Hospital case-fatality and mortality related to Chagas disease in Brazil over two decades

Objective To analyse hospital case fatality and mortality related to Chagas disease (CD) in Brazil, 2000–2019. Method This is a mixed ecological study with spatial and temporal trends, based on national population data from the Brazilian Ministry of Health - hospital admissions (HA) and death certificates (DC). Records with CD as a primary or secondary cause of death in HA and/or as an underlying or associated cause of death in DC were evaluated. Temporal trends were analysed by Joinpoint regression and the spatial distribution of age- and gender-adjusted rates, spatial moving averages, and standardized morbidity ratios. Results There was a total of 4,376 HAs due to CD that resulted in death and 122,275 deaths from CD. The Southeast region recorded the highest proportions and rates of HAs resulting in death (63.9%, n = 2,796; 0.17/100,000 inhabitants), and overall deaths from CD (51.0%, n = 62,308; 3.79/100,000 inhabitants). The highest risk of CD-related death was found in males (Relative risk [RR] 1.27) and Afro-Brazilians (RR 1.63). There was an increase in hospital mortality from CD (Average Annual Percent Change [AAPC] 7.5, 95% Confidence Interval [CI] 5.3 to 9.9), and stability in the North, Northeast and Southeast regions. For CD-related mortality, a decrease was observed in the country (AAPC − 0.7%, 95%CI -0.9 to -0.5), with an increase in the Northeast region (AAPC 1.1%, 95%CI 0.6 to 1.6). Municipalities with a very high Brazilian Deprivation Index tended to show increased mortality (AAPC 2.1%, 95%CI 1.6 to 2.7), while the others showed a decrease. Conclusion Hospital case fatality and specific mortality due to CD are a relevant public health problem in Brazil. Differences related to gender, ethnicity, and social vulnerability reinforce the need for comprehensive care, and to ensure equity in access to health in the country. Municipalities, states, and regions with indicators that reveal higher morbidity and mortality need to be prioritized.