Impact of the social context on the prognosis of Chagas disease patients: Multilevel analysis of a Brazilian cohort

Abstract

The present study aims to investigate how the social context contributes to the prognosis of Chagas disease (CD). This is a multilevel study that considered individual and contextual data. Individual data came from a Brazilian cohort study that followed 1,637 patients who lived in 21 municipalities to which CD is endemic, over two years. Contextual data were collected from official Brazilian government databases. The dependent variable was the occurrence of cardiovascular events in CD during the two-year follow-up, defined from the grouping of three possible combined events: death, development of atrial fibrillation, or pacemaker implantation. Analysis was performed using multilevel binary logistic regression. Among the individuals evaluated, 205 (12.5%) manifested cardiovascular events in CD during two years of follow-up. Individuals living in municipalities with a larger rural population had protection for these events (OR = 0.5; 95% CI = 0.4-0.7), while those residing in municipalities with fewer physicians per thousand inhabitants (OR = 1.6; 95% CI = 1.2-2.5) and those living in municipalities with lower Primary Health Care (PHC) coverage (OR = 1.4; 95% CI = 1.1-2.1) had higher chances of experiencing cardiovascular events. Among the individual variables, the probability of experiencing cardiovascular events was higher for individuals aged over 60 years (OR = 1.4; 95% CI = 1.01-2.2), with no stable relationship (OR = 1.4; 95% CI = 0.98-2.1), without previous treatment with Benznidazole (OR = 1.5; 95% CI = 0.98-2.9), with functional class limitation (OR = 2.0; 95% CI = 1.4-2.9), with a QRS complex duration longer than 120 ms (OR = 1.5; 95% CI = 1.1-2.3), and in individuals with high NT-proBNP levels (OR = 6.4; 95% CI = 4.3-9.6). CONCLUSION: The present study showed that the occurrence of cardiovascular events in individuals with CD is determined by individual conditions that express the severity of cardiovascular involvement. However, these individual characteristics are not isolated protagonists of this outcome, and the context in which individuals live, are also determining factors for a worse clinical prognosis.

Estudo Longitudinal De Indivíduos Com Doença De Chagas De Região Endêmica Brasileira: A Coorte Samitrop

“…O óbito, assim como a fibrilação atrial e implantação de marca-passo, representa, de forma nítida, o agravamento das condições cardíacas entre portadores de DC 23 . No decorrer de dois anos de seguimento, foi registrado cerca de 7% de óbitos entre os participantes da coorte SaMi-Trop em virtude do agravamento de suas condições cardíacas.…”

“…Na coorte SaMi-Trop, foi observada uma incidência de 2,63% de implante de marca-passo nos últimos dois anos. A DC, ainda, é uma das principais causas de implante de marca-passos no Brasil 4,25 , representando um risco treze vezes maior quando comparado com outras causas 23 . A coorte SaMi-Trop observou taxa de 14,3% de hospitalização entre portadores de DC em um período de 2 anos.…”

“…Foi observado que 30% dos portadores de DC residiam a uma distância superior a 100 km da unidade de saúde mais próxima. Além disso, estudo prévio verificou que nos municípios participantes desta coorte, há uma média de 0,68 (± 0,4) médicos por mil habitantes 23 , sendo quase três vezes menor que a média nacional (5,07) e metade da média observada entre municípios do interior do Brasil (1,28) 27 , o que confirma se tratar de uma região carente economicamente e com pouca estrutura em saúde 23 .…”

Indeterminate form of Chagas disease: historical, conceptual, clinical, and prognostic aspects

“…Many factors have been considered to be involved in the risk of CHD development, including exposure to T. cruzi reinfection in areas with sustained vector transmission, male sex, parasite load, genetic aspects of the host, nutritional status, presence of comorbidities, and the social context and quality of life of CD patients 13,[34][35][36][37][38][39] . A favorable medium-term prognosis for IF patients was demonstrated in longitudinal studies 6 , confirming that the mortality rates are similar between IF patients and people without the disease in the same age range 14 .…”

Quality of life in patients with Chagas disease and the instrument used: an integrative review

“…The QoL indicator is an important marker for the organization of health care in addition to the planning of public policies and the allocation of resources 12 , 13 . Because CD is a neglected disease in which the majority of patients attend public health services, there are great challenges in providing comprehensive health care and strengthening epidemiological and entomological surveillance actions 14 .…”