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Rheumatic heart disease in the Western Pacific

Dunya Tomic, Chief of Editorials and Publications PMSA


Rheumatic heart disease (RHD) is a preventable repercussion of acute rheumatic fever (ARF) that is still rife amongst vulnerable communities. Currently, it is estimated that there are 33 million people globally living with RHD (1). Although RHD used to be a widespread issue, developed countries saw a drastic fall in rates of the disease over the 20th century due to socioeconomic advancements and stronger medical treatment. In low-income countries however, it continues to pose a significant burden (2). The Western Pacific region is one of the most severely affected areas in the world in relation to RHD. In itself the Western Pacific comprises 37 countries, with close to 2 billion people (3), which have large variations in socioeconomic development, healthcare systems and health information structure (4).

The burden of RHD within Oceania is well documented, however, this is not the case for the remaining countries in the Western Pacific region. A recent review (5) sought to address this knowledge gap, and its results confirmed the vast difference in RHD rates amongst the region. Studies included were from April to June 2017 across the 14 countries of the Western Pacific that were identified as lying outside Oceania. The highest prevalence of RHD was found to be amongst Singapore, Hong Kong, Japan, South Korea and Brunei. China, Malaysia and Mongolia all showed high rates of disease. The Philippines, Vietnam, Laos and Cambodia had moderate levels of disease. Information for Macao and Taiwan was unavailable.

Although the review found limited data regarding the proportion of total cardiovascular deaths resultant from RHD, it indicated that these figures decreased over time across all development levels. In high development settings, current RHD mortality estimates were very low, constituting 1.4% of total cardiovascular deaths in Brunei (6) and 1.2 per 100,000 population in Hong Kong (7). For countries classified as medium development, figures were only available for the Philippines, where RHD deaths were less than 2 per 100,000 population in a 2013 study (8).

Ultimately, this study highlighted the socioeconomic and health status diversity amongst Western Pacific regions. In nations with longstanding economic development, RHD rates have fallen. In those with recent economic development, significant RHD persists in the older population, whereas the younger individuals who have seen socioeconomic progress have lower rates of the disease. It also shows that there is insufficient data available in low-income regions that needs to be addressed, as these regions are likely to have the higher rates of RHD. It will also be essential to monitor trends over the years to ensure that the burden of RHD continues to fall as we achieve better levels of development across the Western Pacific.

  1. Watkins JA, Johnson CO, Colquhoun SM, et al. Global, regional and national burden of rheumatic heart disease, 1990-2015. N Engl J Med. 2017;377:713-22.

  2. Rothenbuhler M, O’Sullivan CJ, Stortecky S, et al. Active surveillance for rheumatic heart disease in endemic regions: a systematic review and meta-analysis of prevalence among children and adolescents. Lancet Glob Health. 2014;2:e717-e726.

  3. World Health Organization. WHO in the Western Pacific. Available from: http://www.wpro.who.int/about/in_brief/en/

  4. The World Bank 2017. World DataBank. Health Nutrition and Population Statistics. Available from: http://databank.worldbank.org/data/reports.aspx?source=health-nutrition-and-population-statistics

  5. Abouzeid M, Katzenellenbogen J, Wyber R, Watkins D, Johnson TD, Carapetis J. Rheumatic heart disease across the Western Pacific: not just a Pacific Island problem. Heart Asia. 2017;9:e010948.

  6. Ministry of Health Brunei Dartussalam. Health Information Booklet 2016 (21st Edition Revision 1) Brunei Darussalam. 2016. Available from: http://www.moh.gov.bn/SiteCollectionDocuments/Health%20Indicator%20Booklet/HIB_2016.pdf

  7. The Government of the Hong Kong Special Administrative Region. Non-Communicable Diseases – Highlights Report. Hong Kong: Healthy Hong Kong, Department of Health, 2014. Number of Deaths and Death Rate by Heart Disease Group by Sex, 2005-14. Available from: http://www.healthyhk.gov.hk/phisweb/en/health_info/non_comm_dis/comm_ncd/report.html

  8. Epidemiology Bureau. The 2013 Philippine Health Statistics. Republic of the Philippines: Department of Health, 2013. Available from: http://www.doh.gov.ph/sites/default/files/publications/2013PHScompressed_0.pdf

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