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Table 1 Characteristics of the 25 studies included in the meta-analysis of Chagas disease-associated mortality

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

First author, year [Ref] Country Outcome Study period Diagnostic test Population type Control group Mode of death Disease classification Sample size Outcome Person-yrs of follow up Crude RR Reported effect estimate
exp/ non-exp exp/non-exp exp/non-exp Estimate (95% CI) Adjusted by variables
Coura, 1985 [51] Brazil Death 1974-1984 Serology General population endemic area (included undetermined and cardio-myopathy) Same population but uninfected Cardio-myopathy All stages 235/216 54/23 2350/2160 2.16 2 times higher (NR) NR
Pereira, 1985 [52] Brazil Death 1976-1980 IFAT & CF General population - Municipality La Lapa General population - same municipality SD (64.7%) Asymptomatic/GenP 192/188 22/6 1152/1128 3.59 NR(NR) NR
Maguire, 1987 [53] Brazil Death 1974-1980 IFAT & CF & ELISA Asymptomatic from rural Brazilian community. Normal ECG Asymptomatic from rural Brazilian community. Normal ECG NR Asymptomatic/GenP 40/116 3/3 949/771 0.81 RR=1.8 (0.8–4.2) NR
Mota, 1990 [54] Brazil Death 1974-1983 IFAT & CF & ELISA Rural population Rural population, slightly healthier NR Asymptomatic/GenP 488/509 34/28 3842/3663 1.16 RR=1.1 (NR) Age adjusted
Bestetti & Muccillo, 1997 [8] Brazil Cardiac death 1990-1993 NR Left ventricular dilatation in ECG. Cardiomegaly in the chest X-ray. With or without symptoms Similar, uninfected. HTA 34% SD (38%) Moderate stage 75/50 21/3 225/150 4.67 OR=6.1 (1.7–21.7) Not adjusted
Pimenta & Valente, 1999 [55] Brazil Cardiac death 1977 1996 CF & IFAT & HAI Asymptomatic individuals with bundle branch block (RBBB = 98.2%) Sclerosis of the conducting system of the heart (Lev-Lenègre’s disease) (RBBB: 48.3%) SD (50%) Asymptomatic/GenP 55/29 17/3 554/229 2.34 NR (NR) NR
Freitas, 2005 [56] Brazil Death 1991-2000 Serology NYHA III or IV IDC NR Severe stage 242/454 110/156 516/968 1.32 HR=1.63 (1.10–1.43) NR
Oliveira, 2005 [57] Brazil Death 1993-1995 NR Systolic ventricular dysfunction (LVEF <55%) at the day of hospitalisation. Chagas in 44% of patients Any aetiology identified NR Severe stage 56/70 50/51 71/89 1.23 RR=2.66 (1.10–6.46) Not adjusted
De Campos Lopes, 2006 [49] Brazil Cardiac death 1998-2000 NR Severe HF; hospitalized subsequent-ly. HT was considered a censored event Hospitalized from the same clinic NR Severe stage 102/392 72/169 204/784 1.64 NR (NR) Age and controlled for relevant covariates: health system, myocardial infarction, HTA
Heringer-Walther, 2006 [58] Brazil Cardiac death or HT 2001-2006 2 positive serologies Dilated cardio-myopathy. All stages Idiopathic dilated cardio-myopathy. Other structural cardiac diseases and comor-bidities were excluded in both groups NR All stages 274/504 8/10 716/1108 1.24 OR=3.34 (1.90–5.89) NR
Braga, 2008 [59] Brazil Death 2003-2004 NR HF and moderate to severe left ventricle systolic dysfunction Other aetiologies not specified NR Moderate stage 89/102 16/10 89/102 1.83 OR=1.67 (0.67–4.41) Education level
Silva, 2008 [60] Brazil Death NR NR Admitted for decom-pensated HF. NYHA III-IIV Other aetiologies NR Severe stage 122/232 84/111 122/232 1.44 NR (NR) NR
Lima-Costa 2010a [61] Brazil Death 1997-2007 HAI & 2 ELISA tests Bambui, general >60 years age General population > 60 years age NR Asymptomatic/GenP 524/874 257/310 4569/7621 1.38 NR, p<0.01 Age, sex, and a number of risk factors
Lima-Costa, 2010b [50] Brazil Stroke 1997-2007 HAI & 2 ELISA tests Bambui, general population >60 years age (RBBB in 23.5%, in schooled = 20%) General population > 60 years of age and significantly healthier than chagasic patients (RBBB in 3.3%) and schooled (50%) Stroke Asymptomatic/GenP 563/915 20/25 3479/6261 1.40 HR=1.56 (1.32–1.85) Age, sex, schooling, other risk factors and C-reactive protein level
Nunes, 2010 [62] Brazil Cardiac death or HT 1999-2008 NR HF, dilated cardio-myopathy (diameter/ body surface area ≥31 mm) and LVEF <55%. NYHA III/IV in 25% Same criteria but Idiopathic dilated cardio-myopathy (NYHA III/IV 27%) Progressive HF (48%). SD (42%) Moderate stage 224/63 91/22 737/207 1.16 HR=2.35 (1.25–4.44) NR
Issa, 2010 [40] Brazil Death or HT 1999-2000 IFAT & HAI & ELISA Clinical trial. Irreversible chronic HF of at least 6-month duration Other aetiologies, not specified NR All stages 68/388 49/180 250/1428 1.55 NR (NR) Cox proportional hazards regression model
Cardoso, 2010 [63] Brazil Death 2006-2007 ELISA & IFAT NYHA IV, admitted; poor perfusion and congestion. (LVEF) < 45.0% HTA, Idiopathic, vasculopathic; alcohol cardiomyopathy Progressive HF Severe stage 33/67 22/24 68/139 1.87 HR=2.48 (1.28–4.78) Multi-variate analysis
Conceição-Souza, 2010 [64] Brazil Death 2008-2010 NR (LVEF) < 45.0%. Onset of symptoms>1 month Same criteria and excluded co-morbidities NR Moderate stage 100/62 6/2 100/62 1.86 NR (NR) NR
Cruz, 2010 [65] Brazil Cardiac death NR NR HF; clinics, patients under maximal tolerated medical treatment IDC (33%), HTA (13%), ischemic (12%) SD and progressive HF Moderate stage 21/55 7/11 23/61 1.69 RR=2.75 (1.35–5.63) NR
Barbosa, 2011 [66] Brazil Death or HT 2000-2008 Serology LVEF <55% in ECG or <50% on Radio-nuclide ventriculography IDC with same ECG criteria and in the absence of concomitant obstructive coronary artery disease NR Moderate stage 246/106 109/16 574/247 2.932 HR=3.29 (1.89–5.73) Cox proportional hazards model multi-variate analysis
Ayub-Ferreira, 2013 [39] Brazil Death 1999-2010 ELISA & IFAT & HAI Clinical trial. Chagas All stages Similar but uninfected. Mixed aetiology, not specified SD (14.5%), HF (22.2%) All stages 55/287 31/29 196/1024 5.58 HR= 2.76 (1.34–5.6) NR
Bestetti, 2013 [67] Brazil Death 2000-2008 Serology Chronic systolic HF Same criteria for systemic HTA and chronic systolic heart failure NR Moderate stage 244/130 185/35 1220/650 2.82 HR=2.2 (1.47–3.40) Cox proportional hazard model adjusted for confounders
Peixoto, 2015 [22] Brazil Death 2005-2012 NR Patients under cardiac resynchronization therapy; mean LVEF = 25.3 Same characteristics but Ischemic and idiopathic aetiologies NR Severe stage 115/311 86/111 310/839 2.10 NR (NR) NR
Traina, 2015 [68] USA and CAa Death or HT 2007-2010 IFAT & ELISA Cardio-myopathy with left ventricular ejection fraction (LVEF of ≤40%) and previous residence in Latin America Any aetiology identified NR Moderate stage 25/110 9/11 42/209 4.07 HR=4.46 (1.8–10.8) Un-adjusted
Sherbuk, 2015 [69] Bolivia Death 2012-2013 ELISA & HAI & TESA blot From asymptomatic to severe cases Similar stages but uninfected NR All stages 160/60 23/4 394/462 2.42 HR=1.78 (1.19–2.65) NR
  1. ID identification; exp exposed (Chagas-positive); non-exp non-exposed (Chagas-negative); Crude RR crude relative risk estimated manually form the data in the paper; 95%CI 95% Confidence Interval; HR hazard ratio; OR odds ratio; CF complement fixation test; ELISA Enzyme-Linked Immunosorbent Assay; HAI hemagglutination inhibition test; IFAT immunofluorescent test; TESA Trypanosoma cruzi excreted-secreted antigens blot; LVEF left ventricular ejection fraction; ECG electrocardiogram; RBBB right bundle branch block; IDC idiopathic dilated cardiomyopathy; HF heart failure; HT heart transplant; HTA arterial hypertension; SD sudden death; GenP general population; NYHA New York Heart Association Functional Classification; NR not reported. a CA Central America 90%. The references are as appear on the main text