Childhood Cancer Mortality in Low-HDI Brazilian States: A Nationwide Epidemiological Analysis (2015-2025)
Fernando Augusto Siuta dos Santos, Pedro Dytz Marin, Giulia Scain, Isabela Alicia Fink, Julia Loureiro Chaves Cé, Stéphanie Klein Brum, Mariana Weremeier Weber, Martina de Sá, Rafaela Sumienski Girardi, Solana de MeloPURPOSE
To evaluate regional disparities in childhood cancer mortality in Brazil between 2015 and 2025, focusing on states and regions associated with lower Human Development Index (HDI) indicators.
METHODS
This ecological and retrospective study analyzed data from the Hospital Information System of the Brazilian Unified Health System available through DATASUS. Hospitalizations related to chapter II of the International Classification of Diseases, 10th Revision (ICD-10), corresponding to neoplasms, were included. Patients younger than 19 years old were stratified into the following age groups: under 1 year, 1-4 years, 5-9 years, 10-14 years, and 15-19 years. Variables analyzed included number of hospitalizations, in-hospital mortality rates, and length of hospital stay according to Brazilian regions and states from 2015 to 2025.
RESULTS
A total of 681,019 pediatric cancer hospitalizations were recorded during the study period. The Southeast region accounted for the highest number of admissions (259,824), followed by the Northeast (208,139). However, the highest in-hospital mortality rates were observed in the North (3.66%) and Northeast (2.28%) regions, whereas the South presented the lowest rate (1.64%). Mortality in the North region was more than twice that observed in the South. Higher mortality rates were identified among children younger than 1 year and adolescents aged 15-19 years. States associated with lower HDI indicators, including Maranhão, Pará, Alagoas, and Piauí, demonstrated less favorable outcomes compared with states in the South and Southeast regions. Additionally, substantial regional differences were observed regarding total hospitalization days, suggesting disparities in healthcare infrastructure and access to specialized pediatric oncology services.
CONCLUSION
Significant regional inequalities in childhood cancer mortality persist in Brazil, disproportionately affecting regions with lower socioeconomic development. The findings suggest that social vulnerability, geographic barriers, delayed diagnosis, and unequal access to specialized oncology care may contribute to worse pediatric cancer outcomes in low-HDI regions. These results reinforce the need for public health policies focused on improving early diagnosis and expanding access to specialized pediatric oncology treatment in vulnerable areas.