Association between social inequality, social determinants and congenital syphilis incidence across Brazilian macro-regions: an ecological study, 2024

Abstract

Introduction: Despite prevention and control strategies, congenital syphilis continues to have a significant impact on public health in Brazil, influenced by socioeconomic factors and regional inequalities. Objective: To identify the association between the Gini index and the incidence of congenital syphilis across Brazilian macro-regions in 2024, acknowledging the impact of social inequality on syphilis incidence; to identify the association between sociodemographic variables and the distribution of cases across these macro-regions; and to define the epidemiological profile of the cases regarding maternal education, race/color, age at diagnosis, sex, clinical outcome, and receipt of prenatal care. Method: A descriptive ecological study using secondary data collected from the Department of Informatics of the Unified Health System and the Brazilian Institute of Geography and Statistics, covering Brazil's five macro-regions in 2024, as well as data from the Information System on Live Births. The study analyzed the incidence of congenital syphilis and the Gini index by region, along with sociodemographic and healthcare-related variables associated with congenital syphilis cases. Results: The highest incidences of congenital syphilis were identified in the Southeast, North, and Northeast regions. Regarding the other variables studied, higher frequency of cases was observed among the offspring of mothers with either a completed high school education or an incomplete elementary education. Conclusion: Although the results show positive correlation between the Gini index and the incidence of congenital syphilis, this association was not statistically significant. However, higher prevalence of congenital syphilis was observed among individuals born to mothers with lower levels of education. Thus, it is essential to intensify prevention and control measures for congenital syphilis—particularly by strengthening public awareness, with the aim of improving maternal and child health indicators.