Regional Disparities in Cancer-Related Hospitalizations in Brazil (2015-2025): A Nationwide Analysis of DATASUS Hospital Information System Data

PURPOSE Cancer care in middle-income countries depends on timely access to diagnosis, referral, and hospital-based treatment. In Brazil, a universal public health system provides oncology care across highly heterogeneous regions. This study aimed to evaluate regionaldisparities in cancer-related hospitalizations and in-hospital mortality within Brazil’s public health system. METHODS A nationwide ecological study was conducted using publicly available data from the Hospital Information System of the Brazilian Unified Health System, accessed through DATASUS. We included hospital admissions registered between 2015 and 2025 with a primary diagnosis of malignant neoplasm, defined by ICD-10 codes C00–C97. Admissions for benign neoplasms, carcinoma in situ, and neoplasms of uncertain or unknown behavior were excluded. Outcomes included number of hospitalizations, in-hospital deaths, and in-hospital mortality rate. Analyses were stratified by Brazilian region and cancer site. RESULTS During the study period, 7,440,014 cancer-related hospitalizations and approximately 734,232 in-hospital deaths were recorded. The Southeast accounted for the largest number of admissions, with 3,334,775 hospitalizations, followed by the South, with 1,750,565, and the Northeast, with 1,622,993. Despite having a lower hospitalization volume, the North showed the highest in-hospital mortality rate, approximately 13.3%, followed by the Southeast, approximately 10.7%, and the Central-West, approximately 10.0%. The overall in-hospital mortality rate was approximately 9.9%. Breast cancer was the leading cause of cancer-related hospitalization, followed by colon cancer, malignancies of undefined or secondary sites, non-melanoma skin cancers, leukemia, prostate cancer, rectal and anal cancers, gastric cancer, and lung cancer. Lung cancer accounted for the largest number of in-hospital deaths among specific cancer sites, followed by breast, gastric, colon, and prostate cancers. CONCLUSION Nationwide hospital data reveal marked regional disparities in cancer-related hospitalizations and in-hospital mortality in Brazil. The higher mortality observed in regions with lower hospitalization volume suggests potential inequities in access, referral patterns, disease severity at admission, or regional oncology care capacity. These findings support the use of routinely collected administrative data to guide equitable cancer control policies and strengthen regional oncology networks in middle-income settings.