Impact of the social context on the prognosis of Chagas disease patients: Multilevel analysis of a Brazilian cohort.

Tytuł:: Impact of the social context on the prognosis of Chagas disease patients: Multilevel analysis of a Brazilian cohort.
Autorzy:: Ferreira AM; Graduate Program in Health Sciences, State University of Montes Claros, Montes Claros, Minas Gerais, Brazil.
Sabino ÉC; Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil.
Oliveira LC; Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil.
Oliveira CDL; Federal University of São João del-Rey, Research Group in Epidemiology and New Technologies in Health-Centro Oeste Campus, Brazil.
Cardoso CS; Federal University of São João del-Rey, Research Group in Epidemiology and New Technologies in Health-Centro Oeste Campus, Brazil.
Ribeiro ALP; Department of Internal Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
Damasceno RF; Graduate Program in Health Sciences, State University of Montes Claros, Montes Claros, Minas Gerais, Brazil.
Nunes MDCP; Department of Internal Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
Haikal DSA; Graduate Program in Health Sciences, State University of Montes Claros, Montes Claros, Minas Gerais, Brazil.
Źródło:: PLoS neglected tropical diseases [PLoS Negl Trop Dis] 2020 Jun 29; Vol. 14 (6), pp. e0008399. Date of Electronic Publication: 2020 Jun 29 (Print Publication: 2020).
Typ publikacji:: Journal Article; Research Support, N.I.H., Extramural
Język:: English
Imprint Name(s):: Original Publication: San Francisco, CA : Public Library of Science
MeSH Terms:: Chagas Disease*/epidemiology
Social Environment*
Aged ; Brazil/epidemiology ; Cohort Studies ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Multilevel Analysis ; Prognosis ; Rural Population
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Grant Information:: P50 AI098461 United States AI NIAID NIH HHS; U19 AI098461 United States AI NIAID NIH HHS
Entry Date(s):: Date Created: 20200630 Date Completed: 20200814 Latest Revision: 20240330
Update Code:: 20240330
PubMed Central ID:: PMC7351237
DOI:: 10.1371/journal.pntd.0008399
PMID:: 32598390
: Czasopismo naukowe

Pełny tekst

The present study aims to investigate how the social context contributes to the prognosis of Chagas disease (CD). This is a multilevel study that considered individual and contextual data. Individual data came from a Brazilian cohort study that followed 1,637 patients who lived in 21 municipalities to which CD is endemic, over two years. Contextual data were collected from official Brazilian government databases. The dependent variable was the occurrence of cardiovascular events in CD during the two-year follow-up, defined from the grouping of three possible combined events: death, development of atrial fibrillation, or pacemaker implantation. Analysis was performed using multilevel binary logistic regression. Among the individuals evaluated, 205 (12.5%) manifested cardiovascular events in CD during two years of follow-up. Individuals living in municipalities with a larger rural population had protection for these events (OR = 0.5; 95% CI = 0.4-0.7), while those residing in municipalities with fewer physicians per thousand inhabitants (OR = 1.6; 95% CI = 1.2-2.5) and those living in municipalities with lower Primary Health Care (PHC) coverage (OR = 1.4; 95% CI = 1.1-2.1) had higher chances of experiencing cardiovascular events. Among the individual variables, the probability of experiencing cardiovascular events was higher for individuals aged over 60 years (OR = 1.4; 95% CI = 1.01-2.2), with no stable relationship (OR = 1.4; 95% CI = 0.98-2.1), without previous treatment with Benznidazole (OR = 1.5; 95% CI = 0.98-2.9), with functional class limitation (OR = 2.0; 95% CI = 1.4-2.9), with a QRS complex duration longer than 120 ms (OR = 1.5; 95% CI = 1.1-2.3), and in individuals with high NT-proBNP levels (OR = 6.4; 95% CI = 4.3-9.6). CONCLUSION: The present study showed that the occurrence of cardiovascular events in individuals with CD is determined by individual conditions that express the severity of cardiovascular involvement. However, these individual characteristics are not isolated protagonists of this outcome, and the context in which individuals live, are also determining factors for a worse clinical prognosis.
Competing Interests: The authors have declared that no competing interests exist.

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