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In New Zealand, we can use National Health Index (NHI) numbers (19) to identify cases in health data and link information across datasets. We conducted a descriptive epidemiologic study that linked encrypted NHI numbers to ARF and RHD hospital discharge data in New Zealand from 2000 through 2018. To identify cases of initial ARF and recurrent ARF, we used hospital discharge data coded with the ICD in the National Minimum Dataset (20), which includes information on all publicly funded hospitalizations in New Zealand.

We defined initial cases as a patient’s first known hospitalization for ARF, which had ICD-10 codes I00, I01, or I02 recorded as their principal diagnosis. We excluded cases in persons who had a previous admission for ARF (ICD-9 codes 390–392) or RHD (ICD-9 codes 393–398) as principal or additional diagnoses since 1988 when the records began. We defined recurrences as all readmissions with ARF as principal diagnosis that occurred >180 days after a previous ARF discharge.

We defined initial RHD cases as a patient’s first hospitalization with a principal diagnosis of RHD (ICD-10 codes I05, I06, I07, I09, or I09) and no previous admission for RHD as principal or additional diagnoses since 1988. We defined RHD death as the underlying cause of death (ICD-10 codes I05, I06, I07, I08, or I09) as recorded in the National Mortality Collection (21).

We excluded all non–New Zealand residents from these analyses because they are not part of the usual New Zealand population. We used the New Zealand Deprivation Index (NZDep13) to assess socioeconomic deprivation (22). NZDep13 is an area-based measure of socioeconomic deprivation based on 9 variables from the 2013 census. Decile 10 represents areas considered the most socioeconomically deprived, and decile 1 represents areas with the least deprivation. In this article, when we describe the epidemiology of ARF and RHD, we generally are referring to initial ARF or RHD hospitalizations.

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