Authors
Z M Cucunubá1; O Okuwoga1; M G Basáñez1; P Nouvellet1; 1 Imperial College London Discussion
Accurate estimates of morbidity and mortality due to Chagas disease are needed to improve burden of disease evaluations. A systematic literature review was conducted to select observational studies comparing mortality and progression rates in populations with and without Chagas disease. Five databases, without restrictions on language or date of publication were searched. Data were analysed using a random-effects model. For mortality rates, twenty five studies were selected, providing data on 10,638 patients, 53,346 patient-years of follow-up, and 2739 events. Pooled estimates revealed that Chagas disease patients have significantly higher annual mortality rates (AMR) compared with non-Chagas disease patients (0.18 versus 0.10; RR = 1.74, 95 % CI 1.49-2.03). While RR did not differ significantly between clinical groups, important differences in AMR were found: AMR = 0.43 in Chagas vs. 0.29 in non-Chagas patients (RR = 1.40, 95 % CI 1.21-1.62) in the severe group; AMR = 0.16 (Chagas) vs. 0.08 (non-Chagas) (RR = 2.10, 95 % CI 1.52-2.91) in the moderate group, and AMR = 0.02 vs. 0.01 (RR = 1.42, 95 % CI 1.14-1.77) in the asymptomatic group. The results indicate a statistically significant excess of mortality due to Chagas disease that is shared among both symptomatic and asymptomatic populations. Implications for the evaluation of the burden of disease are discussed. 
