Epidemiology of mortality related to Chagas' disease in Brazil, 1999-2007

Martins-Melo, Francisco Rogerlandio, Alencar, Carlos Henrique, Ramos, Alberto Novaes, and Heukelbach, Jorg (2012) Epidemiology of mortality related to Chagas' disease in Brazil, 1999-2007. PLoS Neglected Tropical Diseases, 6 (2). pp. 1-8.

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Abstract

Background: Chagas' disease is an important neglected public health problem in many Latin American countries, but population-based epidemiological data are scarce. Here we present a nationwide analysis on Chagas-associated mortality, and risk factors for death from this disease.

Methodology/Principal Findings: We analyzed all death certificates of individuals who died between 1999 and 2007 in Brazil, based on the nationwide Mortality Information System (a total of 243 data sets with about 9 million entries). Chagas' disease was mentioned in 53,930 (0.6%) of death certificates, with 44,537 (82.6%) as an underlying cause and 9,387 (17.4%) as an associated cause of death. Acute Chagas' disease was responsible for 2.8% of deaths. The mean standardized mortality rate was 3.36/100.000 inhabitants/year. Nationwide standardized mortality rates reduced gradually, from 3.78 (1999) to 2.78 (2007) deaths/year per 100,000 inhabitants (-26.4%). Standardized mortality rates were highest in the Central-West region, ranging from 15.23 in 1999 to 9.46 in 2007 (-37.9%), with a significant negative linear trend (p = 0.001; R-2 = 82%). Proportional mortality considering multiple causes of death was 0.60%. The Central-West showed highest proportional mortality among regions (2.17%), with a significant linear negative trend, from 2.28% to 1.90% (-19.5%; p = 0.001; R-2 = 84%). There was a significant increase in the Northeast of 38.5% (p = 0.006; R-2 = 82%). Bivariable analysis on risk factors for death from Chagas' disease showed highest relative risks (RR) in older age groups (RR: 10.03; 95% CI: 9.40-10.70; p<0.001) and those residing in the Central-West region (RR: 15.01; 95% CI: 3.90-16.22; p<0.001). In logistic regression analysis, age >= 30 years (adjusted OR: 10.81; 95% CI: 10.03-10.65; p<0.001) and residence in one of the three high risk states Minas Gerais, Goias or the Federal District (adjusted OR: 5.12; 95% CI: 5.03-5.22, p<0.001) maintained important independent risk factors for death by Chagas' disease.

Conclusions/Significance: This is the first nationwide population-based study on Chagas mortality in Brazil, considering multiple causes of death. Despite the decline of mortality associated with Chagas' disease in Brazil, the disease remains a serious public health problem with marked regional differences.

Item ID: 22149
Item Type: Article (Research - C1)
ISSN: 1935-2727
Additional Information:

© 2012 Martins-Melo et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Date Deposited: 28 Jun 2012 15:50
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111706 Epidemiology @ 34%
11 MEDICAL AND HEALTH SCIENCES > 1108 Medical Microbiology > 110803 Medical Parasitology @ 33%
11 MEDICAL AND HEALTH SCIENCES > 1103 Clinical Sciences > 110309 Infectious Diseases @ 33%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920109 Infectious Diseases @ 33%
92 HEALTH > 9204 Public Health (excl. Specific Population Health) > 920404 Disease Distribution and Transmission (incl. Surveillance and Response) @ 34%
92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920120 Zoonoses @ 33%
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