Screening Disparities and Colorectal Cancer Mortality Across Brazilian Regions: A National Ecological Study
Eleonora Balzan Fleck, Analissa Ferraz, Manuela Carneiro de Mattos, Lucas Mazzo, Camila Cunha da SilvaPURPOSE
Colorectal cancer (CRC) is among the leading causes of cancer-related mortality in Brazil, yet screening coverage remains critically low and unevenly distributed across the country. This study aimed to assess regional disparities in CRC screening rates and their ecological association with in-hospital mortality across Brazilian macro-regions, in the context of a middle-income country with marked socioeconomic inequalities.
METHODS
A cross-sectional ecological study was conducted using publicly available data from Brazil's national health information systems. Colonoscopy procedure rates, hospital admissions for CRC, and CRC-related deaths were retrieved from outpatient, inpatient, and mortality national databases, respectively, covering the period from 2020 to 2025 for procedural and admission data, and 2020 to 2024 for mortality data. The five Brazilian macro-regions served as the unit of analysis. All rates were standardized per 100,000 inhabitants using national census population estimates. The ratio of deaths to hospital admissions was calculated as a proxy for case fatality and late-stage diagnosis burden.
RESULTS
A total of 2,467,213 colonoscopies, 327,410 hospital admissions, and 114,790 CRC-related deaths were recorded during the study period. Colonoscopy rates ranged from 378/100,000 inhabitants in the North to 1,616/100,000 in the South—a 4.3-fold difference. Despite the lowest absolute mortality rate (23/100,000), the North region exhibited the highest death-to-admission ratio (64.3%), compared to 20.6% in the South. The Northeast and Central-West regions showed intermediate colonoscopy rates (556 and 999/100,000, respectively) and death-to-admission ratios of 42.5% and 37.5%.
CONCLUSION
Regions with the lowest colonoscopy coverage in Brazil demonstrated the highest proportional in-hospital mortality from CRC, suggesting that limited screening access leads to late-stage diagnosis rather than true lower disease burden. These findings highlight critical inequities in CRC early detection within a middle-income country and reinforce the need for region-specific screening policies prioritizing underserved populations.