title: Acute rheumatic fever in First Nations communities in northwestern Ontario: Social determinants of health "bite the heart".
abstract: OBJECTIVE
  To document a case series of 8 young First Nations patients diagnosed with acute rheumatic fever (ARF), a preventable disease that resulted in the death of 2 patients, in northwestern Ontario in the context of late diagnosis, overcrowded housing, and inadequate public health response.
  
  
  METHODS
  Retrospective case series over an 18-month period.
  
  
  METHODS
  Remote First Nations communities in northwestern Ontario.
  
  
  METHODS
  Eight patients with ARF.
  
  
  METHODS
  Incidence, mortality, residual rheumatic heart disease, time to diagnosis, barriers to diagnosis and treatment, housing situation of patients, patient demographic characteristics (age, sex), and investigation results.
  
  
  RESULTS
  The incidence of ARF in this population was 21.3 per 100,000, which is 75 times greater than the overall Canadian estimated incidence. The average patient age was 9.4 years. Most cases developed joint findings, and 5 of the surviving patients had rheumatic heart disease when they received echocardiography. The average time to diagnosis was 88 days. Two 4-year-old children died from ARF. Most patients lived in inadequate and crowded housing.
  
  
  CONCLUSIONS
  This rare disease still exists in remote First Nations communities. These communities demonstrate an incidence equal to that in aboriginal communities in Australia and New Zealand, which have among the highest international incidence of ARF. Primordial prevention, including improved on-reserve housing, is urgently needed. Case detection and ongoing surveillance for primary and secondary prophylaxis requires a well resourced regional strategy.
authors.forename: Janet
authors.initials: J
authors.lastname: Gordon
authors.forename: Mike
authors.initials: M
authors.lastname: Kirlew
authors.forename: Yoko
authors.initials: Y
authors.lastname: Schreiber
authors.forename: Raphael
authors.initials: R
authors.lastname: Saginur
authors.forename: Natalie
authors.initials: N
authors.lastname: Bocking
authors.forename: Brittany
authors.initials: B
authors.lastname: Blakelock
authors.forename: Michelle
authors.initials: M
authors.lastname: Haavaldsrud
authors.forename: Christine
authors.initials: C
authors.lastname: Kennedy
authors.forename: Terri
authors.initials: T
authors.lastname: Farrell
authors.forename: Lloyd
authors.initials: L
authors.lastname: Douglas
authors.forename: Len
authors.initials: L
authors.lastname: Kelly
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D005260:Female; D006801:Humans; D007198:Indians, North American; D008297:Male; D009864:Ontario / Q000453:epidemiology; D012111:Residence Characteristics; D012189:Retrospective Studies; D012213:Rheumatic Fever / Q000175:diagnosis* / Q000208:ethnology*; D012214:Rheumatic Heart Disease / Q000175:diagnosis* / Q000208:ethnology*; D064890:Social Determinants of Health / Q000706:statistics & numerical data*; D055815:Young Adult