The Rise of Brazil's Primary Care Digitalization: 12 Billion Records Across 27 Federative Units as a Foundation for Real-World Evidence and Scientific Democratization

Background: Brazil operates one of the world's largest national primary health care information systems. Since 2013, the Health Information System for Primary Care (SISAB), the digital platform of the e-SUS primary care strategy, has collected standardized records of all clinical and community health activities performed by Family Health Strategy teams across all Brazilian municipalities. Yet comprehensive longitudinal analyses of this national data infrastructure remain scarce in the international literature. Methods: Descriptive ecological study with time-series analysis using publicly available secondary data extracted from SISAB on May 18, 2026. Annual records were collected for four production types (Individual Care, Dental Care, Procedures, and Home Visits), disaggregated by all 27 Federative Units, covering April 2013 through March 2026. Per capita indicators were calculated using the 2022 Brazilian Demographic Census population by state. Results: The cumulative total of SISAB records from April 2013 through March 2026 is 12,421,073,299. Annual volume grew from 53.3 million in 2014 (first full year) to 1.96 billion in 2025, an approximately 37-fold increase over 11 years. A 9.0% decline in 2020 was associated with the COVID-19 pandemic, with full recovery by 2021. Procedures rose from 21.6% to 35.9% of total records between 2014 and 2025, reflecting deepening clinical record completeness. Per capita records varied 3.2-fold across federative units, from 29.0 (Distrito Federal) to 92.9 (Tocantins). Home visits, performed predominantly by Community Health Workers, accounted for 41.9% of all records, with the highest per capita rates concentrated in the Northeast region. Conclusions: SISAB constitutes a longitudinal national data infrastructure of exceptional scale, covering populations historically underrepresented in biomedical research: rural, Amazonian, and peri-urban communities. With over 12 years of continuous data and 184 million active registered patients, this system represents a strategic foundation for real-world evidence generation and the democratization of health science. Realizing this potential requires investment in data quality, interoperability, ethical governance, and scientific capacity aligned with Brazilian General Data Protection Law (Law n. 13,709/2018). Keywords: Primary Health Care; Health Information Systems; Family Health Strategy; Digital Health; Brazil; Community Health Workers; Real-World Evidence.