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

<h4>Background</h4>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 disea...

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Autores principales:	Francisco Rogerlândio Martins-Melo, Carlos Henrique Alencar, Alberto Novaes Ramos, Jorg Heukelbach
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2012
Materias:	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/9639ce762a0d472796f6f3062ddff8b5
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spelling	oai:doaj.org-article:9639ce762a0d472796f6f3062ddff8b52021-11-18T09:14:27ZEpidemiology of mortality related to Chagas' disease in Brazil, 1999-2007.1935-27271935-273510.1371/journal.pntd.0001508https://doaj.org/article/9639ce762a0d472796f6f3062ddff8b52012-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/22348163/pdf/?tool=EBIhttps://doaj.org/toc/1935-2727https://doaj.org/toc/1935-2735<h4>Background</h4>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.<h4>Methodology/principal findings</h4>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, Goiás 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.<h4>Conclusions/significance</h4>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.Francisco Rogerlândio Martins-MeloCarlos Henrique AlencarAlberto Novaes RamosJorg HeukelbachPublic Library of Science (PLoS)articleArctic medicine. Tropical medicineRC955-962Public aspects of medicineRA1-1270ENPLoS Neglected Tropical Diseases, Vol 6, Iss 2, p e1508 (2012)
institution	DOAJ
collection	DOAJ
language	EN
topic	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270
spellingShingle	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Francisco Rogerlândio Martins-Melo Carlos Henrique Alencar Alberto Novaes Ramos Jorg Heukelbach Epidemiology of mortality related to Chagas' disease in Brazil, 1999-2007.
description	<h4>Background</h4>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.<h4>Methodology/principal findings</h4>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, Goiás 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.<h4>Conclusions/significance</h4>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.
format	article
author	Francisco Rogerlândio Martins-Melo Carlos Henrique Alencar Alberto Novaes Ramos Jorg Heukelbach
author_facet	Francisco Rogerlândio Martins-Melo Carlos Henrique Alencar Alberto Novaes Ramos Jorg Heukelbach
author_sort	Francisco Rogerlândio Martins-Melo
title	Epidemiology of mortality related to Chagas' disease in Brazil, 1999-2007.
title_short	Epidemiology of mortality related to Chagas' disease in Brazil, 1999-2007.
title_full	Epidemiology of mortality related to Chagas' disease in Brazil, 1999-2007.
title_fullStr	Epidemiology of mortality related to Chagas' disease in Brazil, 1999-2007.
title_full_unstemmed	Epidemiology of mortality related to Chagas' disease in Brazil, 1999-2007.
title_sort	epidemiology of mortality related to chagas' disease in brazil, 1999-2007.
publisher	Public Library of Science (PLoS)
publishDate	2012
url	https://doaj.org/article/9639ce762a0d472796f6f3062ddff8b5
work_keys_str_mv	AT franciscorogerlandiomartinsmelo epidemiologyofmortalityrelatedtochagasdiseaseinbrazil19992007 AT carloshenriquealencar epidemiologyofmortalityrelatedtochagasdiseaseinbrazil19992007 AT albertonovaesramos epidemiologyofmortalityrelatedtochagasdiseaseinbrazil19992007 AT jorgheukelbach epidemiologyofmortalityrelatedtochagasdiseaseinbrazil19992007
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Epidemiology of mortality related to Chagas' disease in Brazil, 1999-2007.

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