Rising Ethnic Inequalities in Acute Rheumatic Fever and Rheumatic Heart Disease, New Zealand, 2000-2018

Abstract

We describe trends in acute rheumatic fever (ARF), rheumatic heart disease (RHD), and RHD deaths among population groups in New Zealand. We analyzed initial primary ARF and RHD hospitalizations during 2000-2018 and RHD mortality rates during 2000-2016. We found elevated rates of initial ARF hospitalizations for persons of Māori (adjusted rate ratio [aRR] 11.8, 95% CI 10.0-14.0) and Pacific Islander (aRR 23.6, 95% CI 19.9-27.9) ethnicity compared with persons of European/other ethnicity. We also noted higher rates of initial RHD hospitalization for Māori (aRR 3.2, 95% CI 2.9-3.5) and Pacific Islander (aRR 4.6, 95% CI 4.2-5.1) groups and RHD deaths among these groups (Māori aRR 12.3, 95% CI 10.3-14.6, and Pacific Islanders aRR 11.2, 95% CI 9.1-13.8). Rates also were higher in socioeconomically disadvantaged neighborhoods. To curb high rates of ARF and RHD, New Zealand must address increasing social and ethnic inequalities.

Keywords: Māori; New Zealand; Pacific Islander; Socioeconomic deprivation; bacteria; children; epidemiology; inequalities; poverty; rheumatic fever; rheumatic heart disease; streptococci; trends.

Figure 1

Annual rates of initial and recurrent acute rheumatic fever hospitalizations, New Zealand, 2000–2018. ARF, acute rheumatic fever.

Figure 2

Incidence of initial acute rheumatic fever hospitalizations by age group and time period, New Zealand, 2000–2018. ARF, acute rheumatic fever.

Figure 3

Incidence of initial acute rheumatic fever hospitalizations by major ethnic group and time period among persons <30 years of age, New Zealand, 2000–2018. ARF, acute rheumatic fever.

Figure 4

New Zealand annual incidence rates of initial RHD hospitalizations, all ages, 2000–2018. RHD, rheumatic heart disease.

Figure 5

Age distribution of ARF, RHD, and RHD mortality rates across major ethnic groups, New Zealand, 2000–2018. A) ARF incidence among Māori; B) RHD incidence among Māori; C) RHD mortality rates among Māori; D) ARF incidence among Pacific Islanders; E) RHD incidence among Pacific Islanders; F) RHD mortality rates among Pacific Islanders; G) ARF incidence among European or other persons; H) RHD incidence among European or other persons; I) RHD mortality rates among European or other persons. ARF, acute rheumatic fever; RHD, rheumatic heart disease.