171 - Rheumatic Fever in Indigenous Youth: A Retrospective Study of Disparities in the Pacific Northwest and Alaska

Publication Number: 171.6136

Simona A. Martin, Seattle Children's, Seattle, WA, United States; Elizabeth Stein, University of Colorado School of Medicine, Denver, CO, United States; Bhawna Arya, Seattle Children's, Seattle, WA, United States; William Tressel, Seattle Children's, Seattle, WA, United States; Jason Deen, University of Washington School of Medicine, Seattle, WA, United States

Background: Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are diseases that follow untreated Group A Streptococcal (GAS) infection, and are associated with socioeconomic factors such as lack of access to healthcare and high household occupancy. Historically, in the U.S., these conditions have disproportionately affected Indigenous individuals, and the last decade has seen a rise in RHD-associated morbidity and mortality in the U.S. However, there is a paucity of data studying ARF/RHD in Indigenous youth in the U.S. today.

Objective: Our study seeks to interrogate disparities in ARF/RHD in Indigenous youth in the Pacific Northwest and Alaska.

Design/Methods: This study involves a retrospective analysis of patients presenting to a U.S. children’s hospital in the Pacific Northwest serving a wide catchment area with a large Indigenous population (>270 tribes representing 9.2% of the total U.S. Indigenous population). 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 U.S. 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 Indigenous. T-test and chi-squared testing was performed. Average age at diagnosis for Indigenous 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 be diagnosed with chronic RHD at the time of diagnosis (43% vs. 19%, p=0.009). Indigenous youth had higher rates of aortic regurgitation on diagnostic echocardiography (49% vs 25%, p=0.023). Analysis of follow up echocardiography data found no significant difference in persistence or resolution of cardiac findings. There was no significant difference in rates of cardiac surgery between the two groups.

Conclusion(s): In this study of patients at a major pediatric referral center for a large geographic area in the Western United States, Indigenous youth were found to be diagnosed with ARF/RHD at an older age than non-Indigenous youth and were more likely to have chronic RHD and aortic regurgitation at time of diagnosis. This data should inform further study and intervention for RHD in Indigenous communities.