Federal Institute of Education, Science and Technology of Ceará, Fortaleza, Ceará 60040-531, Brazil.
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
Acta Trop. 2021 Aug;220:105948. doi: 10.1016/j.actatropica.2021.105948. Epub 2021 May 7.
Chagas disease remains an important public health problem with high morbidity and mortality in several Latin American countries. This nationwide population-based ecological study analyzes the epidemiological characteristics and time trends of Chagas disease-related mortality in Brazil, 2000-2019. We included all deaths reported in Brazil in which Chagas disease was mentioned in the death certificate either as an underlying or associated cause of death (multiple causes of death). Crude and age-adjusted mortality rates (per 100,000 inhabitants) were calculated and time trends analysis was performed using joinpoint regression models. In the study period, a total of 22,663,092 deaths were recorded in Brazil. Chagas disease was identified in 122,291 deaths (0.54%), 94.788 (77.5%) as an underlying cause and 27,503 (22.5%) as an associated cause. Average annual age-adjusted mortality rate was 3.22 deaths/100,000 inhabitants (95% confidence interval [CI]: 3.14-3.30). Chronic Chagas disease with cardiac involvement was the predominant clinical presentation mentioned. The highest mortality rates were observed in males, age group ≥80 years, black race/skin color, schooling 1-3 years of study, and residents in the Central-West region. Age-adjusted mortality rates showed a significant declining trend at the national level in the period (Average Annual Percent Change: -3.1%; 95% CI: -3.3; -3.0), with different local patterns and a more pronounced reduction in important endemic areas in the past. The findings show that, despite a consistent decline in mortality rates in Brazil over the study period, Chagas disease remains an important and neglected cause of death in the country, showing a marked regional variation that has social and health care implications. In addition to the control measures for disease transmission, it is necessary to guarantee access, coverage, and quality of health care to Chagas disease patients, seeking to prevent the occurrence of severe forms and deaths from the disease.
恰加斯病仍然是拉丁美洲几个国家一个重要的公共卫生问题，具有较高的发病率和死亡率。本项全国性基于人群的生态研究分析了 2000-2019 年巴西的恰加斯病相关死亡率的流行病学特征和时间趋势。我们纳入了所有在巴西报告的死亡病例，这些死亡病例的死亡证明中提到了恰加斯病，无论是作为根本原因还是作为死亡的相关原因（多种死因）。计算了粗死亡率和年龄调整死亡率（每 10 万人），并使用 Joinpoint 回归模型进行了时间趋势分析。在研究期间，巴西共记录了 22663092 例死亡。在 122291 例死亡中（0.54%）确定了恰加斯病，94.788 例（77.5%）为根本原因，27503 例（22.5%）为相关原因。平均年龄调整死亡率为每年每 10 万人 3.22 例死亡（95%置信区间[CI]：3.14-3.30）。以心脏受累为主要临床表现的慢性恰加斯病是最常见的临床表现。男性、年龄组≥80 岁、黑皮肤/肤色、受教育年限为 1-3 年以及居住在中西部地区的人群的死亡率最高。在研究期间，全国的年龄调整死亡率呈现出显著的下降趋势（平均年变化百分比：-3.1%；95%CI：-3.3；-3.0），不同地区的模式不同，过去在重要的流行地区的死亡率下降更为明显。这些发现表明，尽管巴西在研究期间死亡率持续下降，但恰加斯病仍然是该国一个重要且被忽视的死亡原因，表现出明显的区域差异，对社会和医疗保健具有影响。除了疾病传播的控制措施外，还必须确保恰加斯病患者获得医疗保健的机会、覆盖范围和质量，以防止疾病的严重形式和死亡的发生。
