Prevalence of clinical forms of Chagas disease: a systematic review and meta-analysis - data from the RAISE study

Bruno Ramos Nascimento; André Dias Nassar Naback; Beatriz Marino Pena Santos; Yvonne Geissbühler; Caroline Demacq; Monica Quijano; Pablo A Perel; Israel Molina; Isis Eloah Machado; Ewerton Cousin; Jonathan F Mosser; Pedro Emanuel de Paula Carvalho; Francisco Rogerlândio Martins-Melo; Antonio Luiz Pinho Ribeiro; RAISE investigators

doi:10.1016/j.lana.2024.100681

Prevalence of clinical forms of Chagas disease: a systematic review and meta-analysis - data from the RAISE study

Lancet Reg Health Am. 2024 Feb 3:30:100681. doi: 10.1016/j.lana.2024.100681. eCollection 2024 Feb.

Authors

Bruno Ramos Nascimento^{1

2

3}, André Dias Nassar Naback², Beatriz Marino Pena Santos⁴, Yvonne Geissbühler⁵, Caroline Demacq⁵, Monica Quijano⁵, Pablo A Perel⁶, Israel Molina^{7

8}, Isis Eloah Machado⁹, Ewerton Cousin¹⁰, Jonathan F Mosser¹⁰, Pedro Emanuel de Paula Carvalho¹, Francisco Rogerlândio Martins-Melo^{11

12}, Antonio Luiz Pinho Ribeiro^{1

2}; RAISE investigators

Affiliations

¹ Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
² Serviço de Cardiologia e Cirurgia Cardiovascular, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
³ Serviço de Hemodinâmica, Hospital Madre Teresa, Belo Horizonte, MG, Brazil.
⁴ Curso de Medicina, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, MG, Brazil.
⁵ Novartis Pharma AG, Basel, Switzerland.
⁶ World Heart Federation, Geneva, Switzerland.
⁷ International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain.
⁸ Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.
⁹ Departamento de Medicina de Família, Saúde Mental e Coletiva, Escola de Medicina, Universidade Federal de Ouro Preto, Ouro Preto, MG, Brazil.
¹⁰ Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA.
¹¹ Universidade Federal do Ceará, Fortaleza, CE, Brazil.
¹² Federal Institute of Education, Science and Technology of Ceará, Fortaleza, Brazil.

Abstract

Background: There is a lack of up-to-date estimates about the prevalence of Chagas disease (ChD) clinical presentations and, therefore, we aimed to assess the prevalence of clinical forms of ChD among seropositive adults, pooling available data.

Methods: A systematic review was conducted in Medline, Embase, Biblioteca Virtual em Saúde and Cochrane databases looking for studies published from 1990 to August 2023, which investigated the prevalence of ChD clinical forms among seropositive adults, including: (i) indeterminate phase, (ii) chronic Chagas cardiomyopathy (CCM), (iii) digestive and (iv) mixed (CCM + digestive) forms. Pooled estimates and 95% confidence intervals (CI) were calculated using random-effects models. Studies quality and risk of bias was assessed with the Leboeuf-Yde and Lauritsen tool. Heterogeneity was assessed with the I² statistic. The study was registered in the PROSPERO database (CRD42022354237).

Findings: 1246 articles were selected for screening and 73 studies were included in the final analysis (17,132 patients, 44% men). Most studies were conducted with outpatients (n = 50), followed by population-based studies (n = 15). The pooled prevalence of the ChD clinical forms was: indeterminate 42.6% (95% CI: 36.9-48.6), CCM 42.7% (95% CI: 37.3-48.3), digestive 17.7% (95% CI: 14.9-20.9), and mixed 10.2% (95% CI: 7.9-13.2). In population-based studies, prevalence was lower for CCM (31.2%, 95% CI: 24.4-38.9) and higher for indeterminate (47.2%, 95% CI: 39.0-55.5) form. In meta-regression, age was inversely associated with the prevalence of indeterminate (β = -0.05, P < 0.001) form, and directly associated with CCM (β = 0.06, P < 0.001) and digestive (β = 0.02, P < 0.001) forms. Heterogeneity was overall high.

Interpretation: Compared to previous publications, our pooled estimates show a higher prevalence of CCM among ChD seropositive patients, but similar rates of the digestive form.

Funding: This study was funded by the World Heart Federation, through a research collaboration with Novartis Pharma AG.

Keywords: Chagas disease; Clinical forms; Meta-analysis; Prevalence.