LEPROSY-RELATED MORTALITY IN BRAZIL: SPATIOTEMPORAL PATTERNS AND HIGH-RISK CLUSTERS OF DEATHS, 2000-2011

Introduction and Objective Leprosy is a public health problem and a neglected condition of morbidity and mortality in several countries of the world. We analyzed spatiotemporal patterns of leprosy-related mortality in Brazil during 2000-2011 and identified high-risk clusters of deaths. Methods We performed a nationwide population-based study using secondary mortality data. We included all deaths that occurred in Brazil between 2000 and 2011, in which leprosy was mentioned in any field of death certificates.We calculated crude and age-adjusted mortality rates (per 100,000 inhabitants), and proportional mortality rates. Spatial and spatiotemporal mortality cluster analysis at municipality-level was performed using Moran’s I and spice-time scan statistics. Result and Conclusions Leprosy was identified in 7,732/12,491,280 deaths (0.1%). We observed decreasing mortality rates in the South, Southeast and Central-West regions, while the rates maintained stable in North and Northeast regions. We identified spatial and space-time high-risk clusters for leprosy-related mortality covering large areas located mainly in North, Central-West, and Northeast regions. Despite of the low mortality impact, leprosy is still a neglected cause of death in Brazil, with significant regional differences. High-risk areas are located mainly in highly endemic and socio-economically deprived regions,where primary health care plays a key role in the control. Leprosy cases are exposed to increase mortality risks due to its direct and indirect effects. Sustainable control measures should include early diagnosis and treatment, besides the monitoring of leprosy-related chronic complications and deaths.We emphasize the relevance of family medicine in reducing the morbimortality of leprosy in Brazil.