Temporal trends in the epidemiology of primary biliary cholangitis in the public healthcare system of Brazil: a large population-based study.

BACKGROUND

Population-based data on the epidemiology of primary biliary cholangitis (PBC) in Latin America are lacking. We aimed to characterise incidence, prevalence, and geographic patterns of PBC within Brazil's public healthcare system.

METHODS

We performed a nationwide population-based retrospective study using de-identified administrative data from the Unified Health System (DATASUS), curated through an artificial intelligence platform. Adults (≥16 years) with ICD-10 code K74.3 and public dispensation of ursodeoxycholic acid between 1 January 2021 and 31 December 2024 were included. Annual World Health Organization (WHO) age-standardised incidence and prevalence were estimated by sex, age group, and macroregion. Temporal trends were modelled with log-linear regression to obtain average annual percent change (AAPC). Correlation with macroregional Human Development Index (HDI) was explored.

FINDINGS: We identified 10,125 PBC patients [77.75% (7872) women; mean age 54.95 ± 20 years], within a nationwide dataset comprising approximately 230 million records. Age-standardised prevalence increased from 10.5 to 17.8 per 100,000 people (AAPC +18.2%; 95% CI: 12.5; 24.3%); while age-standardised incidence modestly declined from 4.00 to 3.42 per 100,000 person-years (AAPC -5.0%; 95% CI: -6.3; -3.7%). The female-to-male prevalence ratio in 2024 was 3.67:1, with peak rates at ages 66-70 years. A marked south-north gradient was observed, with highest rates in the South and Southeast and lowest in the North and Northeast; macroregional HDI showed a positive correlation with both incidence and prevalence.

INTERPRETATION: In Brazil, PBC is characterised by rising prevalence, relatively stable incidence, a narrower female predominance than historically reported, and marked geographic inequalities. These findings suggest possible under-recognition in less developed regions and provide a foundation for targeted public health strategies. The observed south-north gradient warrants further investigation in relation to environmental, socioeconomic, and healthcare-access factors.

FUNDING: This study is supported by a research grant from IPSEN.