Rheumatic Heart Disease-Attributable Mortality at Ages 5–69 Years in Fiji: A Five-year, National, Population-Based Record Linkage Cohort Stud

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.
Methods and Findings
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 meth�ods, 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