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 |