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Peer-reviewedCC BY 4.0Cureus

Mortality From Chronic Chagas Cardiomyopathy in Brazil: National and Regional Trends, 2000-2023

  • Humberto G Moreira1
  • Beatriz Modesto P Reis2
  • Lisia Raquel F Paz3
  • Sofia de Souza F e Silva4
  • Letícia C Tavares5
5 affiliations
  1. 1School of Medicine, Federal University of Goiás, Goiânia, BRA
  2. 2School of Medicine, Universidade de Uberaba, Uberaba, BRA
  3. 3School of Medicine, Centro Universitário UNINOVAFAPI, Teresina, BRA
  4. 4School of Medicine, Faculdade da Saúde e Ecologia Humana, Vespasiano, BRA
  5. 5School of Medicine, Faculdade de Medicina de Barbacena, Barbacena, BRA
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Abstract

Background: Chronic Chagas cardiomyopathy is the main cause of death from Trypanosoma cruzi infection. Nationwide analyses of its mortality in Brazil are either restricted to all forms of Chagas disease or end before 2020, and none has examined the cardiac form separately across regions, sexes, and age groups through 2023.

Methods: This is a nationwide ecological time-trend study of all deaths registered in the Brazilian Mortality Information System with chronic Chagas disease with heart involvement (ICD-10 B57.2) as the underlying cause, 2000-2023. Age-standardized mortality rates (ASMR, direct method, Brazilian 2022 population as standard) were calculated for Brazil, its five macroregions, and each sex. Trends were estimated as annual percent change (APC) from age-adjusted quasi-Poisson regression and by joinpoint regression of the annual ASMR series, with the average APC (AAPC) for 2000-2023; sensitivity analyses used the World Health Organization (WHO) standard population and restricted windows (2006-2023; 2000-2019).

Results: Eighty-nine thousand seventy-nine deaths were attributed to B57.2 in 2000-2023 (56.1% male; 68.3% aged ≥60 years). The national ASMR fell from 4.06 (95% confidence interval (CI) 3.94-4.18) to 1.29 (1.24-1.34) per 100,000 population between 2000 and 2023 (−68%), with an AAPC of −4.7% (95% CI −4.9 to −4.5) and a single joinpoint in 2020, after which the decline accelerated (APC −6.9%, −8.7 to −5.2). Rates fell in all macroregions (APC from −2.6% in the Northeast to −6.5% in the South) and in both sexes (men −5.1%, women −3.9%), yet the Central-West retained an ASMR 3.5 times the national value in 2020-2023 (5.18 vs 1.49 per 100,000). The decline was steepest below 40 years of age (APC −9.9%) and negligible at ≥80 years (−0.5%, −0.7 to −0.2), in whom the rate remained above 20 per 100,000.

Conclusions: Mortality attributed to chronic Chagas cardiomyopathy in Brazil has declined by about two-thirds since 2000, in every region and both sexes. The age pattern is consistent with the aging and extinction of cohorts infected before vector control rather than with improved survival of established cardiomyopathy, although this ecological design cannot separate age, period, and cohort effects; deaths are now concentrated in elderly residents of historically endemic areas, particularly the Central-West.

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Cite

BibTeXRIS
BibTeX
@article{moreira2026mortality,
  title = {{Mortality From Chronic Chagas Cardiomyopathy in Brazil: National and Regional Trends, 2000-2023}},
  author = {Humberto G Moreira and Beatriz Modesto P Reis and Lisia Raquel F Paz and Sofia de Souza F e Silva and Letícia C Tavares},
  journal = {Cureus},
  year = {2026},
  month = oct,
  doi = {10.7759/cureus.117681},
  url = {https://doi.org/10.7759/cureus.117681},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Mortality From Chronic Chagas Cardiomyopathy in Brazil: National and Regional Trends, 2000-2023
AU  - Humberto G Moreira
AU  - Beatriz Modesto P Reis
AU  - Lisia Raquel F Paz
AU  - Sofia de Souza F e Silva
AU  - Letícia C Tavares
PY  - 2026
DA  - 2026/10/09
JO  - Cureus
DO  - 10.7759/cureus.117681
UR  - https://doi.org/10.7759/cureus.117681
AB  - Background: Chronic Chagas cardiomyopathy is the main cause of death from Trypanosoma cruzi infection. Nationwide analyses of its mortality in Brazil are either restricted to all forms of Chagas disease or end before 2020, and none has examined the cardiac form separately across regions, sexes, and age groups through 2023.  Methods: This is a nationwide ecological time-trend study of all deaths registered in the Brazilian Mortality Information System with chronic Chagas disease with heart involvement (ICD-10 B57.2) as the underlying cause, 2000-2023. Age-standardized mortality rates (ASMR, direct method, Brazilian 2022 population as standard) were calculated for Brazil, its five macroregions, and each sex. Trends were estimated as annual percent change (APC) from age-adjusted quasi-Poisson regression and by joinpoint regression of the annual ASMR series, with the average APC (AAPC) for 2000-2023; sensitivity analyses used the World Health Organization (WHO) standard population and restricted windows (2006-2023; 2000-2019).  Results: Eighty-nine thousand seventy-nine deaths were attributed to B57.2 in 2000-2023 (56.1% male; 68.3% aged ≥60 years). The national ASMR fell from 4.06 (95% confidence interval (CI) 3.94-4.18) to 1.29 (1.24-1.34) per 100,000 population between 2000 and 2023 (−68%), with an AAPC of −4.7% (95% CI −4.9 to −4.5) and a single joinpoint in 2020, after which the decline accelerated (APC −6.9%, −8.7 to −5.2). Rates fell in all macroregions (APC from −2.6% in the Northeast to −6.5% in the South) and in both sexes (men −5.1%, women −3.9%), yet the Central-West retained an ASMR 3.5 times the national value in 2020-2023 (5.18 vs 1.49 per 100,000). The decline was steepest below 40 years of age (APC −9.9%) and negligible at ≥80 years (−0.5%, −0.7 to −0.2), in whom the rate remained above 20 per 100,000.  Conclusions: Mortality attributed to chronic Chagas cardiomyopathy in Brazil has declined by about two-thirds since 2000, in every region and both sexes. The age pattern is consistent with the aging and extinction of cohorts infected before vector control rather than with improved survival of established cardiomyopathy, although this ecological design cannot separate age, period, and cohort effects; deaths are now concentrated in elderly residents of historically endemic areas, particularly the Central-West.
SN  - 2168-8184
ER  -