title: A Critical Assessment of Officially Reported Chagas Disease Surveillance Data in Mexico.
abstract: OBJECTIVE
  Chagas disease, a disease caused by Trypanosoma cruzi, disproportionately affects poor people throughout Latin America. In Mexico, assessments of officially reported burden have not been previously reported. To evaluate discontinuity between surveillance data and data from other sources, we used data from the Mexican Ministry of Health to describe the distribution of reported Chagas disease over time in Mexico and compare it with estimates from the literature.
  
  
  METHODS
  We summarized age and sex differences for Chagas cases and mortality for 1995-2013 and 1982-2010, respectively. We examined the spatial distribution of Chagas disease over time with respect to disease burden. We further compared officially reported figures with estimates from the literature.
  
  
  RESULTS
  Among 6,494 officially reported cases, rates of Chagas disease were highest in adults aged 25-44 years (47.3%). Mortality was highest in adults aged ≥45 years (423/495, 85.5%). The data indicated increasing temporal trends for incidence and mortality. The greatest burden occurred in southern states, with increasing spatial distribution over time. Fewer than 900 cases and 40 deaths were officially reported annually, in contrast to estimates from the literature of approximately 69,000 new cases and 25,000 deaths annually.
  
  
  CONCLUSIONS
  While increasing trends in officially reported data have been observed, large discrepancies in case estimates compromise our understanding of Chagas disease epidemiology. Reported cases based on current practices are not enough to correctly assess the Chagas disease burden and spatial distribution in Mexico. Understanding the true epidemiology of this disease will lead to more focused and successful control and prevention strategies to decrease disease burden.
authors: University of Arizona, Mel and Enid Zuckerman College of Public Health, Tucson, AZ.
authors: Ellen M
authors: EM
authors: Shelly
authors: Universidad Nacional Autónoma de México, Mexico City, Mexico.
authors: Rodolfo
authors: R
authors: Acuna-Soto
authors: University of Arizona, Mel and Enid Zuckerman College of Public Health, Tucson, AZ.
authors: Kacey C
authors: KC
authors: Ernst
authors: University of Arizona, School of Animal and Comparative Biomedical Sciences, Tucson, AZ.
authors: Charles R
authors: CR
authors: Sterling
authors: University of Arizona, Mel and Enid Zuckerman College of Public Health, Tucson, AZ.
authors: Heidi E
authors: HE
authors: Brown
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D014355:Chagas Disease / Q000453:epidemiology* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D006801:Humans; D015994:Incidence; D007223:Infant; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D015397:Program Evaluation; D011635:Public Health Administration / Q000379:methods / Q000592:standards*; D012737:Sex Factors; D055815:Young Adult