Epidemiological Profile and Temporal Trends of Exogenous Poisoning in the State of São Paulo and Brazil From 2010 to 2020

BACKGROUND: Exogenous poisoning is a compulsorily notifiable condition in Brazil, but analyses of its temporal trends in the state of São Paulo remain scarce. This study aimed to describe the epidemiological profile of exogenous poisoning in the state of São Paulo from 2010 to 2020 and its distribution across Regional Health Care Networks (Redes Regionais de Atenção à Saúde (RRAS)) and to analyze temporal trends in incidence, mortality, and case fatality compared with Brazil. METHODS: An observational time-series study was conducted using data from the Notifiable Diseases Information System (Sistema de Informação de Agravos de Notificação (SINAN)), obtained through the TabNet platform of the Brazilian Ministry of Health, and population estimates from the Brazilian Institute of Geography and Statistics. Sociodemographic, exposure, and outcome variables were analyzed. Incidence, mortality, and case fatality rates were calculated, and notifications were stratified by RRAS. Temporal trends were assessed by joinpoint regression, estimating the annual percent change (APC) with 95% confidence intervals (CIs) for each segment and for the entire period, with sensitivity analyses. RESULTS: A total of 315,266 notifications and 3,209 deaths were recorded in São Paulo, accounting for 25.7% of notifications and 27.4% of deaths in Brazil. Cases predominated among females (n=169,740; 53.8%), individuals aged 20-39 years (n=142,989; 45.4%), and White individuals (n=166,896; 52.9%). Medications were the main toxic agent (n=144,567; 45.9%), and suicide attempt was the main circumstance (n=125,491; 39.8%). Incidence was 64.7 cases per 100,000 inhabitants per year (Brazil: 54.8), mortality was 6.6 deaths per 1,000,000 inhabitants per year (Brazil: 5.2), and case fatality was 1.02% (Brazil: 0.95%). Incidence (APC=13.9%; p<0.001) and mortality (APC=11.7%; p<0.001) increased over the period, whereas case fatality showed no significant trend over the entire period; a decline between 2016 and 2020 (APC=-14.8%; p=0.031) was not statistically significant in sensitivity analyses. The highest incidence was observed in RRAS 12 (São José do Rio Preto/Araçatuba; 126.2 per 100,000 inhabitants per year), a region of intense agricultural activity. CONCLUSIONS: Exogenous poisoning in São Paulo showed increasing incidence and mortality, at levels above the national average, with a decline in case fatality after 2016 that should be interpreted with caution, and marked regional heterogeneity. These findings support strengthening toxicological surveillance and tailoring prevention strategies to regional and epidemiological characteristics.