Estimating the risk of acute rheumatic fever in New Zealand by age, ethnicity and deprivation.
In New Zealand, efforts to control acute rheumatic fever (ARF) and its sequelae have focused on school-age children in the poorest socioeconomic areas; however, it is unclear whether this approach is optimal given the strong association with demographic risk factors other than deprivation, especially ethnicity. The aim of this study was to estimate the stratum-specific risk of ARF by key sociodemographic characteristics. We used hospitalization and disease notification data to identify new cases of ARF between 2010 and 2013, and used population count data from the 2013 New Zealand Census as our denominator. Poisson logistic regression methods were used to estimate stratum-specific risk of ARF development. The likelihood of ARF development varied considerably by age, ethnicity and deprivation strata: while risk was greatest in Māori and Pacific children aged 10-14 years residing in the most extreme deprivation, both of these ethnic groups experienced elevated risk across a wide age range and across deprivation levels. Interventions that target populations based on deprivation will include the highest-risk strata, but they will also (a) include groups with very low risk of ARF, such as non-Māori/non-Pacific children; and (b) exclude groups with moderate risk of ARF, such as Māori and Pacific individuals living outside high deprivation areas.
Department of Public Health,University of Otago,Wellington,New Zealand.
J K
JK
Gurney
Department of Public Health,University of Otago,Wellington,New Zealand.
J
J
Stanley
Department of Public Health,University of Otago,Wellington,New Zealand.
M G
MG
Baker
Starship Children's Hospital,Auckland District Health Board,Auckland,New Zealand.
N J
NJ
Wilson
Department of Public Health,University of Otago,Wellington,New Zealand.
D
D
Sarfati
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D012213:Rheumatic Fever / Q000453:epidemiology* / Q000208:ethnology / Q000382:microbiology; D012307:Risk Factors; D012959:Socioeconomic Factors; D013297:Streptococcus pyogenes / Q000502:physiology*; D055815:Young Adult
Public health; rheumatic fever; rheumatic heart disease