Geographic and Temporal Patterns in Biologic Prescriptions for Inflammatory Bowel Diseases in the Public Healthcare System in Brazil: An Ecological Study
Corresponding Author
Caroline Tianeze de Castro
Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
Correspondence:
Caroline Tianeze de Castro ([email protected])
Search for more papers by this authorMarcio dos Santos Natividade
Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
Search for more papers by this authorMarcos Pereira
Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
Search for more papers by this authorSamilly Silva Miranda
Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
Search for more papers by this authorErika Aragão
Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
Search for more papers by this authorCarlos Antonio de Souza Teles Santos
Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil
Search for more papers by this authorDjanilson Barbosa dos Santos
Center for Health Sciences, Federal University of Recôncavo da Bahia, Santo Antônio de Jesus, Brazil
Search for more papers by this authorCorresponding Author
Caroline Tianeze de Castro
Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
Correspondence:
Caroline Tianeze de Castro ([email protected])
Search for more papers by this authorMarcio dos Santos Natividade
Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
Search for more papers by this authorMarcos Pereira
Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
Search for more papers by this authorSamilly Silva Miranda
Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
Search for more papers by this authorErika Aragão
Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
Search for more papers by this authorCarlos Antonio de Souza Teles Santos
Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil
Search for more papers by this authorDjanilson Barbosa dos Santos
Center for Health Sciences, Federal University of Recôncavo da Bahia, Santo Antônio de Jesus, Brazil
Search for more papers by this authorFunding: The authors received no specific funding for this work.
ABSTRACT
Purpose
To analyze the geographic and temporal patterns of biologic prescriptions for inflammatory bowel disease (IBD) in Brazil's public national unified health system (SUS).
Methods
This ecological study used data from patients with IBD in the SUS Outpatient Information System between 2008 and 2022. Prais-Winsten regression was used to estimate the trends in prescription rate of biologics. For geographic analysis, average prescription rate of biologics was calculated by state for three periods: 2008–2012, 2013–2017, and 2018–2022. Global Moran's index (GMI) and local indicators of spatial autocorrelation (LISA) were used to assess spatial autocorrelation and identify spatial clusters of biologic prescriptions, respectively.
Results
The prescription rate of biologics increased from 3.0% to 16.7%. Infliximab was the most prescribed drug from 2008 to 2012 (3.0%–4.2%), and adalimumab was the most widely prescribed drug from 2013 to 2022 (4.3%–9.1%). Higher prescription rates of biologics were observed in patients with Crohn's disease than in those with ulcerative colitis (40.5% vs. 3.2%). Biologics were primarily prescribed in the Southeast and South; however, the central-western and northern regions showed greater changes in prescription rates over time. There were increased clusters of high biologic prescriptions across the three evaluated periods.
Conclusions
The increase in biologic prescriptions over time may be attributed to their enhanced efficacy in inducing and maintaining IBD remission. Biologic prescriptions in Brazil are experiencing temporal and geographical changes, indicating that disparities in drug prescriptions may decrease with universal, equitable healthcare access, despite administrative challenges in obtaining these medications through SUS.
Conflicts of Interest
The authors declare no conflicts of interest.
Supporting Information
| Filename | Description |
|---|---|
| pds70114-sup-0001-Supinfo.docxWord 2007 document , 7.2 MB |
Table S1. Definition of inflammatory bowel diseases. Table S2. Frequency and crude biologic prescription rates (%) by medicine according to the population characteristics. Brazil, 2008–2022. Figure S1. Regional Divisions of Brazil. Figure S2. Crude biologic prescription rates (%): (a) total; (b) by biologic drug. Brazil, 2008–2022. Figure S3. Crude biologic prescription rates (%) by age group. Brazil, 2008–2022. Figure S4. Crude biologic prescription rates (%) by biologic drug according to age group: (a) children; (b) adults; (c) older adults. Brazil, 2008–2022. Figure S5. Crude biologic prescription rates (%) by sex. Brazil, 2008–2022. Figure S6. Crude biologic prescription rates (%) by biologic drug according to sex: (a) female; (b) male. Brazil, 2008–2022. Figure S7. Crude biologic prescription rates (%) by race. Brazil, 2008–2022. Figure S8. Crude biologic prescription rates (%) by biologic drug according to race: (a) nonblack; (b) black. Brazil, 2008–2022. Figure S9. Crude biologic prescription rates (%) by IBD type. Brazil, 2008–2022. Figure S10. Crude biologic prescription rates (%) by biologic drug according to IBD type: (a) Crohn’s disease; (b) Ulcerative colitis. Brazil, 2008–2022. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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