Cardiac and digestive forms of chronic Chagas disease in Brazilian social welfare, 2004-2016/ Doenca de Chagas cronica cardiaca e digestiva na seguridade social brasileira, 2004-2016

Introduction: Chagas disease is a neglected tropical disease with a chronic clinical course and high rates of morbidity and mortality. Despite a drastic reduction in the disease's incidence in Brazil in recent decades, older cases still impact the national social welfare system. Objectives: To analyze the sociodemographic characteristics of Brazilian social welfare beneficiaries affected by the cardiac and digestive forms of chronic Chagas disease between 2004 and 2016. Methods: This cross- sectional study was based on data from the Brazilian Ministry of Labor and Social Security. Crude and adjusted odds ratios were estimated using logistic regression. Results: Benefits were granted to 25,085 affected individuals, mostly men (15,812; 63%) with the cardiac form (20,424; 81.4%) who resided in urban areas (16,051; 64%). The highest relative frequency of benefits were granted in the Midwest macroregion (31.1/100,000 inhabitants). Male sex (odds ratios = 1.2; 95% CI 1.1- 1.2), age 30-49 years (odds ratios = 1.8; 95% CI 1.4-2.1), residence in rural areas (odds ratios = 1.6; 95% CI 1.5-1.7) or the Southeast macroregion (odds ratios = 2.9; 95% CI 2.43.4) had the highest association with the cardiac form. Individuals with the cardiac form had a higher median age at disease onset (45 years; p < 0.001) but a lower age at work disability onset (50 years; p = 0.01). Conclusions: The impact of Chagas disease on Brazilian social welfare is mainly due to chronic Chagas cardiomyopathy, which was mainly associated with men in their productive years who live in rural areas in Southeastern Brazil. Keywords | Chagas cardiomyopathy; Chagas disease; social welfare; social security; social support. Introduc ao: A doenca de Chagas e uma doenca tropical negligenciada, de evolucao cronica e com elevada morbimortalidade. Apesar da drastica reducao na incidencia da doenca nas ultimas decadas no Brasil, casos infectados no passado ainda impactam o sistema de seguridade social brasileiro. Objetivos: Analisar as caracteristicas sociodemograficas de beneficiarios da seguridade social brasileira acometidos pela doenca de Chagas cronica nas formas clinicas cardiaca e digestiva no periodo de 2004 a 2016. Metodos: Estudo transversal com dados do Ministerio do Trabalho e Previdencia Social brasileiro. Empregou- se regressao logistica para estimar odds ratio brutas e ajustadas. Resultados: Houve concessao de 25.085 beneficios, a maioria relacionada a forma cardiaca da doenca de Chagas (20.424;