title: Mortality due to Chagas disease in Brazil from 1979 to 2009: trends and regional differences.
abstract: BACKGROUND
  Studies on mortality due to parasitic diseases such as Chagas disease are useful to understand the epidemiology and to plan and guide control measures for these diseases. We analyzed mortality trends due to Chagas disease in Brazil and regions, between 1979 and 2009.
  
  
  METHODS
  Mortality data (underlying cause of death) were obtained from the nationwide Mortality Information System (SIM) of the Ministry of Health. We calculated crude mortality rates and rates standardized by age, as well as proportional mortality.
  
  
  RESULTS
  In total, 27,560,043 deaths occurred in the study period. In 172,066 deaths, Chagas disease was mentioned as the underlying cause (proportional mortality: 0.62%). The mean crude and age-standardized mortality rates were 3.61 and 5.19 deaths/100,000 inhabitants/year, respectively. During the observation period, Chagas mortality declined significantly at the national level (R2=97%, p < 0.001), with different patterns between regions. There was a significant reduction in mortality in the Central-West (R2=90%, p < 0.001), Southeast (R2=98%, p < 0.001) and South (R2=94%, p < 0.001), but in the North (R2=34%, p=0.001) and Northeast (R2=65%, p < 0.001) regions mortality increased.
  
  
  CONCLUSIONS
  Despite the overall decline in mortality due to Chagas disease in Brazil, it remains an important public health problem. After successful control of the primary vector Triatoma infestans, intervention measures must focus on improved access to health care and secondary prevention. The North and Northeast regions, where vectors other than T. infestans have a primary role, need special attention.
authors.affiliation: Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil. rogerlandio@bol.com.br
authors.forename: Francisco Rogerlândio
authors.initials: FR
authors.lastname: Martins-Melo
authors.forename: Alberto Novaes
authors.initials: AN
authors.lastname: Ramos
authors.forename: Carlos Henrique
authors.initials: CH
authors.lastname: Alencar
authors.forename: Jorg
authors.initials: J
authors.lastname: Heukelbach
mesh_terms: D001938:Brazil / Q000453:epidemiology; D014355:Chagas Disease / Q000401:mortality*; D016208:Databases, Factual; D005843:Geography; D006801:Humans; D016014:Linear Models; D011634:Public Health / Q000639:trends*; D013997:Time Factors