REGIONAL INEQUALITIES IN HOSPITALIZATION FOR BLADDER CANCER IN BRAZIL: IMPACTS OF HOSPITAL COST, LENGTH OF STAY, AND MORTALITY (2013-2023)

Abstract

Introduction: Bladder cancer is the seventh most common neoplasm among men and the fourteenth among women in Brazil, and is a disease that predominantly affects the urinary bladder epithelium. The main histological classifications include urothelial carcinoma (transitional cells), squamous cell carcinoma, and adenocarcinoma. Several risk factors are associated with its development, such as advanced age, ethnicity, smoking, occupational exposure to industrial carcinogens, consumption of substances contaminated by arsenic, and family history of the disease. Objective: To analyze the relationship between the average cost of hospitalization, the average length of hospital stay, and the mortality rate from bladder cancer in the five Brazilian macro-regions, from 2013 to 2023. Method: This is an observational ecological study, based on secondary data obtained from the Hospital Information System of the Unified Health System (SIH/SUS), available at DataSUS. Information on hospital morbidity, hospitalization costs, and clinical outcomes of hospitalized patients diagnosed with bladder cancer was analyzed. Results: The Southeast region had the highest absolute number of hospitalizations, while the North region recorded the lowest frequency. The highest average cost per hospitalization was observed in the Northeast region, while the North region had the lowest average hospitalization value. Regarding the average length of hospital stay, the North region led, concomitantly, the highest mortality rate among the regions analyzed. The other regions had an average length of hospital stay of around 4.7 days, with an average hospital mortality rate of approximately 6.5% over the study period. Discussion: The findings suggest that the North region, despite having the lowest average cost of hospitalization, faces greater challenges related to hospital care, reflected in longer hospital stays and higher mortality rates. Factors such as limited availability of hospital infrastructure, barriers to access to specialized treatments, and socioeconomic inequalities can contribute to this scenario. On the other hand, the Southeast region, despite presenting average costs similar to those of the North region, exhibits the best clinical indicators, suggesting greater efficiency in resource management and greater access to specialized care. The Northeast region, although registering the highest investments in hospitalizations, did not present the best clinical outcomes, possibly due to structural differences in health care and in the quality of hospital care. Conclusion: The regional disparities evidenced in the study highlight the need for investments aimed at improving the quality of hospital care, especially in the North region, where the indicators of hospital stay and mortality are higher. Strengthening hospital infrastructure, expanding access to specific treatments, and optimizing cost management are key strategies for reducing regional inequalities in the hospital approach to bladder cancer in Brazil.

DOI: https://doi.org/10.56238/sevened2025.011-003