ArticlePLoS neglected tropical diseases2020
Impact of the social context on the prognosis of Chagas disease patients: Multilevel analysis of a Brazilian cohort.
Article in PLoS neglected tropical diseases, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 2 of them syntheses that pooled it.
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Who cites it
22 citing papers in PubMed, 2 syntheses or guidelines pooled it, 30 citations in OpenAlex.
- Prognostic value of the New York Heart Association classification for cardiovascular events and mortality in Chagas cardiomyopathy: a systematic review and meta-analysis with GRADE recommendations.Revista da Sociedade Brasileira de Medicina Tropical · 2026Pooled it
- SBC Guideline on the Diagnosis and Treatment of Patients with Cardiomyopathy of Chagas Disease - 2023.Arquivos brasileiros de cardiologia · 2023Guideline
- Two-year death prediction models among patients with Chagas Disease using machine learning-based methods.PLoS neglected tropical diseases · 2022Trial
- Factors associated with major electrocardiographic abnormalities in chagas disease patients: SaMi-trop cohort.International journal of cardiology. Heart & vasculature · 2026Article
- Clinical Protocols for the Initial Evaluation and Follow-Up of Patients with Chronic Chagas Disease: A Proposal for Referral Centers.Tropical medicine and infectious disease · 2025Review
- Genetic diversity of Trypanosoma cruzi in individuals with chronic Chagas disease in the Northern Minas Gerais and Vale do Jequitinhonha regions, Minas Gerais, Brazil.PLoS neglected tropical diseases · 2025Article
- Spatial analysis of granting of social welfare benefits to people with gastrointestinal Chagas disease in Brazil, 2004-2016: a time series study.Epidemiologia e servicos de saude : revista do Sistema Unico de Saude do Brasil · 2025Article
- Mechanisms behind the high mortality rate in chronic Chagas cardiomyopathy: Unmasking a three-headed monster.European journal of heart failure · 2024Review
- Cardiac involvement in Chagas disease and African trypanosomiasis.Nature reviews. Cardiology · 2024Review
- Clinical features of Chagas disease progression and severity.Lancet regional health. Americas · 2024Review
- Hospital case fatality and mortality related to Chagas disease in Brazil over two decades.BMC public health · 2024Article
- Cardiovascular Statistics - Brazil 2023.Arquivos brasileiros de cardiologia · 2024Article
- Cardiac Implantable Electronic Devices in Chagasic and Non-Chagasic Patients: A Critical Look at the Prognosis.Arquivos brasileiros de cardiologia · 2024Article
- Chagas disease and perceived quality of life: a cross-sectional study.Revista da Sociedade Brasileira de Medicina Tropical · 2023Article
- Communication in Neglected Tropical Diseases' elimination: A scoping review and call for action.PLoS neglected tropical diseases · 2022Article
- Failure to use health services by people with Chagas disease: Multilevel analysis of endemic area in Brazil.PLoS neglected tropical diseases · 2022Article
- Contextual influence on poor self-rated health in patients with Chagas disease: multilevel study.Ciencia & saude coletiva · 2022Article
- Cardiovascular Statistics - Brazil 2021.Arquivos brasileiros de cardiologia · 2022Article
- Chagas heart disease: An overview of diagnosis, manifestations, treatment, and care.World journal of cardiology · 2021Review
- Cohort profile update: the main and new findings from the SaMi-Trop Chagas cohort.Revista do Instituto de Medicina Tropical de Sao Paulo · 2021Article
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Authors and funding
9 authors at 4 institutions in 1 country.
Funding
Abstract
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).
conclusionThe 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.
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