 2012. Darwin Rheumatic Heart Disease Australia 2012.
- Colquhoun SM, Condon JR, Steer AC, Li SQ, Guthridge S, Carapetis JR. Disparity in Mortality From Rheumatic Heart Disease in Indigenous Australians. Journal of the American Heart Association. 2015;4(7).
- Brown A, McDonald M, Calma T. Acute rheumatic fever and social justice. Medical Journal of Australia. 2007;186(11):pp. 557-8.