Spatiotemporal patterns of kidney transplantation, chronic kidney disease, and traumatic brain injury mortality in Brazil

Abstract Introduction Kidney transplantation, chronic kidney disease (CKD), and traumatic brain injury (TBI) mortality exhibit substantial regional variation in Brazil, yet their spatiotemporal relationships remain poorly understood. Objective To analyze spatiotemporal patterns and geographic associations among kidney transplantation rates, TBI-related mortality, and CKD burden in Brazil using the Space Time Cube (STC) approach. Methods This ecological, retrospective, and longitudinal study analyzed secondary data from DATASUS between 2010 and 2021 across Brazilian health regions. Data included TBI-related mortality, kidney transplantation rates, and CKD-related hospitalizations and hemodialysis procedures used as proxy indicators of advanced CKD burden. Spatial analyses were performed in ArcGIS Pro using the STC tool, and emerging hotspots were identified using the Getis–Ord Gi* statistics. Results Marked regional disparities were observed across Brazil. TBI-related mortality clusters were concentrated in the Northeast, particulary in Alagoas, Paraíba, and Sergipe, whereas kidney transplantation hotspots predominated in the South and Southeast, especially in Paraná and Rio Grande do Sul, followed by the Southeast. Indicators of CKD burden showed a more heterogeneous spatial distribution, with higher concentrations in the Southeast. Notably, regions with higher TBI-related mortality did not necessarily correspond to those with higher transplantation rates, suggesting important geographic inequalities in transplantation access and healthcare infrastructure. Conclusion These findings highlight the importance of regionally targeted policies to strengthen emergency care networks, organ donation systems, and transplant infrastructure, helping reduce geographic inequalities and improve equitable access to kidney transplantation across Brazil.