Volume 28, Number 11—November 2022
Dispatch
Deaths Related to Chagas Disease and COVID-19 Co-Infection, Brazil, March–December 2020
, Marcia C. Castro, Antonio Luiz P. Ribeiro, Jorg Heukelbach, and Guilherme L. Werneck
Table 2
Epidemiologic characteristics and cumulative mortality rates per 100,000 inhabitants related to Chagas disease and COVID-19 co-infection by population subgroups, Brazil, March–December 2020*
| Characteristic |
Deaths, no. (%)† |
Cumulative mortality rate (95% CI)‡ |
Mortality rate ratio (95% CI) |
p value |
| All co-infected deaths |
492 (100.0) |
0.23 (0.21–0.25) |
||
| Sex | ||||
| M | 251 (51.0) | 0.24 (0.21–0.27) | 1.09 (0.91–1.30) | 0.345 |
| F |
241 (49.0) |
0.22 (0.20–0.25) |
Referent |
|
| Age group, y | ||||
| 30–39 | 6 (1.2) | 0.02 (0.01–0.04) | Referent | |
| 40–49 | 14 (2.8) | 0.05 (0.03–0.08) | 2.73 (1.05–7.10) | 0.032 |
| 50–59 | 40 (8.1) | 0.17 (0.12–0.23) | 9.56 (4.05–22.54) | <0.001 |
| 60–69 | 104 (21.1) | 0.62 (0.51–0.75) | 35.46 (15.57–80.75) | <0.001 |
| 70–79 | 182 (37.0) | 2.02 (1.74–2.33) | 115.08 (51.03–259.53) | <0.001 |
| ≥80 |
146 (29.7) |
3.29 (2.80–3.87) |
187.56 (82.90–424.34) |
<0.001 |
| Region of residence | ||||
| North | 7 (1.4) | 0.04 (0.02–0.08) | Referent | |
| Northeast | 97 (19.7) | 0.17 (0.14–0.21) | 4.51 (2.09–9.71) | <0.001 |
| Southeast | 215 (43.7) | 0.24 (0.21–0.28) | 6.44 (3.04–13.68) | <0.001 |
| South | 18 (3.7) | 0.06 (0.04–0.09) | 1.59 (0.66–3.81) | 0.293 |
| Central-West |
155 (31.5) |
0.94 (0.80–1.10) |
25.05 (11.75–53.43) |
<0.001 |
| Ethnicity§ | ||||
| White (Caucasian) | 204 (43.0) | 0.22 (0.19–0.25) | Referent | |
| Mixed race (Pardo Brazilians) | 213 (44.9) | 0.22 (0.19–0.22) | 0.98 (0.81–1.19) | 0.838 |
| Black (Afro-Brazilian) | 55 (11.6) | 0.30 (0.23–0.39) | 1.36 (1.01–1.83) | 0.042 |
| Asian |
2 (0.4) |
NA |
NA |
NA |
| Schooling, y | ||||
| None (illiteracy) | 93 (25.3) | 0.62 (0.50–0.76) | 24.90 (11.55–53.67) | <0.001 |
| 1–3 | 122 (33.2) | 0.68 (0.57–0.81) | 27.34 (12.76–58.55) | <0.001 |
| 4–7 | 99 (26.9) | 0.23 (0.19–0.27) | 9.09 (4.22–19.56) | <0.001 |
| 8–11 | 47 (12.8) | 0.07 (0.05–0.09) | 2.64 (1.19–5.83) | 0.013 |
| ≥12 |
7 (1.9) |
0.02 (0.01–0.05) |
Referent |
|
| Marital status | ||||
| Single | 60 (13.8) | 0.07 (0.05–0.09) | 0.19 (0.15–0.26) | <0.001 |
| Married | 194 (44.5) | 0.34 (0.30–0.40) | Referent | |
| Divorced/separated | 33 (7.6) | 0.42 (0.30–0.59) | 1.23 (0.85–1.77) | 0.278 |
| Widowed | 136 (31.2) | 1.69 (1.43–1.99) | 4.91 (3.94–6.11) | <0.001 |
| Other |
13 (3.0) |
NA |
NA |
NA |
| Place of occurrence of death | ||||
| Hospital | 428 (87.0) | NA | NA | NA |
| Other health establishment | 40 (8.1) | NA | NA | NA |
| Home | 23 (4.7) | NA | NA | NA |
| Other | 1 (0.2) | NA | NA | NA |
*IQR, interquartile range; NA, not available. †Deaths with missing information are excluded: 18 for ethnicity, 124 for schooling, and 56 for marital status (not included in percentage calculations). ‡Deaths per 100,000 inhabitants. Population denominators used 2020 population estimates from the Brazilian Institute of Geography and Statistics (https://datasus.saude.gov.br/populacao-residente), except for ethnicity, schooling, and marital status. Population estimates for Brazil by ethnicity in 2020 were derived from the Continuous National Household Sample Survey (Continuous PNAD; https://sidra.ibge.gov.br/Tabela/6403), based on median estimates for each category (White, Black, and mixed [Pardo Brazilian]) in the continuous quarterly national surveys conducted in 2020. Population data on marital status in persons >10 years of age were obtained from the 2010 Brazilian Population Census (Brazilian Institute of Geography and Statistics, https://sidra.ibge.gov.br/tabela/1624). Population data on education for persons >10 years of age were extracted from the National Household Sample Survey (PNAD; https://sidra.ibge.gov.br/tabela/272) by using estimates for 2015 (most recent year with schooling estimates stratified by year of study >1 to 15 years). §No measures were calculated for persons of Asian ethnicity because of lack of population denominator information from 2020 Continuous PNAD. There was no record of co-infected death in the indigenous ethnic group.