Morbimortalidade por doenças tropicais negligenciadas no Brasil, 2000-2024: padrões espaço-temporais, iniquidades e prioridades para a resposta no SUS

Abstract

Introduction: Neglected Tropical Diseases (NTDs) are sensitive markers of structural inequalities and serve as proxies for equitable human and social development: where NTDs persist, long-standing barriers to sanitation, adequate housing, education, social protection, and timely, effective health services also persist. In Brazil, their persistence reflects the territorial reproduction of poverty, segmented access to care and surveillance, and insufficient political prioritization of diseases that disproportionately affect Black, Indigenous, rural, and urbanperipheral populations. Despite their relevance, integrated evidence on the country’s NTDrelated morbidity and mortality burden remains limited. Objective: Analyse the magnitude, spatiotemporal patterns, and factors associated with NTD-related morbidity and mortality in Brazil from 2000 to 2024. Methods: Mixed-methods study combining ecological, crosssectional and longitudinal components to analyze epidemiological and operational indicators of NTD-related morbidity and mortality. We used hospitalization data (AIH/SIH-SUS), mortality data (SIM), and case data (SINAN and/or surveys). Selection included underlying and associated causes in SIM and primary and secondary diagnoses in SIH-SUS. Analyses were integratively organized into eight analytical strands: (1) national magnitude and trends in cases and deaths; (2) intersectional inequalities by sex and race/skin color; (3) burden in children (0– 11 and 0–14 years); (4) spatiotemporal persistence of leprosy clusters; (5) rurality and factors associated with risk of death; (6) mortality and in-hospital mortality due to neglected mycoses; (7) mortality, hospitalisations and in-hospital mortality due to paracoccidioidomycosis; and (8) mortality and in-hospital mortality due to ectoparasitoses. We estimated crude and age- and sex-standardized rates (direct method), trends using segmented regression (Joinpoint, Poisson model), and spatial/spatiotemporal patterns (including cluster detection using SaTScan). Associated factors were examined using multivariable modelling. As this study used secondary, de-identified data, submission to a Research Ethics Committee was not required. Results: NTDs showed a high burden in Brazil, with 583,960 cases in 2016–2020 (annual mean 116,792) and 152,894 cases in 2015; in the same periods, high cause-specific rates were observed for conditions such as snakebite envenoming (2016–2020) and Schistosoma mansoni infection (2015). Regarding mortality, 7,978 NTD deaths were recorded in 2015 and 40,857 deaths in 2016–2020 (annual mean 8,171), with Chagas disease as the primary contributor to mortality rates. Inequalities were striking: incidence rates were higher among men and Indigenous peoples, whereas mortality rates were higher among Black men. Among children (2010–2023), the burden was substantial and sensitive to the inclusion of arboviruses: with arboviruses, there were an estimated 1,644,521 cases (0–11 years) and 2,315,516 (0–14 years), with 1,890 and 2,177 deaths, respectively; without arboviruses, there were 222,048 cases (0– 11 years) and 299,024 (0–14 years), with 1,086 and 1,182 deaths, respectively. Spatiotemporal analyses identified persistent leprosy clusters (2001–2023) concentrated in the North and Northeast regions, with 795,802 new cases (adjusted rate: 17.58/100,000). Over 2000–2024, an estimated 253,774 NTD deaths occurred (0.8% of all deaths in Brazil), of which 42,463 were recorded in municipalities classified as rural, with higher risk of death among men, Indigenous peoples, and individuals with no schooling. In addition, conditions often underrepresented in NTD agendas showed relevant burden: neglected mycoses accounted for 22,320 deaths (adjusted rate 0.45/100,000) and 4,471 in-hospital deaths (0.09/100,000); for paracoccidioidomycosis, 4,904 deaths, 18,239 hospitalizations, and 1,136 in-hospital deaths were recorded; for ectoparasitoses, 2,894 deaths and 736 in-hospital deaths were recorded, with rates per 1,000,000 inhabitants. Conclusion: NTD-related morbidity and mortality in Brazil exhibit persistent spatiotemporal patterns and structural inequalities by territory, race/skin color, sex, age, and rurality, with significant variation in the context of COVID-19. These findings support territorial prioritization, strengthened surveillance–care integration, and intersectoral strategies within the Unified Health System (SUS), including a focus on childhood and increased visibility of endemic mycoses and ectoparasitoses as relevant causes of mortality and in-hospital mortality, compounded by the difficulty of accessing medium and high complexity services. This body of evidence provides epidemiological foundations for equityoriented action and the elimination of NTDs, converging with goals for human development and reduced vulnerabilities.