# A Retrospective Linked Data Analysis of Acute Rheumatic Fever and Rheumatic Heart Disease Diagnoses in Children Aged Under Five Years in Australia, 2001–2017

## TL;DR

This study shows that acute rheumatic fever and rheumatic heart disease occur in Australian children under five years old, highlighting the need for greater awareness among clinicians.

## Contribution

The study provides the first comprehensive Australian evidence of ARF and RHD in children under five years old.

## Key findings

- 180 children under five years old were diagnosed with ARF or RHD in Australia between 2001 and 2017.
- 30.6% of under-five-year-olds with ARF or RHD had not been notified to RHD registers.
- High hospitalisation rates for injury in the first year of life were observed in the under-five-year-old ARF/RHD cohort.

## Abstract

To describe the clinical and demographic profile of Australian children first diagnosed with acute rheumatic fever (ARF) or rheumatic heart disease (RHD) before the age of 5 years, with comparison to children aged 5–14 years.

Linked emergency department, hospitalisation, RHD register and death records from the End RHD in Australia: Study of Epidemiology were used to identify first ARF/RHD diagnosis occurring in < 15‐year‐olds. Demographic/clinical profiles and pre‐diagnosis healthcare interactions were analysed with stratification into 5‐year age groups.

Retrospective cross‐sectional linked administrative data analysis.

Northern Territory, South Australia, Queensland and Western Australia.

Children aged < 15 years at first hospitalisation or notification for ARF or RHD, 2001–2017.

Disease stage and severity at diagnosis, register notification status, clinical history prior to ARF or RHD diagnosis.

Of 2382 children diagnosed with ARF/RHD aged < 15 years, 180 (7.6%) were aged under 5 years. Among under 5‐year‐olds with ARF or RHD, 30.6% had not been notified to RHD registers. A total 49 under 5‐year‐olds were diagnosed with RHD; with 22 (44.9%) classified as having mild disease, 16 (32.7%) moderate and 6 (12.2%) severe. High hospitalisation rates for injury in the first year of life were observed for the < 5‐year‐old cohort with ARF/RHD.

We present the first comprehensive Australian evidence that ARF and RHD diagnoses are occurring in Australian children aged under 5 years. Greater awareness among clinicians is needed regarding ARF/RHD as a potential diagnosis in this young, high risk age group.

Linked administrative health data was used to describe acute rheumatic fever (ARF) or rheumatic heart disease (RHD) cases among preschoolers.ARF/RHD was diagnosed among 180 children aged under 5 years in Australia, 2001–2017.Greater clinician awareness about the diagnosis and notification of ARF and RHD within this young age group is needed.

Linked administrative health data was used to describe acute rheumatic fever (ARF) or rheumatic heart disease (RHD) cases among preschoolers.

ARF/RHD was diagnosed among 180 children aged under 5 years in Australia, 2001–2017.

Greater clinician awareness about the diagnosis and notification of ARF and RHD within this young age group is needed.

There are no comprehensive Australian studies of ARF or RHD in under 5‐year‐olds.An analysis of 23 cases of ARF identified in under 7‐year‐olds from the National Child Development Study in the United Kingdom identified history of infection, large household size and migration as ARF risk factors in this age group.

There are no comprehensive Australian studies of ARF or RHD in under 5‐year‐olds.

An analysis of 23 cases of ARF identified in under 7‐year‐olds from the National Child Development Study in the United Kingdom identified history of infection, large household size and migration as ARF risk factors in this age group.