{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T16:24:36Z","timestamp":1787243076242,"version":"build-2736575974"},"reference-count":42,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T00:00:00Z","timestamp":1786665600000},"content-version":"vor","delay-in-days":13,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100020884","name":"Agencia Nacional de Investigaci\u00f3n y Desarrollo","doi-asserted-by":"publisher","award":["CIN250062"],"award-info":[{"award-number":["CIN250062"]}],"id":[{"id":"10.13039\/501100020884","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Chagas disease (CD) in Chile has shifted toward a postvector-control, aging-cohort scenario in which chronic sequelae increasingly shape outcomes. We quantified Chagas-specific mortality and associated factors using competing-risks methods.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a nationwide retrospective cohort study of confirmed CD cases notified in Chile during 2007\u20132021, linked to mortality and hospital discharge records. Chagas-specific death was the primary outcome, with other-cause death as a competing event. We estimated cumulative incidence functions (CIFs), applied Gray's test, and fitted Fine\u2013Gray models for subdistribution hazard ratios (sHRs). Complementary cause-specific Cox models included hospitalization as time-fixed and time-varying markers of clinical severity. Models accounted for the national cohort structure and competing mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 17 508 individuals, 261 (1.49%) died from CD and 1021 (5.83%) from other causes. Ten-year CIF was higher in men (2.66%) and increased with age, reaching 4.80% at 65\u201374 years and 8.89% at \u226575 years. Cumulative incidence functions was highest for chronic digestive disease (B57.3, 6.49%) and elevated for chronic cardiac disease (B57.2, 2.93%) compared with Z22.8 (1.47%; Gray P &amp;lt; .005). In adjusted Fine\u2013Gray models, mortality was associated with each 10-year age increase (sHR 2.31), male sex (sHR 1.47), B57.2 (sHR 1.92), and B57.3 (sHR 3.36). Cause-specific Cox models showed a graded association between recurrent hospitalizations and Chagas-specific death (\u22653 admissions: HR 83.94), consistent with advanced clinical deterioration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Although Chagas-specific death was uncommon, it was concentrated among identifiable high-risk groups. Risk-stratified chronic care and structured follow-up should prioritize patients with organ involvement or recurrent hospitalization.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ofid\/ofag502","type":"journal-article","created":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T11:51:20Z","timestamp":1786189880000},"source":"Crossref","is-referenced-by-count":0,"title":["Chagas-specific Death and Competing Risk of Mortality in Chile: A Nationwide Retrospective Cohort Study, 2007\u20132021"],"prefix":"10.1093","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2982-7402","authenticated-orcid":false,"given":"Franco","family":"Fern\u00e1ndez-Guardiola","sequence":"first","affiliation":[{"name":"School of Public Health, Faculty of Medicine, University of Chile , Santiago ,","place":["Chile"]},{"name":"SENTINET: Surveillance, Epidemiology, and New Technologies for Infectious Emerging Threats, Chile, Pontificia Universidad Cat\u00f3lica de Chile , Santiago ,","place":["Chile"]},{"name":"Department of Medical Technology, Faculty of Medicine, University of Chile , Santiago ,","place":["Chile"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia T","family":"Code\u00e7o","sequence":"additional","affiliation":[{"name":"Scientific Computing Program, Foundation Oswaldo Cruz , Rio de Janeiro ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia","family":"Vergara","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Undersecretariat of Public Health, Ministry of Health of Chile , Santiago ,","place":["Chile"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0973-5097","authenticated-orcid":false,"given":"Jorge","family":"Vilches","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Undersecretariat of Public Health, Ministry of Health of Chile , Santiago ,","place":["Chile"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8513-3634","authenticated-orcid":false,"given":"Diego","family":"Sandoval-Vargas","sequence":"additional","affiliation":[{"name":"Centre for Biotechnology and Engineering (CEBIB), Department of Chemical Engineering, Biotechnology and Materials, University of Chile , Santiago ,","place":["Chile"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4425-1253","authenticated-orcid":false,"given":"Eduardo A","family":"Undurraga","sequence":"additional","affiliation":[{"name":"SENTINET: Surveillance, Epidemiology, and New Technologies for Infectious Emerging Threats, Chile, Pontificia Universidad Cat\u00f3lica de Chile , Santiago ,","place":["Chile"]},{"name":"School of Government, Pontificia Universidad Cat\u00f3lica de Chile , Santiago ,","place":["Chile"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5256-4439","authenticated-orcid":false,"given":"Mauricio","family":"Canals","sequence":"additional","affiliation":[{"name":"School of Public Health, Faculty of Medicine, University of Chile , Santiago ,","place":["Chile"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2144-7181","authenticated-orcid":false,"given":"Kasim","family":"Allel","sequence":"additional","affiliation":[{"name":"SENTINET: Surveillance, Epidemiology, and New Technologies for Infectious Emerging Threats, Chile, Pontificia Universidad Cat\u00f3lica de Chile , Santiago ,","place":["Chile"]},{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford , Oxford ,","place":["UK"]},{"name":"Department of Infectious Diseases, School of Medicine, Pontificia Universidad Cat\u00f3lica de Chile , Santiago 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