Ecological analysis of exogenous metal exposure in Brazilian Amazon

Metal exposure from environmental pollution is a public health issue accounting for millions of deaths annually. In Brazil, such exposure is monitored through the Notifiable Diseases Information System (SINAN). We aimed to assess metal exposure distribution in the state of Pará, located in Brazilian Amazon, and identify high-risk areas to support the development of technical and evidence-based strategies for mitigating metal exposure risks. An ecological observational study was performed using data on exogenous metal exposure reported in SINAN from 2017 to 2024. Variables included sex, ethnicity, age group, education level, health macro-region, municipality of notification, circumstance of exposure, type of exposure, confirmation criteria, and case outcome. Data were analyzed by χ² test, with significance set at p < 0.05. A total of 282 cases were recorded during this period. The mean prevalence rate was 3.95 per million inhabitants, while the mortality rate was 0.11 per million. Most cases occurred in Itaituba, Jacareacanga, and Trairão, with a predominance among indigenous individuals aged 20-39 years. Environmental exposure was the most reported circumstance, confirmed by clinical and laboratory criteria. Although Amazon is a recognized region for metal exposure, the low number of notifications raises concern. Despite scientific advances, surveillance remains limited, especially in remote and vulnerable areas. Thus, strengthening professional training and improving data accuracy in notification system are essential to better characterize the epidemiological profile of metal exposure in the Brazilian Amazon.