Chagas disease mortality in Brazil: A Bayesian analysis of age-period-cohort effects and forecasts for two decades

Abstract

BackgroundChagas disease (CD) is a neglected chronic parasitic infection and a public health problem that is preventable, and has serious complications. In this study, the effects of age, period and birth cohort (APC Effects) on the evolution of the mortality of that disease in Brazil, from 1980–2014, according to sex and geographic region of the country, were analyzed. Mortality forecasts from the years 2015 to 2034 were estimated.MethodsThis is an ecological cross-sectional study in which death records and population data were extracted from the DATASUS (Department of Information Technology of the National Health System) website, in age groups from 20–24 years of age to 80 years and over, from 1980 to 2014. The rates were standardized according to age and sex distributions using the direct method. The APC models were estimated using the Bayesian approach, and the INLA (Integrated Nested Laplace Approximations) method was used for parameter inference. Super dispersion of the data was considered, and we included unstructured random terms in the models.ResultsDuring the analyzed period, there were 178,823 deaths in Brazil (3.85 annual deaths per 100,000 inhabitants). It was found that temporal effects on CD mortality varied by sex and region. In general, there was an increase in mortality rates up to 30 years of age, and the mortality rates were higher between 50 and 64 years of age. On average, men died five years younger than women. Mortality rates were highest in the Central West and Southeast regions. The Central West, Southeast and Southern regions had a reduction over time in the rate of CD deaths between 2000 and 2014. The mortality rate in the Northeast was not statistically different in any period analyzed, while the North had tendency to increase; however, a significant risk increase was only observed between 1995 and 1999. The rate of mortality was high in older birth cohorts. The overall prediction for the next two decades showed a progressive decline in CD mortality, which will be highest among the young. The expected average reduction was 76.1% compared to the last observed period (2010–2014) and the last predicted (2030–2034) period. The average reduction ranged from 86% in the 20–24 age group to 50% in the 80 and over age group.ConclusionsIn the present study, a higher death rate was observed for ages above 30 years, especially 50 to 64 years, and in the older birth cohorts. We believe these results can be related to period effects of vector control actions and preventive and care measures by the health system of Brazil, in addition to demographic changes in the period. The differences among the regions reflect socioeconomic inequities and access to the healthcare systems in the Brazilian population.

Spatiotemporal trends of Chagas disease-related mortality in the Northeast of Brazil, 2007–2017

“…CD affects approximately 6 million people in Latin America, with an incidence rate of 30 thousand cases per year and a mortality rate of 12 thousand deaths per year. In Brazil, it is estimated that 1–4.6 million people are infected and 6000 die per year (Simões et al ., 2018; Bernardo-Pedro et al ., 2019). These occurrences were highlighted by the lack of opportunity for suspicious and delayed diagnosis.…”

Cardiac Chagas Disease: MMPs, TIMPs, Galectins, and TGF-βas Tissue Remodelling Players

“…In the acute phase of infection, cardiomyopathy is characterized by an intense infiltration of inflammatory, mono, and polymorphonuclear cells, which release inflammatory cytokines and chemokines favoring continuous cell recruitment. In the chronic phase, the profile of infiltrated cells is predominantly mononuclear [11] and cardiac damage is mainly associated with inflammation caused by parasitism in the cardiomyocytes, tissue aggression resulting from the immune response [12], and high intensity of tissue remodeling, which is a product of collagen fiber deposition [13].…”

Spatial patterns and temporal tendency of mortality related to Chagas disease in an endemic area of northeastern Brazil

“…Information systems play an important role in health surveillance, including monitoring mortality. However, in Brazil, the quality of this information can cause underreporting of rates [28].…”

“…This finding may be due to healthcare seeking behaviours: women use health services more frequently, ensuring better access to prevention, diagnosis and treatment. Due to sociocultural issues, Brazilian men tend to seek health care at more advanced stages of disease, usually when they have already developed complications of the chronic phase, which reduces their survival compared to women [28]. Most deaths were observed in those with low educational attainment.…”