Hidden in plain sight: national benchmarks for sepsis mortality, dengue burden, and antimicrobial use from 35 million hospitalizations in Brazil's universal health system

Analysis of 35.2 million hospitalization records from Brazil's universal health system reveals three findings absent from current global benchmarks: (1) inpatient sepsis case fatality of 46.5%, approximately 75% above the 26.7% global average reported by Rudd et al. (Lancet, 2020), implying approximately 25,000 potentially preventable deaths per year; (2) the 2024 dengue epidemic reaching 10.5 million notified cases and 247,000 hospitalizations, constituting the largest single-country single-year arboviral epidemic ever documented; and (3) 223.7 million antibiotic dispensations annually, providing the first national baseline for antimicrobial stewardship evaluation. Data were obtained from publicly available national administrative health databases maintained by Brazil's Ministry of Health. These findings demonstrate that the global health data gap for large middle-income countries is substantially a data processing gap rather than a data availability gap.