TRENDS AND REGIONAL DISPARITIES OF CONGENITAL SYPHILIS IN BRAZIL FROM 2014 TO 2023: AN ECOLOGICAL TIME-SERIES STUDY.
DOI:
https://doi.org/10.66104/mtfg4b73Keywords:
Syphilis, Congenital, Infectious Disease Transmission, Vertical, Time Series Studies, Epidemiology, Health InequitiesAbstract
Between 2014 and 2023, congenital syphilis expanded consistently in Brazil, with no reversal in any of the five geographic macroregions. This ecological time-series study analyzed the trends and regional disparities of disease incidence rates across all 27 federative units, using data from SINAN and SINASC available at DATASUS. The outcome was the incidence rate per 1,000 live births, calculated by federative unit and year. Analyses included Prais-Winsten regression preceded by the Durbin-Watson test, Joinpoint analysis, Mann-Kendall with Sen's estimator, Kruskal-Wallis with Dunn/Bonferroni post-hoc test, and Spearman correlation between rates and annual proportions of care indicators. A total of 237,228 confirmed cases were recorded during the period, with the national rate rising from 5.54 to 9.85 cases per 1,000 live births, an annual percent change of +6.23% (95%CI: 2.99–9.57). All macroregions showed an increasing trend, with distinct patterns: an inflection in 2017 for Brazil and the Southeast, a biphasic pattern with significant resumption after 2020 in the North and Central-West, an earlier inflection in 2016 in the South, and a continuous linear trend in the Northeast. Among cases, 81.2% occurred in infants of mothers who attended prenatal care, 33.6% were diagnosed only at delivery, and 74.7% of partners did not receive treatment. The rate of stillbirths and miscarriages due to syphilis increased by 130.6% during the period. The findings indicate that control of vertical transmission requires reorientation of prenatal care, with emphasis on timely screening, partner treatment, and regionally differentiated strategies.
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