Tendência temporal da morbimortalidade e custos das anomalias congênitas prioritárias entre crianças no Brasil, 2013 A 2022

Abstract

Priority congenital anomalies are a group recognized by the Ministry of Health of Brazil, and focusing on this specific set of conditions is an epidemiological surveillance strategy. Therefore, this study aimed to analyze temporal trends in morbidity and mortality and hospitalization costs due to priority congenital anomalies among children under 5 years of age in Brazil from 2013 to 2022. This was an ecological time-series study that assessed trends in mortality, hospitalizations, hospital costs, and case fatality in this population over the study period. We used data from the Mortality Information System and the Hospital Information System of the Brazilian Unified Health System (Sistema Único de Saúde – SUS), including records of deaths and hospitalizations whose underlying cause corresponded to one of the congenital anomalies listed in the national priority diagnoses defined by the Ministry of Health. We analyzed hospitalization costs using a macro-costing approach, adjusted for inflation using the National Broad Consumer Price Index, and converted to US dollars based on the exchange rate in December 2025. We assessed temporal trends in mortality rates, hospitalization rates, total costs, and case fatality using Prais–Winsten linear regression. We investigated factors associated with hospitalization costs using robust linear regression with M-estimators. There were 47,067 deaths and 219,744 hospitalizations, with total hospital costs of approximately BRL 2.13 billion related to priority congenital anomalies among children under five in Brazil between 2013 and 2022. Among the groups of priority congenital anomalies, congenital heart defects accounted for the highest number of deaths, hospitalizations, and associated costs. The temporal trend in mortality rates showed a stationary pattern in Brazil (p-value > 0.05). In contrast, hospitalization rates showed an increasing trend nationwide (APC: 2; 95% CI: 0.54 to 3.49; p-value =0.01), while the Northeast, Midwest, and South regions remained stable (p-value >0.05). Regarding hospitalization costs, the lowest expenditures occurred in the North region (BRL 108,034,820.92; USD 19,634,127.09), whereas the highest concentration of resources was observed in the Southeast (BRL 988,027,221.92; USD 179,562,958.33). The trend in hospital costs for priority congenital anomalies in Brazil remained stable over time (p-value >0.05). Multivariable analysis showed that mean hospitalization costs were significantly lower for females (p-value = 0.001) and for the South region (p-value < 0.001). Case fatality showed a decreasing trend in Brazil during the study period (APC: -3.09; 95% CI: -3.92 to -2.26; p value <0.01). In conclusion, priority congenital anomalies continue to have a significant impact on child morbidity and mortality and healthcare costs, particularly congenital heart defects. The observed trends suggest improvements in care, although these remain insufficient to consistently reduce the overall burden of the problem in the country. In this context, strengthening surveillance, early diagnosis, and the organization of healthcare services is essential to improve outcomes and reduce regional inequalities.