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Liver Diseases and Immunity / Gallbladder and Bile Duct Disorders · Journal article
The Lancet Regional Health - Americas · September 1, 2026
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This is a nationwide administrative cohort study characterising the epidemiology of primary biliary cholangitis in Brazil's public healthcare system from 2021–2024. The data show rising prevalence (10.5 to 17.8 per 100,000; +18.2% AAPC), declining incidence (4.00 to 3.42 per 100,000 person-years; −5.0% AAPC), persistent female predominance (3.67:1 ratio in 2024), and marked geographic inequality correlated with regional development. The findings are descriptive and hypothesis-generating; case ascertainment via administrative codes and drug dispensation rather than clinical diagnosis limits specificity and generalizability.
Nationwide population-based retrospective cohort study using administrative data. Adults aged ≥16 years enrolled in Brazil's Unified Health System with recorded ICD-10 code K74.3 and public dispensation of ursodeoxycholic acid; nationwide dataset comprising approximately 230 million records.. Intervention: PBC diagnosis (defined by ICD-10 code K74.3 and ursodeoxycholic acid dispensation). n = 10,125. Brazil, nationwide, stratified by macroregion (South, Southeast, North, Northeast, and Central-West)..
Age-standardised prevalence increased from 10.5 to 17.8 per 100,000 people (AAPC +18.2%; 95% CI: 12.5–24.3%) over 2021–2024 Age-standardised incidence declined from 4.00 to 3.42 per 100,000 person-years (AAPC −5.0%; 95% CI: −6.3 to −3.7%) Female-to-male prevalence ratio was 3.67:1 in 2024, narrower than historical reports
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These findings provide the first large-scale epidemiologic characterisation of PBC in Latin America and suggest geographic and socioeconomic disparities in disease recognition or incidence within Brazil. The discrepancy between rising prevalence and declining incidence warrants investigation into case ascertainment and diagnostic practices across regions to inform targeted screening and treatment programmes.
Large population-based retrospective administrative study with robust sample size and clear epidemiologic findings, but uses diagnostic coding and medication dispensation as case identification without clinical validation, limiting causal inference and generalizability beyond Brazil's public system.
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These findings provide the first large-scale epidemiologic characterisation of PBC in Latin America and suggest geographic and socioeconomic disparities in disease recognition or incidence within Brazil. The discrepancy between rising prevalence and declining incidence warrants investigation into case ascertainment and diagnostic practices across regions to inform targeted screening and treatment programmes.
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Background Population-based data on the epidemiology of primary biliary cholangitis (PBC) in Latin America are lacking. We aimed to characterise incidence, prevalence, and geographic patterns of PBC within Brazil's public healthcare system. Methods We performed a nationwide population-based retrospective study using de-identified administrative data from the Unified Health System (DATASUS), curated through an artificial intelligence platform. Adults (≥16 years) with ICD-10 code K74.3 and public dispensation of ursodeoxycholic acid between 1 January 2021 and 31 December 2024 were included. Annual World Health Organization (WHO) age-standardised incidence and prevalence were estimated by sex, age group, and macroregion. Temporal trends were modelled with log-linear regression to obtain average annual percent change (AAPC). Correlation with macroregional Human Development Index (HDI) was explored. Findings We identified 10,125 PBC patients [77.75% (7872) women; mean age 54.95 ± 20 years], within a nationwide dataset comprising approximately 230 million records. Age-standardised prevalence increased from 10.5 to 17.8 per 100,000 people (AAPC +18.2%; 95% CI: 12.5; 24.3%); while age-standardised incidence modestly declined from 4.00 to 3.42 per 100,000 person-years (AAPC −5.0%; 95% CI: −6.3; −3.7%). The female-to-male prevalence ratio in 2024 was 3.67:1, with peak rates at ages 66–70 years. A marked south–north gradient was observed, with highest rates in the South and Southeast and lowest in the North and Northeast; macroregional HDI showed a positive correlation with both incidence and prevalence. Interpretation In Brazil, PBC is characterised by rising prevalence, relatively stable incidence, a narrower female predominance than historically reported, and marked geographic inequalities. These findings suggest possible under-recognition in less developed regions and provide a foundation for targeted public health strategies. The observed south–north gradient warrants further investigation in relation to environmental, socioeconomic, and healthcare-access factors. Funding This study is supported by a research grant from IPSEN.
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