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Association Between Socioeconomic Conditions and Biologic Prescriptions for Inflammatory Bowel Diseases in the Brazilian Public Healthcare System: An Ecological Study.

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Τίτλος: Association Between Socioeconomic Conditions and Biologic Prescriptions for Inflammatory Bowel Diseases in the Brazilian Public Healthcare System: An Ecological Study.
Συγγραφείς: de Castro CT; Institute of Collective Health, Federal University of Bahia, Salvador, Brazil., de Oliveira LCF; State University of Feira de Santana, Feira de Santana, Brazil., Santos CAST; 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., Dos Santos DB; Center for Health Sciences, Federal University of Recôncavo da Bahia, Santo Antônio de Jesus, Brazil.
Πηγή: Pharmacoepidemiology and drug safety [Pharmacoepidemiol Drug Saf] 2026 Jul; Vol. 35 (7), pp. e70430.
Τύπος έκδοσης: Journal Article
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: Wiley Country of Publication: England NLM ID: 9208369 Publication Model: Print Cited Medium: Internet ISSN: 1099-1557 (Electronic) Linking ISSN: 10538569 NLM ISO Abbreviation: Pharmacoepidemiol Drug Saf Subsets: MEDLINE
Imprint Name(s): Original Publication: Chichester, West Sussex : Wiley, 1992-
Ιατρικοί όροι (MeSH): Inflammatory Bowel Diseases*/drug therapy , Inflammatory Bowel Diseases*/economics , Inflammatory Bowel Diseases*/epidemiology , Practice Patterns, Physicians'*/statistics & numerical data , Socioeconomic Factors*, Brazil/epidemiology ; Income/statistics & numerical data ; Humans ; Socioeconomic Disparities in Health ; Female
Περίληψη: Purpose: Inflammatory bowel diseases (IBD) are chronic conditions affecting millions of people globally. Brazil's public healthcare system provides free access to IBD medications. However, socioeconomic conditions may affect prescribing patterns. This study examined associations between income inequality, human development, and biologic prescription rates for IBD in the Brazilian public health system (SUS).
Methods: Data from the SUS Outpatient Information System (2008-2022) were analyzed. The biologic prescription rate (percentage of biologic prescriptions among all IBD prescriptions) was the outcome of interest. Random-effects negative binomial regression for panel data evaluated associations between the Gini Index, Municipal Human Development Index (MHDI), and biologic prescriptions while controlling for demographic, social, and healthcare variables.
Results: Biologic prescription rates for IBD in Brazil increased from 3.03% to 16.69%. Municipalities with higher income inequality had 6% lower prescription rates than those with higher income equality (RR 0.94; 95% CI 0.92-0.96). Using low MHDI as the reference, municipalities with medium (RR 0.79; 95% CI 0.70-0.91), high (RR 0.68; 95% CI 0.60-0.78), and very high MHDI (RR 0.66; 95% CI 0.58-0.76) had progressively lower rates.
Conclusions: Income inequality and human development are associated with biologic prescription rates for IBD within the SUS. The paradoxical MHDI pattern probably reflects differential engagement of private health insurance across development levels, whereby biologic-eligible patients in wealthier municipalities access therapy outside the SUS and are not captured by SIA. These findings underscore the need for policies addressing structural disparities in IBD care and for future research integrating public and private sector prescription data.
(© 2026 John Wiley & Sons Ltd.)
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Grant Information: Coordination for the Improvement of Higher Education Personnel (CAPES)
Contributed Indexing: Keywords: Brazil; drug prescriptions; health inequalities; inflammatory bowel diseases; socioeconomic factors
Local Abstract: [plain-language-summary] We investigated the association between socioeconomic factors and the prescription of biologic drugs for inflammatory bowel diseases (IBD) in the Brazilian public health system (SUS). Using data from 2008 to 2022, we found that the rate of biologic prescriptions for IBD increased from 3.03% to 16.69%. Municipalities with higher income inequality had lower prescription rates. Counterintuitively, municipalities with higher human development also showed lower SUS‐based biologic prescription rates, a pattern that most likely reflects the fact that patients in wealthier municipalities tend to access biologic therapy through private health insurance rather than the SUS, making them invisible to the public system's data. These findings highlight the fragmented landscape of IBD care in Brazil and underscore the need for policies and data systems that capture both public and private care pathways.
Entry Date(s): Date Created: 20260705 Date Completed: 20260705 Latest Revision: 20260726
Update Code: 20260726
PubMed Central ID: PMC13355941
DOI: 10.1002/pds.70430
PMID: 42402431
Βάση Δεδομένων: MEDLINE
Περιγραφή
ISSN:1099-1557
DOI:10.1002/pds.70430