P2A162: Investigating Inequities in Indigenous Youth with Rheumatic Fever

Background: Extensive health inequities exist for Indigenous children in the United States due to systemic racism. Rheumatic heart disease, the most common acquired heart disease in children in the US, has been shown to disproportionately affect Indigenous communities. However, there is currently no published data studying disparities in disease burden and outcomes of rheumatic heart disease in Indigenous youth.

Methods: This study involved a retrospective analysis of patients presenting to a major children’s hospital with a large, multistate geographic catchment area. Patients at this single center were initially identified as part of a multicenter study investigating geographic differences in incidence of pediatric acute rheumatic fever (ARF) and rheumatic heart disease (RHD) across the United States. Individuals aged 4-17 with a diagnosis of ARF or RHF who presented between 2008-2018 were identified using ICD-9 and ICD-10 codes. Patients with congenital heart disease were excluded.

Results: Chart review was performed on 132 individuals diagnosed with ARF or RHD, with 57% identifying as American Indian/Alaska Native (AI/AN) or Native Hawaiian/Pacific Islander (NH/PI). T-test and chi-squared testing was performed. Average age at diagnosis for AI/AN and NH/PI youth was found to be older than that of non-Indigenous youth (10.3 years old vs 9.1 years old, p=0.042). Indigenous youth were also more likely to have cardiac involvement at the time of diagnosis (43% vs. 19%, p=0.009). In analyzing echocardiography data at time of diagnosis, Indigenous youth had higher rates of aortic regurgitation (49% vs 25%, p=0.023), but there were no other significant differences in severity or presence of other individual echocardiographic findings. Analysis of follow up echocardiography data was also performed and found no significant difference in persistence or resolution of cardiac findings between these two populations. Finally, there was no significant difference in rates of cardiac surgery between Indigenous and non-Indigenous youth (18% vs 10%, p=0.381).

Conclusion: In this study of patients at a major pediatric referral center for a large geographic area, Indigenous youth are diagnosed with rheumatic fever at an older age than non-Indigenous youth, and are more likely to have cardiac involvement at diagnosis. This data should inform public health interventions for RHD in Indigenous communities.