Paracoccidioidomycosis in Brazil: 25-Year Nationwide Trends in Mortality, Hospitalisations and In-Hospital Deaths of a Neglected Systemic Mycosis

Abstract

Objective: To analyse mortality, hospitalisations and in-hospital mortality related to paracoccidioidomycosis (PCM) in Brazil, 2000–2024, from a spatio-temporal and social inequalities perspective. Methods: We conducted a mixed ecological study using death certificates from the Mortality Information System and hospital admissions from the Hospital Information System of the Brazilian Unified Health System, including admissions that resulted in death. Records with PCM (ICD-10 B40–B41) as the underlying or associated cause of death, or as the primary or secondary diagnosis, were included. Sex- and age-standardised rates (per 1,000,000 inhabitants) were estimated for Brazil and macro-regions. Time trends were assessed using Joinpoint regression and spatial distribution was evaluated by health region. Results: We identified 4904 deaths mentioning PCM over the 25-year period (2980 [60.8%] as the underlying cause and 1924 [39.2%] as an associated cause) corresponding to a standardised mortality rate of 1.00/1,000,000 inhabitants. Deaths occurred predominantly among men of working age. Mortality declined nationally (average annual percent change [AAPC] −3.85%). There were 18,239 hospital admissions (standardised hospitalisation rate 3.71/1,000,000), which also decreased over time (AAPC −2.83%). In total, 1136 admissions resulted in death (standardised in-hospital mortality rate 0.23/1,000,000), with no significant overall trend. The highest mortality, hospitalisation and in-hospital mortality rates clustered in Rondônia, northern Mato Grosso and health regions in the Southeast and Central-West. Conclusions: Despite declining national rates, PCM remains concentrated in specific endemic territories, disproportionately affecting socially vulnerable populations and reinforcing its status as a neglected systemic mycosis in Brazil. Making PCM a nationally notifiable disease is essential to reduce its burden.