Martins-Melo Francisco Rogerlândio, Assunção-Ramos Adriana Valéria, Ramos Alberto Novaes, Alencar Carlos Henrique, Montenegro Renan Magalhães, Wand-Del-Rey de Oliveira Maria Leide, Heukelbach Jorg
Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil Federal Institute of Education, Science and Technology of Ceará, Caucaia, Brazil.
School of Medicine, Health Sciences Center, University of Fortaleza, Fortaleza, Brazil Municipal Secretary of Health of Fortaleza, Ceará, Brazil.
Trans R Soc Trop Med Hyg. 2015 Oct;109(10):643-52. doi: 10.1093/trstmh/trv069. Epub 2015 Sep 8.
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.
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.
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.
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.
麻风病是一个公共卫生问题，在世界上多个国家都是一种被忽视的发病和死亡状况。我们分析了巴西麻风病相关死亡率的时间趋势和时空模式。
我们利用二次死亡数据进行了一项全国性的基于人群的研究。我们纳入了2000年至2011年期间在巴西发生的所有死亡病例，其中死亡证明的任何字段中提及了麻风病。
在12491280例死亡病例中有7732例（0.1%）被确诊为麻风病。年龄调整后的平均年死亡率为每10万居民0.43例死亡（95%置信区间0.40 - 0.46）。男性、老年人、黑人种族/肤色以及麻风病流行地区的麻风病死亡负担更高。瘤型麻风是提及最多的临床类型。在此期间全国死亡率显著下降（年变化百分比[APC]：-2.8%；95%置信区间-4.2至-2.4）。我们观察到南部、东南部和中西部地区的死亡率在下降，而北部和东北部地区的死亡率保持稳定。麻风病相关死亡的空间和时空高风险聚集主要分布在高流行和社会经济贫困地区。
在巴西，麻风病是一个被忽视的死亡原因，因为这种疾病是可预防的，并且有具有成本效益的治疗方法。可持续的控制措施应包括对麻风病相关并发症（如严重的麻风反应和多药疗法的不良反应）进行适当管理和系统监测。
