Oliver Jane, Osowicki Joshua, Cordell Billie, Hardy Myra, Engelman Daniel, Steer Andrew C
Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia.
J Paediatr Child Health. 2020 Sep;56(9):1408-1413. doi: 10.1111/jpc.14950. Epub 2020 Jul 8.
Acute rheumatic fever (ARF) most commonly presents in children aged 5-14 years old. Lifelong rheumatic heart disease (RHD) can result. This study investigated time trends in ARF and RHD using inpatient data from the Royal Children's Hospital, Melbourne (RCH).
A retrospective cohort study covering the period 1937-2013 was conducted using records from RCH, a quaternary paediatric hospital in Melbourne, Victoria, Australia. Patient data were identified using RCH classification of diseases coding for ARF or RHD for years <1952. For the period 1952-1987, this system was used in addition to identifying International Classification of Disease (ICD) discharge codes that corresponded to ARF or RHD. From 1988-2013, only ICD codes were used to identify patient data. Descriptive epidemiological analyses were performed, including incidence rate calculations using historical census population denominator data. Analyses focussed on children in the peak age group.
Among children aged five to 14 years, a total of 4337 RCH admissions with ARF/RHD occurred for 3015 patients. A sharp decline in first ARF/RHD hospitalisations at RCH occurred from 1959, following a peak mean annual incidence rate during 1944-1947 of 40.1/100 000 children (95% confidence interval (CI): 36.6-43.9; P < 0.05). Over 1996-2013, the mean annual incidence rate was 1.6/100 000 (95% CI: 1.3-1.8) and reached 2.3/100 000 (95% CI: 1.3-3.7) in 2005.
The burden of ARF and RHD treated at RCH declined following the 1940s, mirroring changes seen in North America and Europe. Despite this, inpatient treatment for these conditions continued to be provided right up until the end of the study period.
急性风湿热（ARF）最常见于5至14岁的儿童。可导致终身风湿性心脏病（RHD）。本研究利用墨尔本皇家儿童医院（RCH）的住院数据调查了ARF和RHD的时间趋势。
采用澳大利亚维多利亚州墨尔本一家四级儿科医院RCH的记录进行了一项回顾性队列研究，涵盖1937年至2013年期间。对于1952年以前的年份，使用RCH的ARF或RHD疾病分类编码来识别患者数据。在1952年至1987年期间，除了识别与ARF或RHD相对应的国际疾病分类（ICD）出院编码外，还使用了该系统。从1988年至2013年，仅使用ICD编码来识别患者数据。进行了描述性流行病学分析，包括使用历史人口普查分母数据计算发病率。分析重点关注高峰年龄组的儿童。
在5至14岁的儿童中，3015名患者因ARF/RHD共住院4337次。自1959年起，RCH首次因ARF/RHD住院的人数急剧下降，此前在1944年至1947年期间平均年发病率达到峰值，为每10万名儿童中有40.1例（95%置信区间（CI）：36.6 - 43.9；P < 0.05）。在1996年至2013年期间，平均年发病率为每10万名儿童中有1.6例（95% CI：1.3 - 1.8），并在2005年达到每10万名儿童中有2.3例（95% CI：1.3 - 3.7）。
自20世纪40年代以来，RCH治疗的ARF和RHD负担有所下降，这与北美和欧洲的变化情况一致。尽管如此，直到研究期结束，仍持续为这些病症提供住院治疗。
