Abstract Background In recent years, Brazil has shown a marked rise in inflammatory bowel disease (IBD) diagnoses and hospital admissions, reflecting an epidemiological transition towards patterns observed in developed nations. The COVID-19 pandemic disrupted healthcare delivery, potentially affecting diagnostic rates, disease outcomes and regional disparities. Evaluating these temporal and spatial trends is essential to understand the evolving burden of IBD and guide national healthcare strategies. Methods A retrospective ecological time-series study was conducted using nationwide data from the Brazilian Unified Health System (DATASUS). Hospitalisations and deaths related to Crohn’s disease (K50) and ulcerative colitis (K51) between January 2020 and December 2024 were extracted from the Hospital (SIH/SUS) and Mortality (SIM) Information Systems. Data were aggregated by year and macroregion, standardised per 100,000 inhabitants using IBGE population estimates. Records with missing data or incomplete coding were excluded. Analyses were performed in R (v4.3.2) and Python (v3.11). Temporal trends were assessed by Prais–Winsten regression, adjusted for first-order autocorrelation, with Annual Percentage Change (APC) and 95% confidence intervals. Interregional differences were tested by ANOVA or Kruskal–Wallis, with p 0.05 considered significant. Results Between 2020 and 2024, national IBD morbidity rose from 2.09 to 3.65 cases per 100,000 inhabitants (APC = +16.6%; 95%CI: 15.3–17.9; p = 0.0013), and mortality increased from 0.234 to 0.319 per 100,000 (APC = +9.9%; 95%CI: 9.0–10.7; p = 0.0018). No significant difference was found between pre-pandemic (2020–2021) and post-pandemic (2022–2024) periods. Regional analysis revealed heterogeneity: the Northeast had the steepest rise in morbidity (APC = +28.5%; p = 0.0007), followed by the Southeast (+14.5%) and South (+11.8%), while the North remained stable. Mortality increased mainly in the South (+12.6%), Centre-West (+12.9%) and Northeast (+10.2%). Conclusion IBD morbidity and mortality in Brazil increased significantly during the study period, confirming an advanced stage of epidemiological transition. Despite healthcare disruptions during COVID-19, trends remained upward, reflecting resilience of care networks and broader diagnostic access. The sharp rise in the Northeast suggests expansion of specialised services beyond traditional high-incidence regions. Persistent inequalities highlight the need for equitable access to biologics, decentralised infusion centres and stronger epidemiological surveillance. Reinforcing national IBD registries and monitoring systems is essential to promote early diagnosis, continuity of therapy and reduction of preventable complications. References: 1. Rocha, VS. Brazilian Journal of Health Review,Curitiba. 2024; 7(1):5407-5431. 2. Kaplan GG, Ng SC. 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Cornelio et al. (Thu,) studied this question.