High burden of hospital morbidity and mortality due to Chagas disease in Bahia state, Northeast Brazil, 2000–2022

Chagas disease (CD) is a chronic condition associated with high morbidity and mortality in endemic regions of Brazil, particularly in the state of Bahia. The clinical-epidemiologic analysis of hospital admissions is strategic due to limited data on chronic CD infections and the general lack of access to diagnosis and treatment. This study examines sociodemographic and clinical-epidemiological patterns of hospital morbidity and mortality from CD and its temporal trends from 2000 to 2022 in Bahia, Northeast Brazil. A mixed ecological study was conducted using data from hospital and mortality information systems. We calculated the hospital case fatality and all-cause mortality rates for CD, analysing temporal trends through joinpoint regression. Out of 20,189,658 hospital admissions, 4,557 (0.02%) were associated with CD, yielding a hospital lethality of 0.10 per 100,000 inhabitants. Of 1,832,325 Death Certificates, 16,960 (0.93%) were attributed to CD, equating to 5.16 deaths per 100,000 inhabitants. The risk ratios for hospital case fatality and mortality were higher among males, residents of municipalities with a 'medium' Brazilian Deprivation Index, those in the Central-North region, and patients with megacolon. Hospital case fatality significantly increased among males, the elderly (≥70 years) and residents in municipalities with 'high' or 'very high' Brazilian Deprivation Index in the Central-North and Central-East regions. The all-cause mortality trend for CD also rose among women and in municipalities with 'high' and 'very high' Brazilian Deprivation Index across the Southwest, West, North and Central-East regions. Programmatic vulnerabilities related to healthcare access within the Unified Health System likely contributed to delayed diagnoses and the increasing severity of specific forms of CD.