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Rheumatic heart disease among adults in a mining community of Papua, Indonesia: findings from an occupational cohort.

Rodriguez-Fernandez R, Amiya R, Wyber R, Widdodow W, Carapetis J - Heart Asia (2015)

Bottom Line: The prevalence of RHD in Papuan mining workers correlates with adult prevalence data in other populations with a high RHD burden, highlighting RHD as a significant health issue into adulthood.The late stage at which most patients presented points to a strong need for earlier intervention.Both primary and secondary preventive measures must be considered critical tools to prevent and reduce RHD burden, particularly among older age groups.

View Article: PubMed Central - PubMed

Affiliation: Freeport Public Health and Malaria Control , International SOS , Kuala Kencana, Papua , Indonesia ; NCD Asia Pacific Alliance , Tokyo , Japan.

ABSTRACT

Background: Rheumatic heart disease (RHD) remains a significant cause of cardiovascular morbidity and mortality in developing countries such as Indonesia. Yet, despite being one of the most readily preventable chronic diseases, RHD has received scant research or policy attention, particularly in South-East Asia.

Aim: To describe the pattern of RHD occurrence in a sample of presenting cases from an occupational cohort in Papua Province, Indonesia.

Methods: Clinical records of 15 608 mining workers (96.4% men, mean age 36.3±7.4 years) were reviewed retrospectively to identify and extract data on all rheumatic fever (RF) and RHD cases admitted to two hospitals in Papua during 2008-2013. Collected data included basic demographics, employment history and echocardiographic findings.

Results: 83 RHD cases (95.6% men, mean age 39.6±12.5 years) and 3 RF cases were identified between 2008 and 2013. Increased RHD risk was observed among those aged 35-44 (HR=3.60) and 45-68 (HR=4.46) years relative to the youngest age group (p<0.01). RHD incidence density was 6.84 per 10 000 person years of follow-up. Among cases, mitral stenosis was the most common valvular lesion at initial presentation (41.0%), and 6.0% were multivalvular.

Conclusions: The prevalence of RHD in Papuan mining workers correlates with adult prevalence data in other populations with a high RHD burden, highlighting RHD as a significant health issue into adulthood. The late stage at which most patients presented points to a strong need for earlier intervention. Both primary and secondary preventive measures must be considered critical tools to prevent and reduce RHD burden, particularly among older age groups.

No MeSH data available.


Related in: MedlinePlus

Distribution of valvular heart lesion classifications among cases of rheumatic heart disease (n=83). Data shown as raw frequencies with percentages (n (%)), both overall and age stratified. The p value shown is for the χ2 test comparing distributions across age categories. AR, aortic regurgitation; AS, aortic stenosis; MR, mitral regurgitation; MS, mitral stenosis; TR, tricuspid regurgitation.
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HEARTASIA2015010641F3: Distribution of valvular heart lesion classifications among cases of rheumatic heart disease (n=83). Data shown as raw frequencies with percentages (n (%)), both overall and age stratified. The p value shown is for the χ2 test comparing distributions across age categories. AR, aortic regurgitation; AS, aortic stenosis; MR, mitral regurgitation; MS, mitral stenosis; TR, tricuspid regurgitation.

Mentions: Of the 83 cases with RHD, echocardiography findings were available for all cases. The most common valvular lesion was mitral stenosis, found in 41.0% (n=34) of cases, followed by mitral/aortic regurgitation, occurring in 20.5% (n=17) of cases each. Single valve involvement was more frequent than multiple valve involvement, with multivalvular disease identified in only 6.0% (n=5) of cases. The predominance of mitral stenosis was substantially more marked among those aged 18–34 years relative to the older age groups, while most instances of identified multivalvular involvement were in the older age groups (figure 3). The total number of RF patients identified from the medical records review and included in this study was three.


Rheumatic heart disease among adults in a mining community of Papua, Indonesia: findings from an occupational cohort.

Rodriguez-Fernandez R, Amiya R, Wyber R, Widdodow W, Carapetis J - Heart Asia (2015)

Distribution of valvular heart lesion classifications among cases of rheumatic heart disease (n=83). Data shown as raw frequencies with percentages (n (%)), both overall and age stratified. The p value shown is for the χ2 test comparing distributions across age categories. AR, aortic regurgitation; AS, aortic stenosis; MR, mitral regurgitation; MS, mitral stenosis; TR, tricuspid regurgitation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4537650&req=5

HEARTASIA2015010641F3: Distribution of valvular heart lesion classifications among cases of rheumatic heart disease (n=83). Data shown as raw frequencies with percentages (n (%)), both overall and age stratified. The p value shown is for the χ2 test comparing distributions across age categories. AR, aortic regurgitation; AS, aortic stenosis; MR, mitral regurgitation; MS, mitral stenosis; TR, tricuspid regurgitation.
Mentions: Of the 83 cases with RHD, echocardiography findings were available for all cases. The most common valvular lesion was mitral stenosis, found in 41.0% (n=34) of cases, followed by mitral/aortic regurgitation, occurring in 20.5% (n=17) of cases each. Single valve involvement was more frequent than multiple valve involvement, with multivalvular disease identified in only 6.0% (n=5) of cases. The predominance of mitral stenosis was substantially more marked among those aged 18–34 years relative to the older age groups, while most instances of identified multivalvular involvement were in the older age groups (figure 3). The total number of RF patients identified from the medical records review and included in this study was three.

Bottom Line: The prevalence of RHD in Papuan mining workers correlates with adult prevalence data in other populations with a high RHD burden, highlighting RHD as a significant health issue into adulthood.The late stage at which most patients presented points to a strong need for earlier intervention.Both primary and secondary preventive measures must be considered critical tools to prevent and reduce RHD burden, particularly among older age groups.

View Article: PubMed Central - PubMed

Affiliation: Freeport Public Health and Malaria Control , International SOS , Kuala Kencana, Papua , Indonesia ; NCD Asia Pacific Alliance , Tokyo , Japan.

ABSTRACT

Background: Rheumatic heart disease (RHD) remains a significant cause of cardiovascular morbidity and mortality in developing countries such as Indonesia. Yet, despite being one of the most readily preventable chronic diseases, RHD has received scant research or policy attention, particularly in South-East Asia.

Aim: To describe the pattern of RHD occurrence in a sample of presenting cases from an occupational cohort in Papua Province, Indonesia.

Methods: Clinical records of 15 608 mining workers (96.4% men, mean age 36.3±7.4 years) were reviewed retrospectively to identify and extract data on all rheumatic fever (RF) and RHD cases admitted to two hospitals in Papua during 2008-2013. Collected data included basic demographics, employment history and echocardiographic findings.

Results: 83 RHD cases (95.6% men, mean age 39.6±12.5 years) and 3 RF cases were identified between 2008 and 2013. Increased RHD risk was observed among those aged 35-44 (HR=3.60) and 45-68 (HR=4.46) years relative to the youngest age group (p<0.01). RHD incidence density was 6.84 per 10 000 person years of follow-up. Among cases, mitral stenosis was the most common valvular lesion at initial presentation (41.0%), and 6.0% were multivalvular.

Conclusions: The prevalence of RHD in Papuan mining workers correlates with adult prevalence data in other populations with a high RHD burden, highlighting RHD as a significant health issue into adulthood. The late stage at which most patients presented points to a strong need for earlier intervention. Both primary and secondary preventive measures must be considered critical tools to prevent and reduce RHD burden, particularly among older age groups.

No MeSH data available.


Related in: MedlinePlus