Temporal Trends, Regional Inequalities, and Economic Burden of Epilepsy-Related Hospitalizations in Brazil, 2010–2024: A Nationwide Ecological Time-Series Analysis

PURPOSE: To evaluate long-term national trends, regional inequalities, in-hospital mortality, and health system burden associated with epilepsy-related hospitalizations in Brazil. METHODS: A retrospective ecological time-series study was conducted using nationwide administrative data from the Brazilian public health system (SIH/SUS) between 2010 and 2024. Hospital admissions with ICD-10 codes G40 or G41 as the primary diagnosis were included. Temporal trends were assessed using regression models. Regional differences in hospitalization rates and mortality were analyzed across Brazil's five geographic regions and 27 federative units. RESULTS: A total of 804,394 epilepsy-related hospitalizations were recorded over the study period, with a consistent male predominance. National hospitalization rates increased from 25.1 to 31.7 per 100,000 inhabitants. In-hospital mortality ranged from 2.0% to 3.0% and showed a significant upward trend (average annual percent change of 2.37%; p < 0.001). Substantial geographic disparities were observed, with a 5.6-fold variation in mean hospitalization rates across federative units. Mortality odds were higher in the Northeast, Southeast, and North regions, and lower in the South. The proportion of hospitalizations among individuals aged ≥ 60 years increased over time. Urgent admissions accounted for 73% of cases, and mean length of stay increased from 5.31 to 6.29 days. Total hospitalization costs exceeded BRL 664 million. CONCLUSION: Epilepsy-related hospitalizations represent a growing and uneven burden in Brazil. Increasing hospitalization rates and rising in-hospital mortality highlight persistent gaps in both acute and outpatient care. These findings underscore the need for targeted strategies to reduce regional disparities and improve epilepsy management, particularly among older adults.