Pasqualina Coffey|Anna P. Ralph|Vicki Krause
The role of social determinants of health in the risk and prevention of group A streptococcal infection, acute rheumatic fever and rheumatic heart disease: A systematic review
Northern Territory Health Services|Government of Western Australia Department of Health|Menzies School of Health Research|Royal Darwin Hospital|Northern Territory Health Services|Government of Western Australia Department of Health
background rheumatic heart disease rhd poses major disease burden among disadvantaged populations globally results acute rheumatic fever arf complication group streptococcal gas infection conditions acknowledged diseases poverty however role specific social environmental factors gas infection progression arfrhd well understood aim systematic review determine association social determinants health gas infection arf rhd effect interventions targeting methodology conducted systematic literature review using pubmed cochrane library embase observational experimental studies measured crowding dwelling characteristics education employment income nutrition socioeconomic status relationship gas infection arf rhd included findings factor assessed bradford hill criteria evidence causation study quality assessed using standardised tool principle findings 1164 publications identified 90 met inclusion criteria comprising 91 individual studies 49 505 poor quality relation specific study question proportion studies reporting significant associations socioeconomic determinants risk gas infection 571 arfrhd 50 crowding assessed factor 14 studies gas infection 36 studies arfrhd followed socioeconomic status 6 36 respectively majority studies assessing crowding dwelling characteristics education employment status parents cases nutrition reported positive association risk gas infection arf rhd crowding socioeconomic status satisfactorily met criteria causal association substantial heterogeneity across key study aspects conclusion extensive literature examining role social determinants gas infection arf rhd risk lacks quality observational interventional crowding cause gas infection arfrhd presents practical target prevention actions