Associated costs of hospitalizations due to external causes: time series analysis, Brazil, 2000-2023

Abstract Objective To analyze the temporal trend in case fatality and mean length of hospital stay, as well as the costs of hospitalizations due to external causes in Brazil between 2000 and 2023. Methods Time series study using data on hospitalizations due to external causes recorded in the Hospital Information System (SIH). Temporal trend analysis of mean length of stay and case fatality was performed using joinpoint regression, with calculation of the annual percentage change (APC), average annual percentage change (AAPC), and 95% confidence intervals (95%CI). Costs were measured using macro-costing. Results From 2000 to 2023, 23,009,176 (8.1%) hospitalizations due to external causes were recorded. Most occurred in the Southeast region (40.2%), among men aged 20–39 years (40.4%) and older women (31.4%). Falls were the main cause (39.8%). During this period, the mean length of stay decreased across all age groups, with the greatest reduction in the 0–9-year age group (AAPC −1.27; 95%CI −1.43; −1.13) and the smallest among older adults (AAPC −0.51; 95%CI −0.77; −0.29). There was an increasing trend in length of stay among older men between 2003 and 2017 (APC 0.41; 95%CI 0.15; 2.46) and among older women between 2005 and 2017 (APC 0.72; 95%CI 0.30; 2.49). Case fatality showed a decreasing trend between 2000 and 2023 (AAPC −0.58; 95%CI −1.10; −0.04), with higher rates among older adults (men: 7.2%; women: 5.0%). Hospitalizations incurred costs totaling BRL 44.24 billion, with higher expenditures in the Southeast region (BRL 18.33 billion) and among men (BRL 30.65 billion). Conclusion External causes remain a serious public health problem in Brazil. Despite the reduction in case fatality, their costs remain high, requiring strengthening of the health care network and control of the determinants of these health conditions.