Rheumatic Fever: A Disease without Color

Abstract Background: Brazil has approximately 30.000 cases of Acute Rheumatic Fever (ARF) annually. A third of cardiovascular surgeries performed in the country are due to the sequelae of rheumatic heart disease (RHD), which is an important public health problem. Objectives: to analyze the historical series of mortality rates and disease costs, projecting future trends to offer new data that may justify the need to implement a public health program for RF. Methods: we performed a cross-sectional study with a time series analysis based on data from the Hospital Information System of Brazil from 1998 to 2016. Simple linear regression models and Holt’s Exponential Smoothing Method were used to model the behavior of the series and to do forecasts. The results of the tests with a value of p < 0.05 were considered statistically significant. Results: each year, the number of deaths due to RHD increased by an average of 16.94 units and the mortality rate from ARF increased by 215%. There was a 264% increase in hospitalization expenses for RHD and RHD mortality rates increased 42.5% (p-value < 0.05). The estimated mortality rates for ARF and RHD were, respectively, 2.68 and 8.53 for 2019. The estimated cost for RHD in 2019 was US$ 26.715.897,70. Conclusions: according to the Brazilian reality, the 1-year RHD expenses would be sufficient for secondary prophylaxis (considering a Benzatin Penicillin G dose every 3 weeks) in 22.574 people for 10 years. This study corroborates the need for public health policies aimed at RHD.摘要 背景：巴西每年约有30000例急性风湿热（Acute Rheumatic Fever, ARF）病例，该国三分之一的心血管外科手术均由风湿性心脏病（Rheumatic Heart Disease, RHD）后遗症引发，这是一项重要的公共卫生问题。 目的：分析死亡率与疾病成本的历史序列，预测未来发展趋势，以期为风湿热公共卫生防控项目的实施提供新的佐证数据。 方法：本研究基于1998年至2016年巴西医院信息系统的相关数据，开展兼具时间序列分析的横断面研究。采用简单线性回归模型与霍尔特指数平滑法（Holt’s Exponential Smoothing Method）对序列特征进行建模并实施预测，以p值<0.05作为统计学显著性判定标准。 结果：每年因风湿性心脏病导致的死亡人数平均增加16.94例，急性风湿热的死亡率上升215%；风湿性心脏病住院费用增长264%，其死亡率上升42.5%（p<0.05）。预计2019年急性风湿热与风湿性心脏病的死亡率分别为2.68和8.53，当年风湿性心脏病的预估医疗成本为26715897.70美元。 结论：结合巴西的实际国情，每年用于风湿性心脏病的医疗开支可支持22574人接受为期10年的二级预防（每3周注射一次苄星青霉素G（Benzatin Penicillin G））。本研究证实了制定针对风湿性心脏病的公共卫生政策的必要性。