REGIONAL INEQUALITIES IN THE RECOVERY OF HOSPITAL CARE FOR CARDIOVASCULAR DISEASES IN BRAZIL AFTER THE COVID-19 PANDEMIC: AN ECOLOGICAL TIME-SERIES STUDY, 2015–2025

Abstract

Cardiovascular diseases remain the leading cause of morbidity and mortality in Brazil, and the COVID-19 pandemic substantially disrupted hospital care, with potentially persistent effects on healthcare access and clinical outcomes. This study aimed to analyze regional inequalities in the recovery of hospital care for cardiovascular diseases in Brazil following the COVID-19 pandemic. An ecological time-series study was conducted using secondary data from the Brazilian Hospital Information System (SIH/SUS), the Mortality Information System (SIM), and the Brazilian Institute of Geography and Statistics (IBGE), covering the period from 2015 to 2025. Hospitalization rates, hospital mortality, case fatality, length of stay, healthcare costs, and recovery indicators were evaluated using descriptive analyses, the Mann-Kendall test, Prais-Winsten regression, and non-parametric tests for regional comparisons. A marked reduction in hospitalizations was observed during the pandemic, followed by a partial recovery in subsequent years, accompanied by increased hospital case fatality. Recovery occurred unevenly across Brazilian macro-regions, with slower restoration in the North and Northeast and more consistent recovery in the South and Southeast, highlighting disparities in the capacity to reorganize specialized healthcare services. These findings indicate that the indirect effects of the pandemic persisted beyond the acute phase, reinforcing the need for public policies aimed at strengthening cardiovascular care networks, reducing regional inequalities, and improving the responsiveness of Brazil's Unified Health System.