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ORIGINAL ARTICLE • Saúde debate 49 (spe1) • 2025 • https://doi.org/10.1590/2358-28982025E110004I linkcopy

Potential for health monitoring: Exploring SUS outpatient open data

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

The Brazilian Unified Health System (SUS) has disseminated billions of administrative records corresponding to three decades of existence. Unlike hospital and notification data, which are fragmented as they are service-oriented rather than user-oriented, outpatient data can be linked via a pseudonymized identifier, enabling the tracking of therapeutic pathways. This paper presents an automated microdata processing tool from the Open Health Intelligence Platform (SABEIS) using open-source software to handle microdata provided through the TabWin/TabNet strategy from the file transfer directory, without relying on sophisticated Big Data. It describes the open data from the SUS Ambulatory Information System from 2008 to 2023, using modest hardware resources by public health and health informatics specialists. A total of 8,106,361,265 records were processed, corresponding to 3,135 procedures, 16,407 diagnoses, and 51,875,308 users, according to the files of APAC-SIA High-cost ambulatory procedures and high-cost medicines. There was a noticeable improvement in the quality of the pseudonymized identifier, especially from 2022 onwards, with 0.8% of users recorded as having more than one sex, more than one state of residence, over eight procedures, or five diagnoses, demonstrating the potential for public policy monitoring and knowledge generation. This approach demonstrated the potential for monitoring public policies using outpatient data with a pseudonymized SUS user identifier.

KEYWORDS
Data science; Database management systems; Unified Health System; Documentation; Technology assessment; health.

	AB	ACF	AD	AM	AMP	AN	AQ	AR	ATD	BI	PA	PS	SAD
Table 2a
North	1.1	72.6	4,582.8	1,532.1	1.8	85.0	626.9	386.6	164.1	56,927.2	17,560.9	2,139.7	23.5
Northeast	2.1	108.8	6,219.6	3,105.7	4.2	123.6	1,090.9	673.8	232.5	38,917.8	28,031.8	2,512.8	44.1
Southeast	14.7	104.2	6,592.4	6,366.5	10.5	157.7	1,447.4	938.4	252.4	64,636.1	26,230.9	2,250.0	83.3
South	59.8	108.7	7,521.2	4,953.5	13.1	159.5	1,924.5	1,162.6	276.8	92,123.0	29,955.7	3,062.5	40.3
Central-West	0.1	98.8	5,546.3	3,407.7	3.9	136.2	1,029.7	542.8	262.3	45,555.3	18,145.2	2,173.0	32.6
	AB	ACF	AD	AM	AMP	AN	AQ	AR	ATD	BI	PA	PS	SAD
Table 2b
AB	31,757	0.1	11.7	12.0	0.0	0.1	1.3	1.0	0.1	156.0	183.0	4.6	0.1
ACF	16	208,654	708.2	908.5	16.0	119.2	27.1	15.0	1,126.5	804.1	1,202.3	15.0	1.6
AD	2,036	122,909	12,904,559	7,966.8	32.8	947.2	1,846.9	1,156.6	1,523.0	42,692.8	74,326.7	2,738.2	75.6
AM	2,075	157,673	1,382,627	9,362,825	30.5	1,068.5	1,535.6	983.2	1,793.7	27,003.1	53,946.4	2,349.8	87.3
AMP	0	2,771	5,701	5,298	16,034	0.3	3.4	2.1	21.6	68.6	92.4	1.3	0.1
AN	11	20,688	164,393	185,436	55	280,276	32.5	21.0	522.7	722.6	1,614.9	4.6	3.6
AQ	225	4,696	320,530	266,500	588	5,641	2,666,836	6,588.9	82.0	10,055.9	15,365.0	144.8	27.9
AR	168	2,605	200,720	170,633	368	3,651	1,143,500	1,666,261	47.0	6,471.8	9,600.0	100.8	19.8
ATD	26	195,497	264,319	311,303	3,757	90,709	14,239	8,150	485,605	1,715.8	2,798.1	32.4	5.4
BI	27,078	139,554	7,409,285	4,686,353	11,897	125,403	1,745,184	1,123,166	297,768	119,162,740	175,307.6	13,843.0	350.7
PA	31,757	208,654	12,899,319	9,362,329	16,034	280,258	2,666,584	1,666,074	485,600	30,424,434	51,875,308	7,809.5	259.3
PS	807	2,609	475,205	407,802	223	797	25,137	17,501	5,615	2,402,434	1,355,333	4,903,392	9.6
SAD	23	285	13,126	15,154	16	628	4,846	3,433	944	60,872	45,003	1,673	116,282

Variable	Users	North	Northeast	Southeast	South	Central-West
Total	51,875,308	3,000,390	15,093,470	21,985,990	8,810,592	2,903,022
Sex**
Female only	56.6%	56.3%	59.4%	55.0%	56.6%	53.8%
Male only	40.1%	38.6%	37.6%	41.4%	41.1%	41.6%
Both	3.4%	5.1%	3.0%	3.6%	2.3%	4.6%
Race/color***
Unidentified	35.5%	30.6%	41.7%	33.2%	33.1%	32.9%
White	30.8%	5.1%	8.0%	40.2%	57.7%	23.4%
Black/brown	30.0%	58.7%	42.4%	25.2%	8.1%	38.8%
Yellow	3.7%	5.5%	7.9%	1.5%	1.1%	4.5%
Indigenous	0.1%	0.1%	0.0%	0.0%	0.0%	0.4%
Age***
00-17	11.7%	14.5%	12.8%	10.2%	12.2%	12.0%
18-40	25.0%	27.4%	27.5%	22.6%	25.6%	25.1%
41-60	31.3%	31.6%	31.5%	31.5%	30.4%	31.9%
60+	31.8%	26.1%	27.8%	35.5%	31.5%	30.8%
Unknown	0.3%	0.3%	0.3%	0.3%	0.3%	0.3%
States of residence
1	98.9%	98.5%	99.0%	99.0%	98.9%	98.1%
2-14	1.1%	1.5%	1.0%	1.0%	1.1%	1.9%
Procedures
1	47.7%	48.0%	49.6%	46.8%	45.8%	49.7%
2	19.3%	16.8%	19.8%	19.0%	19.8%	20.9%
3	9.3%	7.6%	9.4%	9.3%	9.9%	8.7%
4	5.9%	4.5%	5.7%	6.2%	6.0%	5.5%
5	3.9%	3.0%	3.8%	3.9%	4.1%	3.7%
6	2.9%	2.3%	2.9%	3.0%	2.9%	2.6%
7	2.2%	1.6%	2.2%	2.2%	2.1%	2.0%
8	1.7%	1.5%	1.6%	1.9%	1.7%	1.6%
9	1.4%	1.3%	1.1%	1.6%	1.4%	1.1%
10 to 220	5.8%	13.3%	3.9%	6.1%	6.3%	4.1%
Diagnoses
0	23.9%	26.9%	31.1%	17.4%	28.0%	19.8%
1	50.7%	48.6%	47.5%	53.3%	48.6%	56.1%
2	14.4%	13.6%	12.6%	16.0%	13.9%	14.8%
3	5.5%	5.2%	4.6%	6.4%	5.1%	5.1%
4	2.5%	2.3%	2.0%	3.0%	2.1%	2.0%
5	1.2%	1.3%	1.0%	1.5%	1.0%	0.9%
6	0.7%	0.7%	0.5%	0.8%	0.5%	0.4%
7 to 2,098	1.2%	1.4%	0.8%	1.6%	0.8%	0.8%
Investigate (users of both genders, from more than 2 states, 15 procedures, or 10 diagnoses
2008	8.5%	11.2%	7.3%	8.7%	8.4%	9.6%
2009 to 2015	5.8%	8.5%	5.3%	6.1%	5.2%	5.9%
2016 to 2021	6.4%	16.1%	4.5%	6.8%	5.4%	7.4%
2022	4.5%	15.3%	2.7%	4.5%	3.6%	4.6%
2023	3.1%	11.4%	1.8%	2.9%	2.8%	3.3%

Subsystem	Period	Original files	FTP Mbytes	Mbytes database**	Records	List of Procedures***	List of Diagnoses ****	Municipalities of residence
AB	01/2008-04/2017	544	438	897	211,252	1	-	1,425
ACF	08/2014-12/2023	2,945	14	29	315,631	1	-	5,378
AD	01/2008-12/2023	5,182	2,453	6,225	49,021,697	211	2,518	5,597
AM	01/2008-12/2023	5,131	13,115	35,958	287,923,699	608	660	5,591
AMP	03/2016-12/2023	541	3,821	6,570	64,900	2	-	1,050
AN	01/2008-10/2014	2,145	305	508	6,534,272	8	376	5,413
AQ	01/2008-12/2023	5,143	103,923	252,140	49,523,199	157	647	5,596
AR	01/2008-12/2023	4,683	137,080	563,504	3,615,964	39	719	5,595
ATD	08/2014-12/2023	3,047	51	322	12,391,833	6	-	5,551
BI	01/2008-12/2023	5,184	2,242	12,156	2,546,881,910	1,893	16,199	5,599
PA	01/2008-12/2023	5,447	24	62	5,024,137,874	3,135	16,184	5,599
PS	11/2012-12/2023	3,557	762	1,380	122,214,893	21	3,858	5,064
SAD	04/2012-10/2018	1,088	4	13	3,524,141	69	4,552	530
Total	01/2008-12/2023	44,637	264,232	879,764	8,106,361,265	3,135	16,407	5,599*

Variable	User	North	Northeast	Southeast	South	Central-West
Total	3,168,693	135,069	701,393	1,455,544	672,032	204,655
Sex**
Female only	53.7%	57.5%	56.1%	52.7%	52.8%	53.5%
Male only	45.7%	41.2%	43.3%	46.8%	46.7%	45.8%
Both	0.6%	1.4%	0.6%	0.5%	0.5%	0.6%
Race/color***
White	46.7%	8.7%	17.6%	52.6%	77.9%	27.0%
Black/brown	33.8%	54.5%	56.0%	31.8%	8.8%	40.1%
Unidentified	17.5%	35.8%	20.7%	14.5%	12.6%	31.9%
Yellow	2.0%	0.8%	5.7%	1.1%	0.7%	0.8%
Indigenous	0.0%	0.2%	0.0%	0.0%	0.0%	0.1%
Age***
00-17	2.6%	5.0%	3.3%	2.2%	1.9%	3.3%
18-40	8.9%	13.8%	10.2%	7.9%	8.3%	10.5%
41-60	35.5%	38.6%	35.4%	34.9%	35.8%	37.6%
60+	52.8%	42.5%	50.9%	54.9%	53.8%	48.4%
Unknown	0.1%	0.2%	0.1%	0.1%	0.1%	0.2%
States of residency
1	99.2%	96.0%	99.1%	99.6%	99.4%	98.5%
2-4	0.8%	4.0%	0.9%	0.4%	0.6%	1.5%
Procedures
1	38.2%	37.9%	37.0%	38.2%	39.1%	39.7%
2	17.8%	17.2%	18.1%	17.6%	17.9%	18.6%
3	9.3%	11.7%	10.1%	9.1%	8.2%	9.4%
4	8.5%	9.8%	8.0%	9.2%	7.1%	8.5%
5	10.8%	10.1%	10.8%	11.1%	10.5%	9.5%
6	8.3%	7.4%	8.2%	8.1%	9.2%	7.8%
7	4.1%	3.5%	4.7%	3.8%	4.4%	3.8%
8	1.7%	1.3%	1.9%	1.6%	2.0%	1.6%
9-18	1.3%	0.9%	1.3%	1.2%	1.5%	1.2%
Diagnoses
1	70.5%	68.1%	69.8%	71.2%	70.3%	69.8%
2	24.0%	26.4%	25.2%	23.2%	23.6%	25.1%
3	4.5%	4.5%	4.2%	4.5%	4.9%	4.3%
4	0.8%	0.8%	0.6%	0.9%	1.0%	0.7%
5	0.2%	0.1%	0.1%	0.2%	0.2%	0.1%
6	0.0%	0.0%	0.0%	0.1%	0.0%	0.0%
7+	0.0%	0.0%	0.0%	0.0%	0.0%	0.0%
Investigate (users of both sexes, more than 1 state, 8 procedures, or 6 diagnoses)
2008	3.8%	12.7%	3.6%	3.2%	3.5%	4.4%
2009 a 2015	3.2%	5.4%	3.6%	2.7%	3.2%	3.9%
2016 a 2021	2.4%	6.4%	2.4%	1.8%	2.5%	3.1%
2022	0.8%	3.8%	0.8%	0.5%	0.6%	1.1%
2023	0.5%	1.5%	0.4%	0.3%	0.4%	0.6%

Procedure	Users	Records per user	Quantity per use	Value per user (BRL)	Treatment days (median)	Age (median)
Hemodialysis (maximum 3 sessions per week)	466,918	36	445	81,945.25	818	56
Urea measurement	495,295	33	63	116.26	849	56
Potassium measurement	482,057	34	34	63.05	848	56
Care/monitoring of patients undergoing neuropsychomotor development rehabilitation	103,736	155	426	6,820.61	605	6
Glutamic-pyruvic transaminase (GPT) dosage	477,795	33	33	67.33	849	56
Phosphorus measurement	448,613	36	36	65.99	820	56
Calcium measurement	451,827	35	35	65.54	847	56
Formoterol 12 mcg + Budesonide 400 mcg inhalation powder (per 60-dose bottle)	457,793	33	35		1,034	59
Physiotherapy for motor disorders	512,731	27	69	324.80	147	50
Atorvastatin 20 mg (per tablet)	461,091	28	1,221		879	62
Alfaepoetin 4,000 IU injectable (per vial)	491,314	25	279		848	59
Creatinine dosage	495,165	19	19	35.97	819	56
Olanzapine 10 mg (per tablet)	235,140	38	1,554	1,423.08	1,153	39
Hematocrit	339,472	26	26	40.33	849	56
Hemoglobin measurement	336,777	26	26	40.21	849	56
Complete blood count	480,839	17	17	70.27	969	55
Specialized medical consultation	789,478	10	11	115.88	666	53
Formoterol 12 mcg + Budesonide 400 mcg (per inhalation capsule)	295,265	27	1,311		941	61
Glucose measurement	352,682	21	21	38.41	939	57
Azathioprine 50 mg (per tablet)	191,635	35	2,622		1,095	39
Hormone therapy for advanced prostate adenocarcinoma - 1st line	270,434	25	25	7,491.04	697	72
Atorvastatin 40 mg (per tablet)	321,568	21	751		606	64
Sodium measurement	247,959	27	27	49.72	757	57
Ferric hydroxide saccharate 100 mg injectable (per 5 ml vial)	345,532	19	82	355.58	817	57
Hormone therapy for stage II breast carcinoma	177,361	36	36	2,883.72	1,154	57
Leflunomide 20 mg (per tablet)	191,217	33	994	1,241.15	971	55
Tacrolimus 1 mg (per capsule)	115,763	51	6,692	229.86	1,549	46
Timolol 5 mg/ml ophthalmic solution (per 5 ml bottle)	219,855	25	25		909	65
Risperidone 2 mg (per tablet)	193,391	28	1,668	132.41	789	38
Alkaline phosphatase measurement	365,816	15	15	29.39	1,031	55

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