Estimating the health and economic burden of Chagas cardiomyopathy in the United States: a population-based analysis
Background
Chagas disease (ChD) presents a growing concern in the United States (US), stemming largely from Chagas cardiomyopathy, a severe complication linked to heart failure, arrhythmias, and sudden death. This condition not only has health impacts in the form of morbidity and premature mortality but also carries significant economic burden related to its cost of care. This study aims to evaluate the current health and economic burden of Chagas cardiomyopathy in the US using a health system perspective.
Methods
We estimated the number of adults infected with Trypanosoma cruzi in the US using 2018–2022 data from the American Community Survey Public Use Microdata Sample (ACS-PUMS) and prevalence estimates from prior literature. Age-specific prevalence rates were applied to determine those with Chagas cardiomyopathy. To assess the disease’s broader impact, we incorporated proportions of hospitalized patients with concurrent cardiac conditions from prior literature and estimated healthcare costs using 2019 Healthcare Costs and Utilization Project, National Inpatient Sample (HCUP–NIS) data. We calculated Disability-Adjusted Life Years (DALYs), adjusted for multimorbidity, conducted a probabilistic sensitivity analysis, and compared the burden of Chagas cardiomyopathy to other US diseases.
Findings
An estimated 427,145 Latin America-born adults in the US were infected with T. cruzi, with 82,269 living with Chagas cardiomyopathy. The estimated economic burden was $4.96 billion (2019 USD) (95% CI: $4.91–$5.01), with 1.176 million DALYs (95% CI: 1.165–1.186). The disease burden was 1.9 times greater than HIV, 8.8 times greater than malaria, and 35.4 times greater than tuberculosis, yet ChD research funding in 2023 was disproportionately lower.
Interpretation
Our study highlights the significant health and economic burden of Chagas cardiomyopathy in the US. Despite this substantial burden, ChD remains significantly underfunded. Increased investment is crucial to improving diagnosis, treatment, and public health interventions.