@article{103815,
  keywords = {Trypanosoma cruzi, Chagas disease, Cohort study, effect modification, Mortality, Survival Analysis},
  author = {Díaz M and Rojas L and González-Rugeles C and Echeverría L and Gómez-Ochoa S},
  title = {Chagas disease and mortality in a community-based cohort in Colombia: evidence for age-dependent effect modification.},
  abstract = {<p><strong>BACKGROUND: </strong></p>

<p>Chagas disease (CD), caused by Trypanosoma cruzi, is a leading cause of cardiomyopathy in Latin America. Community-based prospective data on the CD-mortality association remain scarce.</p>

<p><strong>METHODS: </strong></p>

<p>We analysed the ANTORCHA prospective cohort, enrolling individuals from T. cruzi-endemic communities in Santander, Colombia (2015-2025). The primary exposure was serologically confirmed CD; the primary outcome was all-cause mortality. Cox proportional hazards models with hierarchical adjustment and restricted mean survival time (RMST) were used.</p>

<p><strong>RESULTS: </strong></p>

<p>Among 1509 participants (314 Chagas positive), 81 deaths occurred over a median follow-up of 5.6 y. After full multivariate adjustment, CD was not associated with overall mortality (hazard ratio [HR] 1.02 [95% confidence interval {CI} 0.61 to 1.72]). A significant age-dependent interaction was identified (p=0.007): CD was independently associated with increased mortality among participants &lt;60 y of age (HR 4.96 [95% CI 1.80 to 13.71]) but not among those ≥60 y of age (HR 0.73 [95% CI 0.43 to 1.22]). RMST analysis confirmed an absolute survival loss of 121 d at approximately 10 y of follow-up in the younger subgroup (p=0.02).</p>

<p><strong>CONCLUSIONS: </strong></p>

<p>In this community-based cohort, CD was independently associated with markedly elevated mortality among adults &lt;60&nbsp;y of age. Younger T. cruzi-positive individuals warrant intensified cardiovascular surveillance.</p>
},
  year = {2026},
  journal = {Transactions of the Royal Society of Tropical Medicine and Hygiene},
  month = {07/2026},
  issn = {1878-3503},
  doi = {10.1093/trstmh/trag074},
  language = {ENG},
}