Schistosomiasis remains a severe public health issue in Brazil, reflecting an epidemiological gap sustained by social inequality. Classified as a neglected tropical disease, its persistence burdens the health system, being intrinsically linked to precarious basic sanitation and disordered urbanization.To analyze the spatiotemporal distribution of schistosomiasis and correlate its prevalence, morbidity, and mortality with sanitation coverage in the Brazilian macro-regions between 2013 and 2023.An ecological time-series study was conducted in the five Brazilian macro-regions using secondary data from DATASUS/TABNET (PCE, SINAN, and SIM) for epidemiological indicators and from the Painel Saneamento Brasil for sanitation coverage. Annual rates of infection and morbidity were analyzed, and the association between schistosomiasis morbidity and lack of sewage collection was assessed using Spearman’s correlation coefficient.Population proportions without adequate sewage collection exceeding 50% were associated with higher rates of infection and morbidity. The year 2013 presented the highest percentage of the population without collection (62.4%) and the highest morbidity rate (3.229). The highest positivity rate was recorded in 2014 (2.791). The Southeast region presented the highest burden of cases, followed by the Northeast region. The Spearman calculation between the morbidity rate and population without sewage access, comparing 11 temporal observations, resulted in approximately 0.909, indicating a strong positive correlation: the greater the sanitation deprivation, the higher the disease incidence.The results support the hypothesis that precarious sanitation conditions are key predictive factors for the persistence of schistosomiasis. The strong positive correlation observed highlights the central role of socioeconomic vulnerability in sustaining the parasite’s transmission cycle. Higher morbidity and positivity rates were identified in areas with sanitation deficits, while increased notification burdens in the Southeast and Northeast regions suggest that climate, population density, and social inequality directly influence disease distribution. The continued morbidity and mortality reflect persistent regional disparities driven by structural socioeconomic conditions over time.The findings highlight sanitation deficits as a key determinant of schistosomiasis persistence in Brazil. Control strategies focused exclusively on treatment are insufficient; intersectoral public policies integrating health surveillance, primary care actions, and investments in basic sanitation are essential to reduce morbidity and mortality and address regional health inequalities.