Leprosy-related mortality in Brazil: a neglected condition of a neglected disease.
BACKGROUND
Leprosy is a public health problem and a neglected condition of morbidity and mortality in several countries of the world. We analysed time trends and spatiotemporal patterns of leprosy-related mortality in Brazil.


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.


RESULTS
Leprosy was identified in 7732/12 491 280 deaths (0.1%). Average annual age-adjusted mortality rate was 0.43 deaths/100 000 inhabitants (95% CI 0.40-0.46). The burden of leprosy deaths was higher among males, elderly, black race/colour and in leprosy-endemic regions. Lepromatous leprosy was the most common clinical form mentioned. Mortality rates showed a significant nationwide decrease over the period (annual percent change [APC]: -2.8%; 95% CI -4.2 to -2.4). We observed decreasing mortality rates in the South, Southeast and Central-West regions, while the rates remained stable in North and Northeast regions. Spatial and spatiotemporal high-risk clusters for leprosy-related deaths were distributed mainly in highly endemic and socio-economically deprived regions.


CONCLUSIONS
Leprosy is a neglected cause of death in Brazil since the disease is preventable, and a cost-effective treatment is available. Sustainable control measures should include appropriate management and systematic monitoring of leprosy-related complications, such as severe leprosy reactions and adverse effects to multidrug therapy.
Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil Federal Institute of Education, Science and Technology of Ceará, Caucaia, Brazil.
Francisco Rogerlândio
FR
Martins-Melo
School of Medicine, Health Sciences Center, University of Fortaleza, Fortaleza, Brazil Municipal Secretary of Health of Fortaleza, Ceará, Brazil.
Adriana Valéria
AV
Assunção-Ramos
Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil.
Alberto Novaes
AN
Ramos
Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil.
Carlos Henrique
CH
Alencar
Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil.
Renan Magalhães
RM
Montenegro
Training Center on Dermatology, University Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
Maria Leide
ML
Wand-Del-Rey de Oliveira
Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil Anton Breinl Centre for Public Health and Tropical Medicine, School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, Australia heukelbach@web.de.
Jorg
J
Heukelbach
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003644:Death Certificates; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007918:Leprosy / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D058069:Neglected Diseases / Q000401:mortality*; D012307:Risk Factors
Brazil; Epidemiology; Leprosy; Mortality; Spatial analysis; Time analysis