title: Rheumatic Heart Disease-Attributable Mortality at Ages 5-69 Years in Fiji: A Five-Year, National, Population-Based Record-Linkage Cohort Study.
abstract: BACKGROUND
  Rheumatic 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.
  
  
  RESULTS
  Using 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.
  
  
  CONCLUSIONS
  Rheumatic 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.
authors.affiliation: University of Oxford, Oxford, United Kingdom; London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Tom
authors.initials: T
authors.lastname: Parks
authors.affiliation: Fiji Islands Ministry of Health, Suva, Fiji.
authors.forename: Joseph
authors.initials: J
authors.lastname: Kado
authors.affiliation: Townsville General Hospital, Douglas, Australia.
authors.forename: Anne E
authors.initials: AE
authors.lastname: Miller
authors.affiliation: Murdoch Children's Research Institute, Melbourne, Australia.
authors.forename: Brenton
authors.initials: B
authors.lastname: Ward
authors.affiliation: Murdoch Children's Research Institute, Melbourne, Australia; Royal Children's Hospital, Melbourne, Australia.
authors.forename: Rachel
authors.initials: R
authors.lastname: Heenan
authors.affiliation: Murdoch Children's Research Institute, Melbourne, Australia; Centre for International Child Health, University of Melbourne, Melbourne, Australia.
authors.forename: Samantha M
authors.initials: SM
authors.lastname: Colquhoun
authors.affiliation: Harvard School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Till W
authors.initials: TW
authors.lastname: Bärnighausen
authors.affiliation: Institut National de la Santé et de la Recherche Médicale, Paris, France.
authors.forename: Mariana
authors.initials: M
authors.lastname: Mirabel
authors.affiliation: Harvard School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: David E
authors.initials: DE
authors.lastname: Bloom
authors.affiliation: London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Robin L
authors.initials: RL
authors.lastname: Bailey
authors.affiliation: Fiji Islands Ministry of Health, Suva, Fiji.
authors.forename: Isimeli N
authors.initials: IN
authors.lastname: Tukana
authors.affiliation: Murdoch Children's Research Institute, Melbourne, Australia; Royal Children's Hospital, Melbourne, Australia; Centre for International Child Health, University of Melbourne, Melbourne, Australia.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Steer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004812:Epidemiologic Methods; D005260:Female; D005367:Fiji / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012214:Rheumatic Heart Disease / Q000401:mortality*; D016019:Survival Analysis; D014481:United States; D055815:Young Adult