ESTER CERDEIRA SABINO

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Departamento de Patologia, Faculdade de Medicina - Docente
LIM/46 - Laboratório de Parasitologia Médica, Hospital das Clínicas, Faculdade de Medicina - Líder

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  • article 3 Citação(ões) na Scopus
    Hospitalizations due to gastrointestinal Chagas disease: National registry
    (2022) BIERRENBACH, Ana Luiza; QUINTINO, Nayara Dornela; MOREIRA, Carlos Henrique Valente; DAMASCENO, Renata Fiuza; NUNES, Maria do Carmo Pereira; BALDONI, Nayara Ragi; SILVA, Lea Campos de Oliveira da; FERREIRA, Ariela Mota; CARDOSO, Clareci Silva; HAIKAL, Desiree Sant'Ana; SABINO, Ester Cerdeira; RIBEIRO, Antonio Luiz Pinho; OLIVEIRA, Claudia Di Lorenzo
    Objectives Analyze the hospitalizations of patients admitted for Chagas disease with gastro-intestinal involvement (CD-GI) in the Brazilian Unified Health System, describe the epidemiological profile, mortality and costs. Methods This is an observational study that uses secondary data from the National Hospital Information System (SIH-SUS) for the years 2017-2019. CD-GI admissions were defined by specific ICD-10 codes that identify the main diagnosis. Results From 2017 to 2019, there were 4,407 hospitalizations for CD-GI in Brazil, considering only public hospitals and those associated with the SUS. This corresponds to an average of 1,470 hospitalizations per year, or 0.6 per 100,000 inhabitants, with significant regional variation. Hospitalizations increased with age and were slightly higher in men. More than 60% were emergencies and in 50% the procedure performed was surgical. The most used code was the one for megaesophagus followed by megacolon. In-hospital mortality was 5.8% and 17.2% went to intensive care units. The median cost was USD$ 553.15 per hospitalization, and an overall cost of USD$ 812,579.98 per year to the SUS budget. Conclusion The numbers, rates and costs presented here are possibly underestimated but they give us an idea of the overall profile of hospitalizations due to CD-GI, which are not rare and are related to significant in-hospital mortality. CD-GI is a neglected manifestation of a neglected disease.
  • article 4 Citação(ões) na Scopus
    Left ventricular systolic dysfunction predicted by artificial intelligence using the electrocardiogram in Chagas disease patients-The SaMi-Trop cohort
    (2021) BRITO, Bruno Oliveira de Figueiredo; ATTIA, Zachi I.; MARTINS, Larissa Natany A.; PEREL, Pablo; NUNES, Maria Carmo P.; SABINO, Ester Cerdeira; CARDOSO, Clareci Silva; FERREIRA, Ariela Mota; GOMES, Paulo R.; RIBEIRO, Antonio Luiz Pinho; LOPEZ-JIMENEZ, Francisco
    BackgroundLeft ventricular systolic dysfunction (LVSD) in Chagas disease (ChD) is relatively common and its treatment using low-cost drugs can improve symptoms and reduce mortality. Recently, an artificial intelligence (AI)-enabled ECG algorithm showed excellent accuracy to detect LVSD in a general population, but its accuracy in ChD has not been tested. ObjectiveTo analyze the ability of AI to recognize LVSD in patients with ChD, defined as a left ventricular ejection fraction determined by the Echocardiogram <= 40%. Methodology/principal findingsThis is a cross-sectional study of ECG obtained from a large cohort of patients with ChD named Sao Paulo-Minas Gerais Tropical Medicine Research Center (SaMi-Trop) Study. The digital ECGs of the participants were submitted to the analysis of the trained machine to detect LVSD. The diagnostic performance of the AI-enabled ECG to detect LVSD was tested using an echocardiogram as the gold standard to detect LVSD, defined as an ejection fraction <40%. The model was enriched with NT-proBNP plasma levels, male sex, and QRS >= 120ms.Among the 1,304 participants of this study, 67% were women, median age of 60; there were 93 (7.1%) individuals with LVSD. Most patients had major ECG abnormalities (59.5%). The AI algorithm identified LVSD among ChD patients with an odds ratio of 63.3 (95% CI 32.3-128.9), a sensitivity of 73%, a specificity of 83%, an overall accuracy of 83%, and a negative predictive value of 97%; the AUC was 0.839. The model adjusted for the male sex and QRS >= 120ms improved the AUC to 0.859. The model adjusted for the male sex and elevated NT-proBNP had a higher accuracy of 0.89 and an AUC of 0.874. ConclusionThe AI analysis of the ECG of Chagas disease patients can be transformed into a powerful tool for the recognition of LVSD. Author summaryChagas disease (ChD) is caused by the protozoan parasite Trypanosoma cruzi and continues to be a health problem despite the control of its transmission. ChD is a heterogeneous condition with a wide variation in its clinical course and prognosis. The majority (60%-70%) of infected individuals remain asymptomatic throughout life. Although some develop only conduction defects and mild segmental wall motion abnormalities, others develop severe symptoms of heart failure (HF), thromboembolic phenomena, and life threatening ventricular arrhythmias. HF is one of major causes of the death of patients with ChD. There is some evidence on effective drugs against the parasite in the chronic form of the disease capable of preventing long-term adverse outcomes, but it is still limited. However low-cost medications are able to reduce mortality and improve the quality of life of patients with HF. Because of the lack of tertiary care facilities outside urban centers, an automatic diagnostic tool based on the ECG, which is a relatively simple exam without requiring human interpretation, would improve the capacity to recognize HF. Recently, digital signals of the electrocardiogram were recognized by Artificial Intelligence (AI) and associated with an excellent accuracy for HF in the general population. Our results demonstrate that AI-ECG could ensure a rapid recognition of HF in patients who require a referral to a cardiologist and the use of disease-modifying drugs. AI can be used as a powerful public heath tool, it can transform the lives of 6 million patients with ChD worldwide, and it may well have a formidable impact on patient management and prognosis.
  • article 50 Citação(ões) na Scopus
    Electrocardiographic Abnormalities in Trypanosoma cruzi Seropositive and Seronegative Former Blood Donors
    (2013) RIBEIRO, Antonio L.; SABINO, Ester C.; MARCOLINO, Milena S.; SALEMI, Vera M. C.; IANNI, Barbara M.; FERNANDES, Fabio; NASTARI, Luciano; ANTUNES, Andre; MENEZES, Marcia; OLIVEIRA, Claudia Di Lorenzo; SACHDEV, Vandana; CARRICK, Danielle M.; BUSCH, Michael P.; MURPHY, Eduard L.
    Background: Blood donor screening leads to large numbers of new diagnoses of Trypanosoma cruzi infection, with most donors in the asymptomatic chronic indeterminate form. Information on electrocardiogram (ECG) findings in infected blood donors is lacking and may help in counseling and recognizing those with more severe disease. Objectives: To assess the frequency of ECG abnormalities in T. cruzi seropositive relative to seronegative blood donors, and to recognize ECG abnormalities associated with left ventricular dysfunction. Methods: The study retrospectively enrolled 499 seropositive blood donors in Sao Paulo and Montes Claros, Brazil, and 483 seronegative control donors matched by site, gender, age, and year of blood donation. All subjects underwent a health clinical evaluation, ECG, and echocardiogram (Echo). ECG and Echo were reviewed blindly by centralized reading centers. Left ventricular (LV) dysfunction was defined as LV ejection fraction (EF), 0.50%. Results: Right bundle branch block and left anterior fascicular block, isolated or in association, were more frequently found in seropositive cases (p<0.0001). Both QRS and QTc duration were associated with LVEF values (correlation coefficients -0.159, p<0.0003, and -0.142, p = 0.002) and showed a moderate accuracy in the detection of reduced LVEF (area under the ROC curve: 0.778 and 0.790, both p<0.0001). Several ECG abnormalities were more commonly found in seropositive donors with depressed LVEF, including rhythm disorders (frequent supraventricular ectopic beats, atrial fibrillation or flutter and pacemaker), intraventricular blocks (right bundle branch block and left anterior fascicular block) and ischemic abnormalities (possible old myocardial infarction and major and minor ST abnormalities). ECG was sensitive (92%) for recognition of seropositive donors with depressed LVEF and had a high negative predictive value (99%) for ruling out LV dysfunction. Conclusions: ECG abnormalities are more frequent in seropositive than in seronegative blood donors. Several ECG abnormalities may help the recognition of seropositive cases with reduced LVEF who warrant careful follow-up and treatment.
  • article 24 Citação(ões) na Scopus
    Mortality among blood donors seropositive and seronegative for Chagas disease (1996-2000) in Sao Paulo, Brazil: A death certificate linkage study
    (2017) CAPUANI, Ligia; BIERRENBACH, Ana Luiza; ALENCAR, Airlane Pereira; MENDRONE JR., Alfredo; FERREIRA, Joao Eduardo; CUSTER, Brian; RIBEIRO, Antonio Luiz P.; SABINO, Ester Cerdeira
    Background Individuals in the indeterminate phase of Chagas disease are considered to have mortality rates similar to those of the overall population. This study compares mortality rates among blood donors seropositive for Chagas disease and negative controls in the city of Sao Paulo, Brazil. Methodology/principal findings This is a retrospective cohort study of blood donors from 1996 to 2000: 2842 seropositive and 5684 seronegative for Chagas disease. Death status was ascertained by performing probabilistic record linkage (RL) with the Brazil national mortality information system (SIM). RL was assessed in a previous validation study. Cox Regression was used to derive hazard ratios (HR), adjusting for confounders. RL identified 159 deaths among the 2842 seropositive blood donors (5.6%) and 103 deaths among the 5684 seronegative (1.8%). Out of the 159 deaths among seropositive donors, 26 had the 10th International Statistical Classification of Diseases and Related Health Problems (ICD-10) indicating Chagas disease as the underlying cause of death (B57.0/B57.5), 23 had ICD-10 codes (I42.0/I42.2/I47.0/I47.2/I49.0/I50.0/I50.1/I50.9/I51.7) indicating cardiac abnormalities possibly related to Chagas disease listed as an underlying or associated cause of death, with the others having no mention of Chagas disease in part I of the death certificate. Donors seropositive for Chagas disease had a 2.3 times higher risk of death due to all causes (95% Confidence Interval (95% CI), 1.8-3.0) than seronegative donors. When considering deaths due to Chagas disease or those that had underlying causes of cardiac abnormalities related to Chagas disease, seropositive donors had a risk of death 17.9 (95% CI, 6.3-50.8) times greater than seronegative donors. Conclusions/significance There is an excess risk of death in donors seropositive blood for Chagas disease compared to seronegative donors. Chagas disease is an under-reported cause of death in the Brazilian mortality database.
  • article 0 Citação(ões) na Scopus
    Mortality among blood donors seropositive and seronegative for Chagas disease (1996-2000) in Sao Paulo, Brazil: A death certificate linkage study (vol 11, e0005542, 2017)
    (2020) CAPUANI, Ligia; BIERRENBACH, Ana Luiza; ALENCAR, Airlane Pereira; MENDRONE JR., Alfredo; FERREIRA, Joao Eduardo; CUSTER, Brian; RIBEIRO, Antonio Luiz P.; SABINO, Ester Cerdeira
  • article 60 Citação(ões) na Scopus
    Genomic, epidemiological and digital surveillance of Chikungunya virus in the Brazilian Amazon
    (2019) NAVECA, Felipe Gomes; CLARO, Ingra; GIOVANETTI, Marta; JESUS, Jaqueline Goes de; XAVIER, Joilson; IANI, Felipe Campos de Melo; NASCIMENTO, Valdinete Alves do; SOUZA, Victor Costa de; SILVEIRA, Paola Paz; LOURENCO, Jose; SANTILLANA, Mauricio; KRAEMER, Moritz U. G.; QUICK, Josh; HILL, Sarah C.; THEZE, Julien; CARVALHO, Rodrigo Dias de Oliveira; AZEVEDO, Vasco; SALLES, Flavia Cristina da Silva; NUNES, Marcio Roberto Teixeira; LEMOS, Poliana da Silva; CANDIDO, Darlan da Silva; PEREIRA, Glauco de Carvalho; OLIVEIRA, Marluce Aparecida Assuncao; MENESES, Catia Alexandra Ribeiro; MAITO, Rodrigo Melo; CUNHA, Claudeth Rocha Santa Brigida; CAMPOS, Daniela Palha de Sousa; CASTILHO, Marcia da Costa; SIQUEIRA, Thalita Caroline da Silva; TERRA, Tiza Matos; ALBUQUERQUE, Carlos F. Campelo de; CRUZ, Laura Nogueira da; ABREU, Andre Luis de; MARTINS, Divino Valerio; SIMOES, Daniele Silva de Moraes Vanlume; AGUIAR, Renato Santana de; LUZ, Sergio Luiz Bessa; LOMAN, Nicholas; PYBUS, Oliver G.; SABINO, Ester C.; OKUMOTO, Osnei; ALCANTARA, Luiz Carlos Junior; FARIA, Nuno Rodrigues
    Background Since its first detection in the Caribbean in late 2013, chikungunya virus (CHIKV) has affected 51 countries in the Americas. The CHIKV epidemic in the Americas was caused by the CHIKV-Asian genotype. In August 2014, local transmission of the CHIKV-Asian genotype was detected in the Brazilian Amazon region. However, a distinct lineage, the CHIKV-East-Central-South-America (ECSA)-genotype, was detected nearly simultaneously in Feira de Santana, Bahia state, northeast Brazil. The genomic diversity and the dynamics of CHIKV in the Brazilian Amazon region remains poorly understood despite its importance to better understand the epidemiological spread and public health impact of CHIKV in the country. Methodology/Principal findings We report a large CHIKV outbreak (5,928 notified cases between August 2014 and August 2018) in Boa vista municipality, capital city of Roraima's state, located in the Brazilian Amazon region. We generated 20 novel CHIKV-ECSA genomes from the Brazilian Amazon region using MinION portable genome sequencing. Phylogenetic analyses revealed that despite an early introduction of the Asian genotype in 2015 in Roraima, the large CHIKV outbreak in 2017 in Boa Vista was caused by an ECSA-lineage most likely introduced from northeastern Brazil. Epidemiological analyses suggest a basic reproductive number of R-0 of 1.66, which translates in an estimated 39 (95% CI: 36 to 45) % of Roraima's population infected with CHIKV-ECSA. Finally, we find a strong association between Google search activity and the local laboratory-confirmed CHIKV cases in Roraima. Conclusions/Significance This study highlights the potential of combining traditional surveillance with portable genome sequencing technologies and digital epidemiology to inform public health surveillance in the Amazon region. Our data reveal a large CHIKV-ECSA outbreak in Boa Vista, limited potential for future CHIKV outbreaks, and indicate a replacement of the Asian genotype by the ECSA genotype in the Amazon region.
  • article 34 Citação(ões) na Scopus
    Development of a Novel Multiplex Immunoassay Multi-cruzi for the Serological Confirmation of Chagas Disease
    (2016) GRANJON, Elodie; DICHTEL-DANJOY, Marie-Laure; SABA, Esber; SABINO, Ester; OLIVEIRA, Lea Campos de; ZREIN, Maan
    Background Chagas disease is due to the parasite Trypanosoma cruzi, a protist disseminated by a Triatome vector. This disease is endemic to Latin America and considered by WHO as one of the 17 world's neglected diseases. In Europe and in North America, imported cases are also detected, due to migration of population outside of the endemic region. Diagnosis of T. cruzi infection is usually made indirectly by the detection of specific antibodies to T. cruzi antigens. Following initial diagnostic evaluation or screening test (qualifying or discarding blood donation), a confirmation test is performed for samples initially reactive. The test presented in this study aims at the confirmation/refutation of the infectious status of human blood samples and will permit taking appropriate clinical measures. Methodology/Principal Findings We designed a novel array of twelve antigens and printed these antigens onto 96-well plates. We tested 248 positive samples T. cruzi, 94 unscreened blood donors' samples from non-endemic area, 49 seronegative blood donors, 7 false-positive and 3 doubtful samples. The observed reactivities were analyzed to propose a decision-tree algorithm that correctly classifies all the samples, with the potential to discriminate false-positive results and sticky samples. We observed that antibodies levels (Sum of all antigens) was significantly higher for PCR positive than for PCR negative samples in all studied groups with Multi-cruzi. Conclusion/Significance The results described in this study indicate that the Multi-cruzi improves the serological confirmation of Chagas disease. Moreover the ""sum of all antigens"" detected by Multi-cruzi could reflect parasitemia level in patients-like PCR signals does-and could serve as an indicator of parasite clearance in longitudinal follow-ups. Validation of this assay is still required on an independent large collection of well characterized samples including typical false-reactive samples such as Leishmaniasis.
  • article 2 Citação(ões) na Scopus
    Clinical markers of post-Chikungunya chronic inflammatory joint disease: A Brazilian cohort
    (2023) LAZARI, Carolina dos Santos; RAMUNDO, Mariana Severo; TEN-CATEN, Felipe; BRESSAN, Clarisse S.; FILIPPIS, Ana Maria Bispo de; MANULI, Erika Regina; MORAES, Isabella de; PEREIRA, Geovana Maria; CORTES, Marina Farrel; CANDIDO, Darlan da Silva; GERBER, Alexandra L.; GUIMARAES, Ana Paula; FARIA, Nuno Rodrigues; NAKAYA, Helder I.; VASCONCELOS, Ana Tereza R.; BRASIL, Patricia; PARANHOS-BACCALA, Glaucia; SABINO, Ester Cerdeira
    BackgroundChikungunya-fever (CHIKF) remains a public health major issue. It is clinically divided into three phases: acute, post-acute and chronic. Chronic cases correspond to 25-40% individuals and, though most of them are characterized by long-lasting arthralgia alone, many of them exhibit persistent or recurrent inflammatory signs that define post-Chikungunya chronic inflammatory joint disease (pCHIKV-CIJD). We aimed to identify early clinical markers of evolution to pCHIKV-CIJD during acute and post-acute phases. Methodology/Principal findingsWe studied a prospective cohort of CHIKF-confirmed volunteers with longitudinal clinical data collection from symptoms onset up to 90 days, including a 21-day visit (D21). Of 169 patients with CHIKF, 86 (50.9%) completed the follow-up, from whom 39 met clinical criteria for pCHIKV-CIJD (45.3%). The relative risk of chronification was higher in women compared to men (RR = 1.52; 95% CI = 1.15-1.99; FDR = 0.03). None of the symptoms or signs presented at D0 behaved as an early predictor of pCHIKV-CIJD, while being symptomatic at D21 was a risk factor for chronification (RR = 1.31; 95% CI = 1.09-1.55; FDR = 0.03). Significance was also observed for joint pain (RR = 1.35; 95% CI = 1.12-1.61; FDR = 0.02), reported edema (RR = 3.61; 95% CI = 1.44-9.06; FDR = 0.03), reported hand and/or feet small joints edema (RR = 4.22; 95% CI = 1.51-11.78; FDR = 0.02), and peri-articular edema observed during physical examination (RR = 2.89; 95% CI = 1.58-5.28; FDR = 0.002). Furthermore, patients with no findings in physical examination at D21 were at lower risk of chronic evolution (RR = 0.41, 95% CI = 0.24-0.70, FDR = 0.01). Twenty-nine pCHIKV-CIJD patients had abnormal articular ultrasonography (90.6% of the examined). The most common indings were synovitis (65.5%) and joint effusion (58.6%). ConclusionThis cohort has provided important insights into the prognostic evaluation of CHIKF. Symptomatic sub-acute disease is a relevant predictor of evolution to chronic arthritis with synovitis, drawing attention to joint pain, edema, multiple articular involvement including small hand and feet joints as risk factors for chronification beyond three months, especially in women. Future studies are needed to accomplish the identification of accurate and early biomarkers of poor clinical prognosis, which would allow better understanding of the disease's evolution and improve patients' management, modifying CHIKF burden on global public health. Author summaryChikungunya fever (CHIKF) is a vector-borne viral disease first described in 1952 in Africa, which recently reached the Americas, where it then originated epidemics of unprecedented magnitude. Its acute phase is characterized by fever associated with joint pain and edema, which resolve in about seven days for most patients. However, 25-40% of these patients develop chronic musculoskeletal and arthritic symptoms, which may be incapacitating and lead to permanent joint damage. We have conducted a prospective longintudinal cohort of CHIKF confirmed individuals, in Brazil, which aimed to identify clinical early markers of evolution to post-Chikungunya chronic inflammatory joint disease (pCHIKV-CIJD) after 90 days, using objective physical examination to define pCHIKV-CIJD. We have also performed joint ultrasonography to improve evaluation of chronic arthritis. We found that 45.3% of patients who completed the follow-up met criteria for pCHIKV-CIJD. Women were at higher risk of chronification, as well as individuals who remain symptomatic 21 days after the onset of symptoms. Abnormal ultrasonography results were seen in 90.6% of examined pCHIKV-CIJD patients, in whom synovitis and joint effusion were the most commom songraphic signs, affecting mostly ankles and knees. The adoption of objective criteria to define pCHIKV-CIJD is crucial to estimate accurately the proportion of patients who evolve to chronic rheumatism, and to indentify early risk factors to this outcome, which may add important information to tailor therapeutic strategies for this particular population. It may also help to understand the burden of CHIKF in developing countries, measuring either its impact in individual's quality of life, or its communitary repercussion after widespread outbreaks.
  • article 2 Citação(ões) na Scopus
    Genome-wide association study for Chagas Cardiomyopathy identify a new risk locus on chromosome 18 associated with an immune-related protein and transcriptional signature
    (2022) SABINO, Ester Cerdeira; FRANCO, Lucas Augusto Moyses; VENTURINI, Gabriela; RODRIGUES, Mariliza Velho; MARQUES, Emanuelle; SILVA, Lea Campos de Oliveira-da; MARTINS, Larissa Natany Almeida; FERREIRA, Ariela Mota; ALMEIDA, Paulo Emilio Clementino; SILVA, Felipe Dias Da; LEITE, Samara Fernandes; NUNES, Maria do Carmo Pereira; HAIKAL, Desiree Sant'Ana; OLIVEIRA, Claudia Di Lorenzo; CARDOSO, Clareci Silva; SEIDMAN, Jonathan G.; SEIDMAN, Christine E.; CASAS, Juan P.; RIBEIRO, Antonio Luiz Pinho; KRIEGER, Jose E.; PEREIRA, Alexandre C.
    Background Chronic Chagas Cardiomyopathy (CCC) usually develops between 10 and 20 years after the first parasitic infection and is one of the leading causes of end-stage heart failure in Latin America. Despite the great inter-individual variability in CCC susceptibility (only 30% of infected individuals ever present CCC), there are no known predictors for disease development in those chronically infected. Methodology/Principal findings We describe a new susceptibility locus for CCC through a GWAS analysis in the SaMi-Trop cohort, a population-based study conducted in a Chagas endemic region from Brazil. This locus was also associated with CCC in the REDS II Study. The newly identified locus (rs34238187, OR 0.73, p-value 2.03 x 10(-9)) spans a haplotype of approximately 30Kb on chromosome 18 (chr18: 5028302-5057621) and is also associated with 80 different traits, most of them blood protein traits significantly enriched for immune-related biological pathways. Hi-C data show that the newly associated locus is able to interact with chromatin sites as far as 10Mb on chromosome 18 in a number of different cell types and tissues. Finally, we were able to confirm, at the tissue transcriptional level, the immune-associated blood protein signature using a multi-tissue differential gene expression and enrichment analysis. Conclusions/Significance We suggest that the newly identified locus impacts CCC risk among T cruzi infected individuals through the modulation of a downstream transcriptional and protein signature associated with host-parasite immune response. Functional characterization of the novel risk locus is warranted.
  • article 0 Citação(ões) na Scopus
    Failure to use health services by people with Chagas disease: Multilevel analysis of endemic area in Brazil
    (2022) DAMASCENO, Renata Fiuza; SABINO, Ester Cerdeira; RIBEIRO, Antonio Luiz Pinho; FERREIRA, Ariela Mota; SILVA, Lea Campos de Oliveira-da; OLIVEIRA, Claudia Di Lorenzo; CARDOSO, Clareci Silva; VIEIRA, Thallyta Maria; HAIKAL, Desiree Sant' Ana
    This study aimed to assess the prevalence of non-use of health services in the last year by people with Chagas disease (CD) in an endemic area in Brazil and the contextual and individual factors associated with this non-use. This is a multilevel study that considered contextual and individual data. Contextual data were collected from official publicly accessible databases of the Brazilian government, at the municipal level. The individual data came from the first follow-up of a Brazilian cohort that assessed patients with CD in 21 municipalities in endemic area for the disease. The sample consisted of 1,160 individuals with CD. The dependent variable ""use of health services in the last year"" was categorized as yes vs. no. The analysis was performed using Poisson regression with robust variance. The prevalence of non-use of health services in the last year was 23.5% (IC95%: 21.1-25.9). The contextual factor ""larger population"" (PR: 1.6; 95% CI = 1.2-2.0) and individual factors related to the lower severity of the disease as a functional class without limitations (PR: 1.6; 95% CI = 1.2-2.1) and unaltered N-terminal pro b-type natriuretic peptide levels (PR: 2.2; 95% CI = 1.3-3.6) increased the prevalence of non-use of the health service in the last year by people with CD. The results of this study showed that individual determinants are not isolated protagonists of the non-use of health services in the last year by people with CD, which reinforces the need for public policies that consider the contextual determinants of the use of health services by populations affected by the disease.