Hospitalizations due to stroke and access to physiotherapy rehabilitation in the Brazilian Unified Health System (SUS): a 10-year analysis (2015–2024)

Background: Stroke is a leading cause of mortality and long-term disability in Brazil, making access to rehabilitation within the public health system (SUS) a critical issue. Physiotherapy is essential for functional recovery, yet national-level data on care integration remains limited. This study analyzes over a decade of hospitalization and rehabilitation data to quantify trends in care provision. Methods: This descriptive ecological study used public data from Brazil's SIH/SUS (stroke hospitalizations, ICD-10 I60-I64) and SIA/SUS (neuro-kinetic-functional physiotherapy and acute stroke treatment codes). We analyzed trends across complete calendar years from 2015 to 2024, with data from the first semester of 2025 reported separately to indicate the most recent trajectory. Results: From 2015-2024, 2,269,871 stroke hospitalizations occurred, with 355,143 in-hospital deaths (case-fatality rate: 15.6%). Over the decade, annual hospitalizations increased 125% (from 123,844 to 278,125), despite a temporary decline in 2020. Concurrently, physiotherapy procedures grew at an even faster pace of 146% (from 2.9 to 7.0 million annually), totaling 51.5 million. This disproportionate growth, however, only slightly increased the sessions-per-hospitalization ratio from 23 to 25. Preliminary 2025 data (139,630 hospitalizations; 3.2 million procedures) confirm these trends. Conclusion: Our findings show expanded access to post-stroke physiotherapy in SUS, though this growth mainly absorbed an increasing patient load rather than deepening the care intensity per individual. The persistently high in-hospital mortality (15.6%) points to significant gaps in the acute care chain. This underscores a dual policy priority: improving acute stroke management to reduce mortality, while simultaneously strengthening multidisciplinary rehabilitation. Integrating speech and occupational therapy is essential to address the diverse functional deficits and truly reduce the long-term disability burden of stroke in Brazil.