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Limongi JE, Santos KAR, Perissato IL, Pinto RDMC, Mendonça TMDS, Rinaldi AEM. Survival analysis of Chagas disease patients, beneficiaries of social security and social assistance in Brazil, 1942-2016. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2024; 27:e240020. [PMID: 38775617 PMCID: PMC11111094 DOI: 10.1590/1980-549720240020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/29/2023] [Accepted: 02/02/2024] [Indexed: 05/24/2024] Open
Abstract
OBJECTIVE To analyze the survival of patients with Chagas disease, beneficiaries of social security and social assistance, in Brazil, from 1942 to 2016. METHODS This is a retrospective cohort study with data from the Brazilian Ministry of Social Security. The event of interest was death, and the survival functions were estimated by the Kaplan-Meier and Cox regression methods. RESULTS In the period "onset of the disease until death", women (HR=0.54; 95%CI 0.43-0.53) and receiving social security benefits (HR=0.13; 95%CI 0.11-0.23) were associated with longer survival. Lower survival was associated with the cardiac form of the disease (HR=2.64; 95%CI 2.23-3.12), living in a rural area (HR=1.23; 95%CI 1.14-1.21), and manifestation of the disease between the years 2000 and 2016 (HR=5.32; 95%CI 4.74-5.93). Likewise, in the period "work disability until death", women (HR=0.51; 95%CI 0.41-0.52) and receiving social security benefits (HR=0.24; 95%CI 0,14-0.45) were associated with longer survival, as well as the cardiac form of the disease (HR=1.95; 95%CI 1.83-2.13), living in a rural area (HR=1.31; 95%CI 1.21-1.54), and manifestation of the disease between 2000 and 2016 (HR=1.53; 95%CI 1.33-1.71) were associated with lower survival. CONCLUSION The main predictors of mortality and survival of patients with Chagas disease who receive social security and assistance benefits in Brazil were presented. These findings can guide the definition of priorities for follow-up actions by Primary Health Care, currently recommended for the longitudinal management of the disease.
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Affiliation(s)
- Jean Ezequiel Limongi
- Universidade Federal de Uberlândia, Collective Health Program – Uberlândia (MG), Brazil
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Galvão-Castro B, Grassi MFR, Galvão-Castro AV, Nunes A, Galvão – Barroso AK, Araújo THA, Rathsam-Pinheiro RH, Nunes CLX, Ribeiro A, Lírio M, Gonçalves NL, Rangel SL, Dias CMCC, Ozores DP, Dubois-Mendes SM, Lima I, Silva ALP, de Jesus WLA, Santos FLN, de Oliveira JGR, de Moraes YVP, de Jesus AO, Daltro F, Boa-Sorte N, Castro-Lima H, Soliani MLC. Integrative and Multidisciplinary Care for People Living With Human T-Cell Lymphotropic Virus in Bahia, Brazil: 20 Years of Experience. Front Med (Lausanne) 2022; 9:884127. [PMID: 35746949 PMCID: PMC9210980 DOI: 10.3389/fmed.2022.884127] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/31/2022] [Indexed: 11/28/2022] Open
Abstract
Brazil is home to the highest absolute number of human T-cell lymphotropic virus type-1 (HTLV-1)-infected individuals worldwide; the city of Salvador, Bahia, has the highest prevalence of HTLV-1 infection in Brazil. Due to the complex nature of several diseases associated with this retrovirus, a multidisciplinary health care approach is necessary to care for people living with HTLV-1. The Bahia School of Medicine and Public Health’s Integrative Multidisciplinary HTLV Center (CHTLV) has been providing support to people living with HTLV and their families since 2002, striving to ensure physical and mental well-being by addressing biopsychosocial aspects, providing clinical care and follow-up, including to pregnant/postpartum women, as well as comprehensive laboratory diagnostics, psychological therapy, and counseling to family members. To date, CHTLV has served a total of 2,169 HTLV-infected patients. The average patient age is 49.8 (SD 15.9) years, 70.3% are female, most are considered low-income and have low levels of education. The majority (98.9%) are HTLV-1 cases, and approximately 10% have been diagnosed with tropical spastic paraparesis/HTLV-1-associated myelopathy (TSP/HAM), while 2.2% have infective dermatitis and 1.1% have adult T-cell lymphoma. In all, 178 pregnant/postpartum women [mean age: 32.7 (±6.5) years] have received care at CHTLV. Regarding vertical transmission, 53% of breastfed infants screened for HTLV tested positive in their second year of life, nearly 18 times the rate found in non-breastfed infants. This article documents 20 years of experience in implementing an integrative and multidisciplinary care center for people living with HTLV in Bahia, Brazil. Still, significant challenges remain regarding infection control, and HTLV-infected individuals continue to struggle with the obtainment of equitable and efficient healthcare.
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Affiliation(s)
- Bernardo Galvão-Castro
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
- Laboratório Avançado de Saúde Pública, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- *Correspondence: Bernardo Galvão-Castro,
| | - Maria Fernanda Rios Grassi
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
- Laboratório Avançado de Saúde Pública, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | | | - Aidê Nunes
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
| | | | | | - Regina Helena Rathsam-Pinheiro
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
- Instituto Brasileiro de Oftalmologia e Prevenção da Cegueira, Salvador, Brazil
| | - Ceuci Lima Xavier Nunes
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
- Instituto Couto Maia, Secretaria da Saúde do Estado da Bahia, Salvador, Brazil
| | - Adriele Ribeiro
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
| | - Monique Lírio
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
| | - Noilson Lázaro Gonçalves
- Laboratório Avançado de Saúde Pública, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | | | | | | | | | - Isabela Lima
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
| | | | | | - Fred Luciano Neves Santos
- Laboratório Avançado de Saúde Pública, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | | | | | | | | | - Ney Boa-Sorte
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
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