Estimating the health and economic burden of Chagas cardiomyopathy in the United States: a population-based analysis

Abstract

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.

Funding: The National Institutes of Health (Grant number: D43TW010074).

Keywords: Burden of disease; Chagas cardiomyopathy; Disability-adjusted life years; Healthcare costs; Hispanic origin population; Latin American-born population; Prevalence; United States.

Fig. 1

Burden of disease by cause (Total DALYs in millions), United States, 2019. (a) Burden of disease by cause (Total DALYs in millions), including our estimated burden of Chagas cardiomyopathy adjusted for multimorbidity. (b) Focused view of selected infectious diseases and our estimated burden of Chagas cardiomyopathy (DALYs in millions). Data source: IHME, Global Burden of Disease (2019). Note: Adjusting for multimorbidity in Chagas cardiomyopathy yields 0.886 million total DALYs (95% CI: 0.877–0.893), which remains higher than the burden of tuberculosis (TB) and HIV.

Fig. 2

NIH research funding trends for selected diseases, 2008–2025 (in millions of USD). (a) Research funding for HIV/AIDS, tuberculosis, malaria, Chagas disease, tickborne diseases, and other vector-borne diseases (in millions of USD). (b) Research funding for tuberculosis, malaria, Chagas disease, tickborne diseases, and other vector-borne diseases (excluding HIV/AIDS for clearer scale comparison; in millions of USD). Data source: NIH RePORT. Note: Funding for malaria and tuberculosis includes funding for their respective vaccines. The NIH provides historical data for 2008–2023 and projections for 2024–2025.