Mortality of Chagas' disease in Brazil: Spatial patterns and definition of high-risk areas

Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil  Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland  Institute of Geography, University of Cologne, Köln, Germany  Anton Breinl Centre for Public Health and Tropical Medicine, James Cook University, Townsville, Australia.
Tropical Medicine & International Health (Impact Factor: 2.33). 07/2012; 17(9):1066-75. DOI: 10.1111/j.1365-3156.2012.03043.x
Source: PubMed


To describe patterns of spatial distribution of mortality associated with Chagas' disease in Brazil.

Nationwide study of all deaths in Brazil from 1999 to 2007, where Chagas' disease was recorded as a cause of death. Data were obtained from the national Mortality Information System of the Ministry of Health. We calculated the mean mortality rate for each municipality of residence in three-year intervals and the entire period. Empirical Bayes smoothing was used to minimise random variation in mortality rates because of the population size in the municipalities. To evaluate the existence of spatial autocorrelation, global and local Moran's I indices were used.

The nationwide mean mortality rate associated with Chagas' disease was 3.37/100 000 inhabitants/year, with a maximum of 138.06/100 000 in one municipality. Independently from the statistical approach, spatial analysis identified a large cluster of high risk for mortality by Chagas' disease, involving nine states in the Central region of Brazil.

This study defined geographical priority areas for the management of Chagas' disease and consequently reducing disease-associated mortality in Brazil. Different spatial-analytical approaches can be integrated to provide data for planning, monitoring and evaluating specific intervention measures.

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    • "The epidemiology of Chagas disease has changed in recent decades, with a shift to older age groups, as a consequence of the control of its main vector (the kissing bug Triatoma infestans) and the control of transmission by blood transfusion [1, 10]. The control of these main means of transmission of Chagas disease may have caused this observed higher frequency of deaths in the chronic phase [10, 13]. Our study shows that in contrast to this trend deaths from coinfection were found predominantly in young adults. "
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