92
Souza
CDF
et
al.
60
60
65
55
55
55
50
50
50
45
45
45
35
35
35
30
30
30
25
25
20
2000 2002
Rate obser
ved
Rate obser
ved
Temporal trend 2001-2007
Men
+ Women:
Men:
Women:
APC = 13.9% 95% C
I: 4.7 to 23.9 (p<0.001)
APC = 13.5% 95% C
I: 5.1 to 22.2 (p<0.001)
APC = -3.4% 95% CI: -4.1 to
-2.6 (p<0.001)
APC = 14.5% 95% C
I: 0.5 to 30.5 (p<0.001)
AAPC = 0.2% 95% C
I: -1.4 a 1.7 (p=0.8)
AAPC = 0.7% 95% C
I: -1.7 a 3.2 (p=0.6)
AAPC = -0.4% 95% CI: -1.8 a 0.9 (p=0.5)
APC = -2.2% 95% CI: -3.5 to
-0.8 (p<0.001)
APC = -2.8% 95% CI: -3.6 to
-1.9 (p<0.001)
Rate obser
ved
2004 2006 2008 2010
Det
ection rate of leprosy in the
elderly populati
on (Men + Women)
Det
ection rate of leprosy in the
elderly populati
on (Women)
Det
ection rate of leprosy in the
elderly populati
on (Men)
Year
Year
New cases per 100,000 inhabitants
New cases per 100,000 inhabitants
New cases per 100,000 inhabitants
Year
2012 2014 2016 2018
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
25
40
40
40
Figure
1
Trend
of
the
detection
rates
of
new
cases
of
leprosy
in
the
elderly
population,
stratified
by
gender.
Bahia,
Brazil,
2001---2017.
APC,
annual
percent
change;
AAPC,
average
annual
percent
change;
CI,
confidence
interval.
Brazil
contributed
with
92.3%
of
new
leprosy
cases
in
the
Americas
region.
The
three
countries
(Brazil,
Indian,
and
Indonesia)
with
the
highest
burdens
accounted
for
80.2%
of
the
new
case
load
globally
in
2017.
1
In
2017,
Brazil
recorded
26,875
new
cases
of
the
disease,
2225
of
which
(8.28%)
occurred
in
Bahia’s
residents.
2
Aging
is
characterized
by
important
physical,
functional,
biological
and
psychosocial
transformations
that
increase
the
risk
of
developing
some
diseases.
3
Therefore,
the
aging
process
of
the
Brazilian
population,
a
consequence
of
the
demographic
transition,
justifies
the
need
of
understanding
how
leprosy
has
been
affecting
this
age
range.
Moreover,
the
gender-stratified
analyses,
according
to
the
World
Health
Organization
(WHO)
recommendation,
have
a
special
rele-
vance,
because
they
document
the
nuances
of
the
disease
process
in
each
population
subgroup.
1
Thus,
the
objective
was
to
analyze
epidemiological
tendency
and
characteristics
of
leprosy
in
the
elderly
popu-
lation,
from
2001---2017,
in
the
state
of
Bahia,
Brazil.
An
ecological
study
was
conducted.
The
data
related
to
the
new
cases
were
obtained
from
the
National
Sys-
tem
of
Notification
Diseases
(Sistema
Nacional
de
Agravos
de
Notificac
̧ão
[SINAN]),
and
the
population
data
from
the
Brazilian
Institute
of
Geography
and
Statistics
(Instituto
Brasileiro
de
Geografia
e
Estatística
[IBGE]),
accessed
in
March
2018.
The
first
step
consisted
of
the
analysis
of
the
tendency
of
detection
rate
of
new
cases,
stratified
according
to
gen-
der.
The
joinpoint
regression
model
was
used.
4
The
tendency
was
classified
as
increasing,
decreasing,
or
stationary.
In
addition,
the
annual
percent
change
(APC)
and
the
aver-
age
annual
percent
change
(AAPC)
were
calculated
with
95%
confidence
intervals
(95%
CI).
Authorization
by
the
Research
Ethics
Committee
was
not
required,
because
the
data
used
are
secondary.
The
second
step
consisted
of
the
epidemiological
anal-
ysis
of
the
following
variables:
gender,
age,
race/color,
schooling,
clinical
form,
operational
classification,
detec-
tion
mode,
and
degree
of
physical
incapacity
at
the
time
of
diagnosis.
There
were
8843
new
cases
of
leprosy
recorded
in
the
elderly
Bahia
population.
The
average
detection
rate
was
38.73/100,000
inhabitants,
with
greater
detection
in
men
(45.19/100,000
inhabitants)
when
compared
to
the
women
(33.54/100,000
inhabitants).
Considering
that
the
number
of
leprosy
cases
in
Brazil
has
been
contested
by
researchers,
5
the
actual
epidemiological
scenario
of
leprosy
in
the
elderly
may
be
even
more
worrying.