Chronic Rheumatic Heart Disease in Older Brazilians: Hospitalizations and In-Hospital Deaths, 2015-2024

Q: What are the key findings of this study?

Chronic rheumatic heart disease hospitalizations among older Brazilians declined until 2020-2021 then rebounded through 2024 (from 10.56 to 10.78 per 100,000), while death rates fell from 1.45 to 1.23.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Chronic rheumatic heart disease (n=27046). Intervention: Chronic rheumatic heart disease. Primary outcome: Annual crude hospitalization and in-hospital death rates per 100,000 older adults (AAPC 0.45%, p=0.637 for women, 0.811 for men).

Q: What does this research mean for the field?

Chronic rheumatic heart disease hospitalizations among older Brazilians declined until 2020–2021 and subsequently rebounded through 2024, while crude population-based in-hospital mortality rates declined overall. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Julia R Teixeira; ISABELLE SUGARONI CIQUINI; Alana  R da Costa Rosa; Lorenzo Fogaça Benedet; Mateus Ferreira Marques; Tuany Caroline Bernardi; Thaís Cristina Esteves-Pereira

doi:10.7759/cureus.118576

October 25, 2026CureusOpen Access

Chronic Rheumatic Heart Disease in Older Brazilians: Hospitalizations and In-Hospital Deaths, 2015-2024

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Key result

Older adult rheumatic heart disease hospitalizations rebounded post-2021 despite declining in-hospital mortality.

AAPC 0.45%
P=0.637 for women, 0.811 for men
n=27,046

Figures

Why the study?

Chronic rheumatic heart disease remains a cause of morbidity in older adults, prompting this analysis of hospitalizations and in-hospital deaths among older Brazilians by sex, macroregion, and temporal trends.

Key Points

To analyze hospitalizations and in-hospital deaths associated with chronic rheumatic heart disease among Brazilians aged 60 years or older from 2015 to 2024, assessing differences by sex, macroregion, and temporal trends.
Ecological time-series study analyzing records from the Brazilian Unified Health System Hospital Information System (SIH/SUS) and official population estimates between 2015 and 2024.
Evaluated 27,046 hospitalizations and 3,314 in-hospital deaths among older adults aged 60 years or older.
Calculated crude hospitalization and in-hospital death rates per 100,000 older adults, using joinpoint regression to estimate annual and average annual percent changes.
Hospitalizations rose from 2,632 in 2015 to 3,683 in 2024 (rates: 10.56 to 10.78 per 100,000), while in-hospital deaths increased from 362 to 419 as population death rates declined from 1.45 to 1.23 per 100,000.
Nationally, female hospitalization rates fell by 7.05% annually (2015–2020) and rebounded by 10.69% annually (2020–2024; both p < 0.001); male rates fell by 6.83% annually (2015–2021; p = 0.004) and rose by 16.77% annually (2021–2024; p = 0.008), though overall ten-year trends were not statistically significant.
Regional trends showed marked heterogeneity; women in the Northeast experienced sustained increases in both hospitalization rates (APC = 5.08%; p = 0.021) and in-hospital death rates (APC = 11.88%; p < 0.001).

Study Design

Type

Observational (n=27,046)

Multicenter

Yes

Structured PICO

P

Population

27,046 hospitalization events (51.08% female) for chronic rheumatic heart disease among Brazilian older adults aged ≥60 years across a 10-year period from 2015 to 2024.

O

Outcome

Annual crude hospitalization rates and annual crude in-hospital death rates per 100,000 older adults (aged ≥60 years) associated with chronic rheumatic heart disease from 2015 to 2024, analyzed for temporal trends (annual percent change [APC] and average annual percent change [AAPC]) by sex and macroregion.hard clinical

Main Result

Effect estimate: AAPC 0.45%

Absolute Event Rate: 10.78% vs 10.56%

p-value: p=0.637 for women, 0.811 for men

This national ecological study demonstrates a persistent and regionally heterogeneous hospital burden of chronic rheumatic heart disease among older Brazilians, characterized by a sharp decline and subsequent rebound in admissions around 2020-2021 and sustained increases in both hospitalizations and in-hospital deaths among women in the Northeast.

Limitations

Data from SIH/SUS only captures hospitalizations funded by the public health system and excludes care financed exclusively by the private sector.
Records represent hospitalization events rather than unique individuals, so repeated admissions by the same patient may be counted multiple times.
Case identification relies on the accuracy of ICD-10 diagnostic coding in administrative records.
Aggregated data lack clinical details such as disease severity, valvular characteristics, comorbidities, and prior treatments.
Only in-hospital deaths were captured, which does not reflect total population mortality from chronic rheumatic heart disease.
Ecological study design precludes individual-level inferences and causal interpretations.
SIH/SUS captures hospitalizations funded by the public health system (SUS) and does not fully include private sector care
Records represent hospitalization events rather than unique individuals, so repeated admissions by the same patient cannot be distinguished
Case identification depends on the accuracy of diagnostic coding in Hospital Admission Authorizations
Aggregated data lack information on clinical severity, valvular characteristics, comorbidities, previous treatments, or indications for hospitalization
Ecological design and relatively short annual time series limit individual-level inferences and causal interpretations

Implication

Rebound in chronic rheumatic heart disease hospitalizations after 2020 warrants monitoring; leaves open regional drivers and prevention needs in older Brazilians.

Abstract

Introduction and objectives: Chronic rheumatic heart disease remains a cause of morbidity in older adults.This study analyzed hospitalizations and in-hospital deaths associated with the disease among Brazilians aged 60 years or older from 2015 to 2024, examining differences by sex and macroregion and temporal trends.Methods: This ecological time-series study used data from the Brazilian Unified Health System Hospital Information System and official population estimates.Annual crude hospitalization and in-hospital death rates per 100,000 older adults were calculated by sex and macroregion.Joinpoint regression was used to estimate annual and average annual percent changes.Results: Hospitalizations increased from 2,632 in 2015 to 3,683 in 2024, while crude hospitalization rates changed from 10.56 to 10.78 per 100,000 older adults.In-hospital deaths increased from 362 to 419, whereas corresponding rates declined from 1.45 to 1.23 per 100,000.Nationally, hospitalization rates among women declined by 7.05% annually during 2015-2020 and increased by 10.69% annually during 2020-2024 (both p < 0.001).Among men, rates declined by 6.83% annually during 2015-2021 (p = 0.004) and increased by 16.77% annually during 2021-2024 (p = 0.008).Over the full period, average national trends were not statistically significant for either outcome in either sex.Regional patterns were heterogeneous.In the Northeast, women showed sustained increases in hospitalization rates (5.08% annually; p = 0.021) and in-hospital death rates (11.88% annually; p < 0.001).Conclusions: Hospitalization rates declined and subsequently rebounded, while population-based inhospital death rates and their temporal patterns varied by sex and region.These patterns reflect the joint contribution of hospitalization frequency and the proportion of admissions ending in death and should not be interpreted as deaths causally attributable to chronic rheumatic heart disease.Regional variation indicates an uneven distribution of recorded hospital utilization and outcomes but does not, by itself, establish inequalities in access to or quality of care.The recent increase in hospitalizations indicates greater hospital utilization and should not be interpreted as evidence of increased disease incidence.Continued surveillance incorporating both hospitalization rates and the proportion of admissions resulting in death is warranted to better characterize temporal and regional patterns among older adults.

Discussion

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Cite This Study

Teixeira et al. (2026) conducted an observational in Chronic rheumatic heart disease (n=27,046). Chronic rheumatic heart disease was evaluated on Annual crude hospitalization and in-hospital death rates per 100,000 older adults (AAPC 0.45%, p=0.637 for women, 0.811 for men). Chronic rheumatic heart disease hospitalizations among older Brazilians declined until 2020-2021 then rebounded through 2024 (from 10.56 to 10.78 per 100,000), while death rates fell from 1.45 to 1.23.

synapsesocial.com/papers/6ae13cba043bfbd6353324d2 https://doi.org/10.7759/cureus.118576

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Chronic Rheumatic Heart Disease in Older Brazilians: Hospitalizations and In-Hospital Deaths, 2015-2024

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Chronic Rheumatic Heart Disease in Older Brazilians: Hospitalizations and In-Hospital Deaths, 2015-2024

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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