Temporal trends and identification of risk areas related to the burden of leprosy in Brazil: an ecological study from 2001 to 2021

Background Leprosy is a neglected chronic disease that can cause physical disabilities if left untreated. Despite ongoing efforts, Brazil continues to face a high burden of the disease. Objective This study aimed to estimate the burden of leprosy and evaluate its temporal and spatial patterns in Brazilian municipalities, from 2001 to 2021. Methods The burden of leprosy in Brazil was estimated using Disability-Adjusted Life Years (DALY). Temporal trend analyses were performed using the joinpoint regression model. For spatial analysis, the Global Moran’s I and the Local Univariate Moran’s I indices were used. Results Although the overall burden of leprosy decreased over the two decades, the North, Northeast and Central-West regions presented, at the end of the study period, higher values ​​compared to the South and Southeast regions at the beginning of the studied period. Additionally, the disease burden had a significant impact on older age groups and men. The country did not exhibit random spatial distribution, as there was a substantial clustering of high-risk municipalities, particularly in the North, Central-West, and Northeast regions. Interestingly, the primary factor contributing to the DALY of leprosy was YLL (Years of Life Lost), which resulted in a high burden rate, potentially indicating a significant number of deaths from leprosy. Conclusions Leprosy burden is still high in Brazil, particularly in poorer regions. Strengthening surveillance and improving access to early diagnosis are essential to reduce the burden of leprosy, but interventions need to be adapted to the specific situations and needs of different areas.