Multiple causes of death related to Chagas' disease in Brazil, 1999 to 2007

Abstract

Introduction:Chagas' disease is a major public health problem in Brazil and needs extensive and reliable information to support consistent prevention and control actions. This study describes the most common causes of death associated with deaths related to Chagas' disease (underlying or associated cause of death). Methods: Mortality data were obtained from the Mortality Information System of the Ministry of Health (approximately 9 million deaths). We analyzed all deaths that occurred in Brazil between 1999 and 2007, where Chagas' disease was mentioned on the death certificate as underlying or associated cause (multiple causes of death). Results: There was a total of 53,930 deaths related to Chagas' disease, 44,543 (82.6%) as underlying cause and 9,387 (17.4%) as associated cause. The main diseases and conditions associated with death by Chagas' disease as underlying cause included direct complications of cardiac involvement, such as conduction disorders/arrhythmias (41.4%) and heart failure (37.7%). Cerebrovascular disease (13.2%), ischemic heart disease (13.2%) and hypertensive diseases (9.3%) were the main underlying causes of deaths in which Chagas' disease was identified as an associated cause. Conclusions: Cardiovascular diseases were often associated with deaths related to Chagas' disease. Information from multiple causes of death recorded on death certificates allows reconstruction of the natural history of Chagas' disease and suggests preventive and therapeutic potential measures more adequate and specifics.Keywords: Chagas' disease. Mortality. Underlying cause of death. Multiple causes of death. Epidemiology. Brazil.The World Health Organization (WHO) recommends mortality statistics to be presented by the underlying cause of death. This is defined as the disease or injury, which initiated the cascade of events leading directly to death, or the circumstances of accident or violence that produced fatal injury 1 . However, especially for infectious and parasitic diseases, there is a need for more comprehensive information on fatal events. Additionally, there is a clear relevance to consider all causes of death recorded on death certificates. These include in addition to the underlying causes of death the associated causes that increase the risk of complications, and other contributing causes not directly related to the process that led to death. These three groups together are called multiple causes of death 2,3 .In Brazil, with significant reduction of vector and blood-borne transmission, the number of cases of acute form of Chagas' disease has been drastically reduced in most endemic areas 4 . In addition, both increased knowledge about the natural history of disease and better effectiveness of clinical and surgical interventions, led to the reduction of specific mortality and increased survival of infected individuals 5 . Recent estimates amount to 2 to 3 million individuals infected with the causing agent Trypanosoma cruzi in Brazil [6][7][8] . A large proportion of these cases occurred in o...

2 nd Brazilian Consensus on Chagas Disease, 2015

“…In the multivariate analysis, however, age over 30 years and residence in the States of Minas Gerais and Goiás and in the Federal District were identified as risk factors (59) . It should be noted that more than 40% of expected deaths associated with Chagas disease in Latin America occurred in Brazil (56) (59) .…”

“…When analyzed as the underlying cause, Chagas disease was the fourth leading cause of death (10.8%) among all infectious diseases and parasites (56) . Of the 53,930 recorded deaths, 37,800 (84.9%) were related to cardiac forms and 4,208 (9.4%) to digestive forms of Chagas disease.…”

“…Cerebrovascular disease, ischemic heart disease, and hypertensive diseases were the main underlying causes of death in cases where Chagas disease had been identified as an associated cause. Chronic lung diseases and, in particular, chronic obstructive pulmonary disease also represented particularly important causes of death (56) .…”

Mortality due to Chagas disease in Brazil from 1979 to 2009: trends and regional differences

“…The use of multiple causes of death considers all causes and would give a more reliable estimate [40,41]. In fact, we have shown recently with data from 1999 to 2007 that the use of multiple causes of death increased Chagas mortality by 21% [11,12,19,42]. However, the Brazilian SIM mortality data set only included information on multiple causes after the year 1999; thus this information could not be used in the present analysis.…”

Perfil hematológico e bioquímico de pacientes com doença de Chagas atendidos por um serviço de atenção farmacêutica no estado do Ceará

“…No Brasil, a DC vitimou em média 5.992 pessoas por ano, tendo um aumento significativo das taxas de mortalidade na região Nordeste 4 .…”