Geographic and Temporal Trends in Biologic Therapy for Inflammatory Bowel Disease within Brazil’s Public Healthcare System (2008–2022)
1
Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
2
Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil
3
Center for Health Sciences, Federal University of Recôncavo da Bahia, Santo Antônio de Jesus, Brazil
Popul. Med. 2026;8(Supplement Supplement 1):A1504
ABSTRACT
BACKGROUND:
Access to high-cost medications is a critical pillar of Universal Health Coverage. This study aims to analyze the temporal trends and geographic distribution of biologic prescriptions for Inflammatory Bowel Disease (IBD) within Brazil’s Unified Health System (SUS) to identify progress and persistent regional disparities.
METHODS:
An ecological study was conducted using data from the SUS Outpatient Information System (2008–2022). Temporal trends were estimated using Prais-Winsten regression. To evaluate geographic distribution, prescription rates were mapped across 27 federative units over three periods (2008-12, 2013-17, 2018-22). Spatial autocorrelation and clustering were assessed using Global Moran’s Index (GMI) and Local Indicators of Spatial Association (LISA).
RESULTS:
The overall prescription rate of biologics rose significantly from 3.0% to 16.7% over the study period. While Infliximab led initial prescriptions (2008–2012), Adalimumab became the most utilized biologic from 2013 onwards. A significant clinical disparity remains, with higher utilization in Crohn’s disease compared to ulcerative colitis (40.5% vs. 3.2%). Geographically, while prescriptions were historically concentrated in the Southeast and South, the Central-West and North regions exhibited the highest rates of growth. Spatial analysis confirmed an expansion of high-utilization clusters, suggesting a gradual decentralization of specialized care.
CONCLUSIONS:
Biologic utilization for IBD in Brazil has expanded rapidly, reflecting global shifts in treatment standards. However, the concentration of prescriptions in wealthier regions highlights ongoing challenges in equitable drug access. These findings emphasize the need for targeted public health policies to address administrative and regional barriers, ensuring that the promise of universal, equitable healthcare is realized for all IBD patients regardless of their location.
Access to high-cost medications is a critical pillar of Universal Health Coverage. This study aims to analyze the temporal trends and geographic distribution of biologic prescriptions for Inflammatory Bowel Disease (IBD) within Brazil’s Unified Health System (SUS) to identify progress and persistent regional disparities.
METHODS:
An ecological study was conducted using data from the SUS Outpatient Information System (2008–2022). Temporal trends were estimated using Prais-Winsten regression. To evaluate geographic distribution, prescription rates were mapped across 27 federative units over three periods (2008-12, 2013-17, 2018-22). Spatial autocorrelation and clustering were assessed using Global Moran’s Index (GMI) and Local Indicators of Spatial Association (LISA).
RESULTS:
The overall prescription rate of biologics rose significantly from 3.0% to 16.7% over the study period. While Infliximab led initial prescriptions (2008–2012), Adalimumab became the most utilized biologic from 2013 onwards. A significant clinical disparity remains, with higher utilization in Crohn’s disease compared to ulcerative colitis (40.5% vs. 3.2%). Geographically, while prescriptions were historically concentrated in the Southeast and South, the Central-West and North regions exhibited the highest rates of growth. Spatial analysis confirmed an expansion of high-utilization clusters, suggesting a gradual decentralization of specialized care.
CONCLUSIONS:
Biologic utilization for IBD in Brazil has expanded rapidly, reflecting global shifts in treatment standards. However, the concentration of prescriptions in wealthier regions highlights ongoing challenges in equitable drug access. These findings emphasize the need for targeted public health policies to address administrative and regional barriers, ensuring that the promise of universal, equitable healthcare is realized for all IBD patients regardless of their location.
| eISSN: | 2654-1459 |
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