Leprosy and Social Determinants of Health in South Brazil: Geographically evaluated analysis





Leprosy; Public health; Spatial analysis; Primary health care; Social determinants of health.


Objective: to verify the relationship between leprosy and geographic space, taking into account social determinants of health and using a tool that allows the analysis of these relationships locally. Methodology: Ecological study, carried out in an endemic city in southern Brazil. The geocoding of the cases was conducted and socioeconomic variables of interest were selected. After descriptive analysis, we followed with the spatial correlation through the Bivariate Moran Index, followed by Linear Regression. For the variables present in the selected model, the Geographically Weighted Regression was applied using the ArcGis software version 10.5.1. Subsequently, the results were specialized using thematic maps. Results: Regarding socioeconomic and clinical-operational characteristics, there was a greater number of male cases (55.3%), aged 16 to 60 years (69.3%), white race (67.8%), multibacillary cases (80.9%), borderline clinical form (45.2%) and disability grade I (62.6%). The spatial analysis showed an average incidence of 1.19 cases/10,000 inhabitants, in each census sector. Regarding social determinants, the characteristics are heterogeneous in space, and agglomeration of inhabitants showed a direct association with leprosy, as well as race/brown color, characterizing as risk factors in the most evident regions. On the other hand, literacy had an inverse relationship, associating an increase in literacy with a reduction in the occurrence of the disease. Conclusion: Social determinants in health help to explain the heterogeneity of disease distribution. Understanding this relationship is essential to direct prophylaxis and control actions.


Assis, I. S., Arcoverde, M. A. M., Ramos, A. C. V., Alves, L. S., Berra, T. Z., Arroyo, L. H. et al. (2018). Social determinants, their relationship with leprosy risk and temporal trends in a triborder region in Latin America. PLoS Negl Trop Dis, 14 (4).

Barreto, J. G., Bisanzio, D., Frade, M. A. C., Moraes, T. M. P, Gobbo, A. R., Guimarães, L. S., Silva, M. B., Prokopec, G. M. V., Spencer, J. S., Kitron, U., Salgado, C. G. (2015). Spatial epidemiology and serologic cohorts increase the early detection of leprosy. BMC Infectious Diseases, (15).

Barros, M. V. F., Archela, R. S., Barros, O. N. F., Gratão, L. H., Thery, H., Mello, N. A. (2008). Atlas Ambiental da Cidade de Londrina. http://www.uel.br/revistas/atlasambiental/

Braker, W. H., Sihombing, B. Djarir, H., Beise, K., Kusumawardhani, L., Yulihane, R. et al. (2012). Disability in people affected by leprosy: the role of impairment, activity, social participation, stigma and discrimination. Global Health Action (5).

Brasil. Ministério da Saúde. Sala de Apoio à Gestão Estratégica (SAGE). (2016). Relatório Gerencial. http://sage.saude.gov.br/?link=sistemas/relatorio

Brasil. Ministério da Saúde. DATASUS, Portal da Saúde. http://tabnet.datasus. gov.br

Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. (2018). Boletim Epidemiológico, 49(4). Ministério da Saúde. http://portalarquivos2.saude.gov.br/images/pdf/2018/janeiro/31/2018-004-Hanseniase-publicacao.pdf

Brook, C. E., Beauclair, R., Ngwenya, O., Worden, L., Ndeffombah, M., Lietman, T. M., Satpathys, S. K., Galvani, A. P., & Porco, T. C. (2015). Spatial heterogeneity in projected leprosy trends in India. Parasites & Vectors (8).

Chaptini, C., Marshman, G. (2015). Leprosy: a review on elimination, reducing the disease burden and future research. Lepr. Rev., 86(4).

CNDSS. (2008). As causas sociais das iniquidades em saúde no Brasil. Relatório final da Comissão Nacional sobre Determinantes Sociais da Saúde. http://bvsms.saude.gov.br/bvs/publicacoes/causas_sociais_iniquidades.pdf

CSDH. (2008). Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva, World Health Organization.

Cunha, M. D., Almeida, A. S., Cunha, G. M., Santos, R. S. (2016). Geographic weighted regression: applicability to epidemiological studies of leprosy. Rev. Soc. Bras. Med. Trop., 49(1).

Freitas, L. R. S., Duarte, E. C., Garcia, L. P. (2017). Análise da situação epidemiológica da hanseníase em uma área endêmica no Brasil: distribuição espacial dos períodos 2001 – 2003 e 2010 – 2012. Rev bras epidemiol, 20(4).

Freitas, L. R. S., Duarte, E. C., Garcia, L. P. (2014). Leprosy in Brazil and its association with characteristics of municipalities: ecological study, 2009–2011. Trop Med Int Health, 19(10).

IBGE. Instituto Brasileiro de Geografia e Estatística. (2017) Censo demográfico 2010: resultados do universo por setor censitário.

Jannuzzi, P. M. (2012) Indicadores sociais na formulação e avaliação de políticas públicas. Flacso, 2012.

Londrina. Londrina em dados 2017. http://www1.londrina.pr.gov.br/index.php?option=com_content&view=article&id=543&Itemid=558&limitstart=4.

Lopes, V. A. S, Rangel, E. M. (2014) Hanseníase e vulnerabilidade social: uma análise do perfil socioeconômico de usuários em tratamento irregular. Saúde Debate, 38(103).

Marmot, M. (2017). The health gap: Doctors and the social determinants of health. Scandinavian Journal of Public Health (45).

Montgomery, D. C., Peck, E. A., Vining, G. G. (2013). Intoduction to linear regression analysis. (4a ed.), John Wiley & Sons.

Mongenstern, H. (2008). Ecologic Studies. In: Rothman KJ, Greenland S, Lash TL, editors. Modern Epidemiology. (3a ed.), Lippincot Williams & Wilkins.

Nery, J. D., Pereira, S. M., Rasella, D., Penna, M. L. F., Aquino, R., Rodrigues, L. C. et al. (2014). Effect of the Brazilian conditional cash transfer and primary health care programs on the new case detection rate of leprosy. Plos Negl Trop Dis, 8(11).

Organização Mundial da Saúde. Comissão de Determinantes Sociais em Saúde. Relatório Final. http://determinantes.saude.bvs.br/docs/Relatorio_Final_CDSS_OMS.pdf

Organização Mundial da Saúde. (2016). Estratégia global para Hanseníase 2016-2020. Aceleração rumo a um mundo sem Hanseníase. http://apps.who.int/iris/bitstream/handle/10665/208824/9789290225201-pt.pdf,jsessionid=725AAE77B5BA16C6B74396590EBE847B?sequence=17

Organização Mundial da Saúde. (2016). Global leprosy update: time for action, accountability and inclusion. Wkly Epidemiol Rec, 91(36).

Ramos, A.C. V., Yamamura, M., Arroyo, L. H., Popolin, M. P., Chiaravalloti, N. F., Palha, P. F. et al. (2017). Spatial clustering and local risk of leprosy in São Paulo, Brazil. PLoS Negl Trop Dis, 11(2).

Silva, C. L. M., Fonseca, S. C., Kawa, H., Palmer, D. O. Q. (2017). Spatial distribution of leprosy in Brazil: a literature review. Rev Soc Bras Med Trop, 50(4).

Santos, S. D., Penna, G. O., Costa, M. C. N., Natividade, M. S., Teixeira, M. G. (2016). Leprosy in children and adolescents under 15 years old in an urban centre in Brazil. Mem Inst Oswaldo Cruz, 111(6).



How to Cite

FERREIRA, N. M. de A. .; ARROYO, L. H.; GIOIA, T. B.; ARCOVERDE, M. A. M. .; ASSIS, I. S. de .; SANTOS NETO, M.; YAMAMURA, M.; SCHOLZE, A. R. .; RODRIGUES, L. B. B. .; FREITAS, F. M. B. de .; BOLORINO, N.; RIBEIRO, L. C. G. .; STORER, J. M. .; ARCÊNCIO, R. A. .; PIERI, F. M. . Leprosy and Social Determinants of Health in South Brazil: Geographically evaluated analysis. Research, Society and Development, [S. l.], v. 10, n. 9, p. e16110917823, 2021. DOI: 10.33448/rsd-v10i9.17823. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/17823. Acesso em: 23 sep. 2021.



Health Sciences