Leith Jordan, An Kevin R, Harik Lamia, Zhu William, Dell'Aquila Michele, Brashear Taylor, Peck Robert N, Bhamidipati Castigliano M
Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, US.
Center for Global Health, Weill Cornell Medical College, New York, US.
Glob Heart. 2025 Feb 3;20(1):10. doi: 10.5334/gh.1394. eCollection 2025.
Rheumatic heart disease (RHD) is the most common form of acquired heart disease in Africa, often requiring surgical intervention. Previous studies have demonstrated the need for more cardiac surgeons in Africa but have not outlined their distribution relative to populations and incident cases.
We estimate rheumatic heart disease incidence and cardiac surgical capacity to manage RHD in Africa. By characterizing geographic catchment areas served by the nearest cardiac surgeon(s), we estimate patient travel distance and the unmet surgical need.
Subnational population, RHD incidence, cardiac surgeon, and geographic data were collected from credible, publicly accessible sources. Quantum Geographic Information System (QGIS 3.32) was used to create a subnational map of Africa and conduct nearest neighbor analyses to determine the location and distance of each subnational region's nearest cardiac surgeon. Catchment areas were defined and characterized. Incident RHD case-to-capacity ratios (ICCR) and surgical need were calculated. Incident RHD and surgical need were mapped at the subnational level across Africa. The human development index (HDI) of each region was then incorporated to assess the impact of socioeconomic disparities.
A total of 779 subnational regions from 54 countries were included in the analysis. The African continent has an estimated 509 cardiac surgeons practicing in 74 subnational regions (corresponding to 74 catchment areas) and 1,027,974 incident cases of RHD annually. The average distance to travel for care by a cardiac surgeon was found to be 312.01 km (193.87 miles). The ICCR due to RHD for the African continent was 10.64.
Access to cardiac surgical care is limited across Africa despite the high incidence of RHD. While nearly all areas of the continent would benefit from increasing cardiac surgical capacity, attention should be paid towards strategic development of geographically accessible cardiac surgical centers to equitize care for RHD.
风湿性心脏病（RHD）是非洲最常见的后天性心脏病形式，通常需要手术干预。以往研究表明非洲需要更多心脏外科医生，但未阐明其相对于人口和发病病例的分布情况。
我们估计非洲风湿性心脏病的发病率以及管理RHD的心脏外科手术能力。通过描绘最近的心脏外科医生所服务的地理集水区，我们估计患者的就诊行程距离以及未满足的手术需求。
从可靠的公开可用来源收集国家以下层面的人口、RHD发病率、心脏外科医生和地理数据。使用量子地理信息系统（QGIS 3.32）创建非洲国家以下层面的地图，并进行最近邻分析，以确定每个国家以下区域最近的心脏外科医生的位置和距离。定义并描绘集水区。计算RHD发病病例与手术能力比率（ICCR）和手术需求。在非洲国家以下层面绘制RHD发病情况和手术需求图。然后纳入每个区域的人类发展指数（HDI）以评估社会经济差距的影响。
分析纳入了来自54个国家的779个国家以下区域。非洲大陆估计有509名心脏外科医生在74个国家以下区域执业（对应74个集水区），每年有1,027,974例RHD发病病例。发现患者前往心脏外科医生处就诊的平均行程距离为312.01公里（193.87英里）。非洲大陆因RHD导致的ICCR为10.64。
尽管RHD发病率很高，但非洲各地获得心脏外科护理的机会有限。虽然非洲大陆几乎所有地区都将从增加心脏外科手术能力中受益，但应关注地理上可及的心脏外科中心的战略发展，以实现RHD护理的公平性。
