National trends in renal cancer mortality and public-sector surgical delivery in Brazil: a 11-year ecological analysis
Abstract Objectives Renal cell carcinoma represents a growing global health challenge, characterized by rising incidence rates and high mortality associated with late-stage detection. In Brazil, the asymptomatic nature of early-stage disease and the lack of routine screening frequently delay diagnoses, while population-based data on disparities in surgical access remain limited. This study aims to describe parallel national trends in renal cell carcinoma (RCC) mortality and public-sector surgical delivery patterns in Brazil between 2013 and 2023, and to assess demographic and regional disparities. Methods This nationwide ecological study analyzed secondary data from two Brazilian administrative databases: the Mortality Information System (SIM) and the Hospital Information System of the Unified Health System (SIH/SUS). Age-standardized mortality rates were calculated using population estimates from the Brazilian Institute of Geography and Statistics (IBGE). Temporal trends were assessed using Joinpoint regression to estimate Annual Percent Change (APC). Surgical data were analyzed descriptively to evaluate procedure volume and modality distribution within the public health system. Results Between 2013 and 2023, a total of 70,588 renal surgeries were performed within SUS, of which approximately 33,000 were oncological nephrectomies. Among all renal surgeries, radical procedures predominated (92.2 %), while partial nephrectomies accounted for only 7.8 % of the total volume. In the oncological subset, which reached 4,277 annual procedures by 2023, radical techniques accounted for 63.6 % of cases and partial nephrectomies 36.4 %. Mortality analysis demonstrated significant increases among individuals aged ≥80 years in both sexes, whereas middle-aged groups (60–79 years) showed initial increases followed by stabilization. Regional disparities were observed in surgical rates, with the Northeast recording the lowest rate (18.34 per 100,000 inhabitants/year) and the South the highest (48.56 per 100,000 inhabitants/year). Conclusions RCC mortality in Brazil demonstrates age- and region-specific heterogeneity at the population level. Surgical data reveal persistent disparities in access to oncological surgical treatment within the public sector. These findings provide complementary system-level indicators of cancer burden and distribution of healthcare infrastructure, highlighting areas for policy intervention and improvements in national data integration.