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Trends in Hospitalizations, Costs, and In-hospital Mortality in Primary Biliary Cholangitis: a Decade of Real-world Evidence From Brazil’s Unified Health System

Year: 2026

Type: article

Abstract: BACKGROUND: Primary biliary cholangitis (PBC) is a rare autoimmune liver disease with limited epidemiological data from Latin America. OBJECTIVES: To analyzed nationwide trends in PBC-related hospitalizations and in-hospital mortality within Brazil's Unified Health System (SUS) from 2015 to 2024. METHODS: National hospital admission data for ICD-10 code K74.3 were analyzed. Hospitalization rates per 100,000 inhabitants, in-hospital mortality, costs, and mean length of stay were estimated. Temporal changes were assessed using interrupted time-series segmented regression, and descriptive analyses were stratified into pre-pandemic, pandemic (COVID-19), and post-pandemic periods. RESULTS: Between 2015 and 2024, 2,913 hospitalizations were recorded. The annual hospitalization rate ranged from 0.11 per 100,000 in 2022 to 0.19 per 100,000 in 2020, with a mean of 0.15 per 100,000 over the study period. Mean admission-level in-hospital mortality was 15.4%, ranging from 11.7%-18.5%. Mean length of stay was 7.9 days, with little variation over time. A transient increase in hospitalizations was observed in 2020 (β2 = +0.046, P=0.03), followed by a negative slope change in the post-2020 period (β2 = -0.009, P=0.04), suggesting temporary disruption related to the COVID-19 pandemic. The Southeast had the highest hospitalization burden. Inflation-adjusted expenditures totaled R$ 11.38 million (USD 2,112,227.43), with a mean cost of R$ 3,908 (USD 725.10) per admission. CONCLUSION: PBC-coded hospitalizations in Brazil are infrequent but associated with substantial in-hospital mortality. Strengthening outpatient management and regional equity in hepatology care remains a public health priority.

Source: Arquivos de Gastroenterologia

DOI: 10.1590/s0004-2803.24612026-070