Abstract
BackgroundIndividuals in the indeterminate phase of Chagas disease are considered to have mortality rates similar to those of the overall population. This study compares mortality rates among blood donors seropositive for Chagas disease and negative controls in the city of São Paulo, Brazil.Methodology/principal findingsThis is a retrospective cohort study of blood donors from 1996 to 2000: 2842 seropositive and 5684 seronegative for Chagas disease. Death status was ascertained by performing probabilistic record linkage (RL) with the Brazil national mortality information system (SIM). RL was assessed in a previous validation study. Cox Regression was used to derive hazard ratios (HR), adjusting for confounders. RL identified 159 deaths among the 2842 seropositive blood donors (5.6%) and 103 deaths among the 5684 seronegative (1.8%). Out of the 159 deaths among seropositive donors, 26 had the 10th International Statistical Classification of Diseases and Related Health Problems (ICD-10) indicating Chagas disease as the underlying cause of death (B57.0/B57.5), 23 had ICD-10 codes (I42.0/I42.2/I47.0/I47.2/I49.0/I50.0/I50.1/ I50.9/I51.7) indicating cardiac abnormalities possibly related to Chagas disease listed as an underlying or associated cause of death, with the others having no mention of Chagas disease in part I of the death certificate. Donors seropositive for Chagas disease had a 2.3 times higher risk of death due to all causes (95% Confidence Interval (95% CI), 1.8–3.0) than seronegative donors. When considering deaths due to Chagas disease or those that had underlying causes of cardiac abnormalities related to Chagas disease, seropositive donors had a risk of death 17.9 (95% CI, 6.3–50.8) times greater than seronegative donors.Conclusions/significanceThere is an excess risk of death in donors seropositive blood for Chagas disease compared to seronegative donors. Chagas disease is an under-reported cause of death in the Brazilian mortality database.
Highlights
Chagas disease was first described in 1909 by the Brazilian scientist Carlos Ribeiro Justiniano Chagas (1879–1934)
To improve the measurement of disease burden and policy decision-making in regard to treatment availability, more accurate estimates of mortality, especially among otherwise asymptomatic seropositive individuals are needed
This study compares mortality rates and causes of death of asymptomatic blood donors who tested seropositive for Chagas disease and seronegative for all screening tests conducted in Brazil
Summary
Chagas disease was first described in 1909 by the Brazilian scientist Carlos Ribeiro Justiniano Chagas (1879–1934). The main measures of disease control implemented were the elimination of Triatoma infestans peri and in-house habitat by the use of insecticides, housing stock improvement, sanitary education, and the adoption of screening tests among blood donors to detect the parasite and avoid transmission [3]. Donor screening for T cruzi is mandatory in all Latin American countries with more than 92% of screening coverage of the Chagas disease mortality rates among blood donors blood supply.[4] The prevalence of T cruzi has declined among first time blood donors in Brazil, from 0.52% in 1996 [5] to 0.14% in 2008 [6]. This study compares mortality rates among blood donors seropositive for Chagas disease and negative controls in the city of São Paulo, Brazil
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