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

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,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. 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. © 2012 martins-melo et al.