Environmental determinants and regional inequalities in mortality from HBV/HCV-associated hepatocarcinoma in Brazil: an ecological study (2013-2022)

The aim of this study is to analyze the spatial and temporal distribution of hepatocellular carcinoma (HCC) mortality associated with hepatitis B (HBV) and C (HCV) in Brazil between 2013 and 2022, considering environmental determinants and regional inequalities. This ecological study used data from the Brazilian Mortality Information System (SIM/DATASUS). Age-standardized mortality rates were assessed using multivariate regression and Generalized Additive Models (GAM), integrating environmental indicators such as annual mean temperature and wildfire occurrence. A significant increase in HCC mortality rates was observed, especially in the South and Southeast regions. However, proportional increases were more pronounced in the North and Northeast, indicating disease expansion. Spatial analysis identified mortality clusters in areas with higher wildfire frequency and rising temperatures. The findings highlight the impact of environmental and structural determinants on HCC mortality. Exposure to fine particulate pollution and climate-related temperature rise may exacerbate the progression of chronic liver disease, especially in socioeconomically vulnerable contexts. HCC mortality associated with HBV/HCV in Brazil reflects marked regional disparities and environmental influences, underscoring the need for integrated public health policies aimed at epidemiological surveillance, environmental control, and equitable healthcare access.