Leukemia mortality analysis in the pediatric population in São Paulo state, Brazil, 2000-2019.

Childhood leukemia is the leading cause of cancerrelated death among children. In Brazil, limited data on pediatric leukemia trends hinder public health strategies. This study analyzed leukemia mortality in individuals aged 0-19years in São Paulo State, Brazil, from 2000 to 2019. An ecological time-series design was applied using official Mortality Information System (SIM/ DATASUS) microdata, identifying leukemia cases through ICD-10 codes C91-C96. Mortality trends were assessed using the Prais- Winsten regression model and Durbin-Watson test, estimating annual percent change (APC) and 95% confidence intervals. Between 2000 and 2019, 3687 deaths occurred (24.34/100,000), with a decreasing trend (APC: -0.017), from 1.69/100,000 in 2000 to 1.21/100,000 in 2019. Mortality was higher among males (56%), white individuals (71%), and adolescents aged 15-19years (30.8%). Acute lymphoblastic leukemia (C910) accounted for 50.8% of deaths, and unspecified septicemia (A419) was the most frequent associated cause (25.8%). SIGNIFICANCE STATEMENT Analyzing pediatric leukemia mortality trends in São Paulo state provides valuable epidemiological evidence to support surveillance, guide public health policies, and identify regional disparities. As one of Brazil's main referral centers, São Paulo offers important insights into the impact of demographic, socioeconomic, and healthcare factors on mortality, contributing to improved prevention and management strategies nationwide.