Increased mortality attributed to Chagas disease: a systematic review and meta-analysis

Area of Science:

• Epidemiology
• Infectious Diseases
• Public Health

Background:

• Clinical outcomes of Chagas disease, caused by Trypanosoma cruzi infection, are not well understood.
• Quantifying the mortality burden of Chagas disease is challenging due to study heterogeneity.
• Accurate mortality estimates are crucial for disease modeling and cost-effectiveness studies.

Purpose of the Study:

• To systematically review and quantify the mortality risk associated with Chagas disease.
• To provide accurate estimates of annual mortality rates (AMR) and relative risk (RR) for Chagas disease patients.
• To analyze mortality differences across clinical Chagas disease groups.

Main Methods:

• Systematic literature review of observational studies comparing mortality in Chagas disease patients versus controls.
• Data extraction from PubMed, MEDLINE, EMBASE, Web of Science, and LILACS without language or date restrictions.
• Random-effects meta-analysis to calculate RR, attributable risk percent (ARP), and AMR, assessing heterogeneity with I(2) statistic.

Main Results:

• Twenty-five studies with 10,638 patients and 53,346 patient-years revealed a significantly higher AMR in Chagas disease patients (0.18 vs. 0.10; RR=1.74).
• Substantial heterogeneity (I(2)=67.3%) was observed; however, the attributable risk percent was 42.5%.
• Elevated mortality risk was present across severe (RR=1.40), moderate (RR=2.10), and asymptomatic (RR=1.42) groups, with varying AMRs.

Conclusions:

• Chagas disease is associated with a statistically significant excess mortality.
• This increased mortality risk is evident in both symptomatic and asymptomatic individuals.
• The findings support the need for improved Chagas disease management and public health strategies.