Hospital Mortality and Lethality From Colorectal Cancer in Brazil: A Nationwide Ecological Analysis of Regional and Age-Group Disparities (2015-2024)
Cássio Minuzzo, Fernando Keizo Lima, Anita Nunes de Oliveira, Angélica Ferreira de Andrade, Lara Feliciano Potrich, Lívia Salaberry Massarani, Gabriela das Neves Sampaio de Souza, Maria Fernanda Assis, Juliana Boaventura, Gabriel De Marchi AioffiPURPOSE
Colorectal cancer (CRC) represents a significant public health concern in Brazil, with evidence of increasing disease burden in younger populations. This study aimed to analyze the temporal trend of hospital mortality and in-hospital lethality rates for CRC in Brazil between 2015 and 2024, correlating regional and age-group disparities throughout the period.
METHODS
An ecological time-series study was conducted using secondary data from the Hospital Information System of the Unified Health System via DATASUS. Hospital deaths due to CRC between 2015 and 2024 were analyzed. Variables included hospital mortality rate (per 100,000 inhabitants), using Brazilian Institute of Geography and Statistics demographic estimates as denominator, and in-hospital lethality rate. Analyses were stratified by macro-region and age group, with focus on young adults (20-49 years), to establish an epidemiological overview of hospital mortality during the period.
RESULTS
The analyzed period recorded 68,445 hospital deaths from CRC in Brazil. Annual deaths increased 61%, rising from 5,463 in 2015 to 8,793 in 2024. The national hospital mortality rate increased from 3.90 to 5.65 per 100,000 inhabitants, a 44.8% rise. Regionally, the South and Southeast presented the highest rates in 2024 (7.39 and 7.40 per 100,000, respectively). The North region, however, recorded the highest relative hospital mortality growth (95.6%) and the highest lethality rate (0.12), more than double that of the South (0.05). Among adults aged 20-49, hospital mortality grew 25.3%, from 0.91 to 1.14 per 100,000 inhabitants, while in-hospital lethality remained stable between 0.04 and 0.06, suggesting persistent unfavorable hospital outcomes despite increasing mortality rates.
CONCLUSION
Rising CRC mortality among young adults highlights a growing burden on Brazil's working-age population, exposing stark regional inequities in diagnosis access, especially in the North. Since current screening focuses on individuals over 45-50, these findings underscore the urgency to reform public policies. Expanding early detection to younger populations is an ethical, healthcare, and economic imperative, essential to reduce premature mortality, mitigate fiscal risks, and secure the country's productive future.