Abstract / Summary
Background: Chronic Chagas cardiomyopathy is the main cause of death from Trypanosoma cruzi infection.Nationwide analyses of its mortality in Brazil are either restricted to all forms of Chagas disease or end before 2020, and none has examined the cardiac form separately across regions, sexes, and age groups through 2023.Methods: This is a nationwide ecological time-trend study of all deaths registered in the Brazilian Mortality Information System with chronic Chagas disease with heart involvement (ICD-10 B57.2) as the underlying cause, 2000-2023.Age-standardized mortality rates (ASMR, direct method, Brazilian 2022 population as standard) were calculated for Brazil, its five macroregions, and each sex.Trends were estimated as annual percent change (APC) from age-adjusted quasi-Poisson regression and by joinpoint regression of the annual ASMR series, with the average APC (AAPC) for 2000-2023; sensitivity analyses used the World Health Organization (WHO) standard population and restricted windows (2006-2023; 2000-2019).Results: Eighty-nine thousand seventy-nine deaths were attributed to B57.2 in 2000-2023 (56.1% male; 68.3% aged ≥60 years).The national ASMR fell from 4.06 (95% confidence interval (CI) 3.94-4.18)to 1.29 (1.24-1.34)per 100,000 population between 2000 and 2023 (-68%), with an AAPC of -4.7% (95% CI -4.9 to -4.5) and a single joinpoint in 2020, after which the decline accelerated (APC -6.9%, -8.7 to -5.2).Rates fell in all macroregions (APC from -2.6% in the Northeast to -6.5% in the South) and in both sexes (men -5.1%, women -3.9%), yet the Central-West retained an ASMR 3.5 times the national value in 2020-2023 (5.18 vs 1.49 per 100,000).The decline was steepest below 40 years of age (APC -9.9%) and negligible at ≥80 years (-0.5%, -0.7 to -0.2), in whom the rate remained above 20 per 100,000.Conclusions: Mortality attributed to chronic Chagas cardiomyopathy in Brazil has declined by about twothirds since 2000, in every region and both sexes.The age pattern is consistent with the aging and extinction of cohorts infected before vector control rather than with improved survival of established cardiomyopathy, although this ecological design cannot separate age, period, and cohort effects; deaths are now concentrated in elderly residents of historically endemic areas, particularly the Central-West.