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gender&#44; age&#44; race&#47;color&#44; schooling&#44; clinical form&#44; operational classification&#44; detection mode&#44; and degree of physical incapacity at the time of diagnosis&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">There were 8843 new cases of leprosy recorded in the elderly Bahia population&#46; The average detection rate was 38&#46;73&#47;100&#44;000 inhabitants&#44; with greater detection in men &#40;45&#46;19&#47;100&#44;000 inhabitants&#41; when compared to the women &#40;33&#46;54&#47;100&#44;000 inhabitants&#41;&#46; Considering that the number of leprosy cases in Brazil has been contested by researchers&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> the actual epidemiological scenario of leprosy in the elderly may be even more worrying&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The joinpoint model showed two distinct temporal trends&#46; The first indicated growth &#40;2001&#8211;2004&#41;&#44; and the second demonstrated reduction &#40;2004&#8211;2017&#41;&#44; with a greater magnitude of reduction in women than men &#40;APC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;3&#46;4 and &#8722;2&#46;2&#37;&#44; respectively&#41;&#44; corroborating other studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;6&#44;7</span></a> At the same time&#44; when considering the tendency of the total period &#40;2001&#8211;2017&#41;&#44; the observed trend was stationary &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">With regard to the epidemiological characteristics&#44; a slight predominance of cases in the male population was detected &#40;52&#46;13&#37;&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4610&#41;&#44; age between 60 and 69 years old &#40;57&#46;86&#37;&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5117&#41;&#44; brown-skinned &#40;50&#46;42&#37;&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4459&#41;&#44; and low level of schooling&#44; with 27&#46;77&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2456&#41; being illiterate&#46; 52&#46;26&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4621&#41; were diagnosed by means of referral &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Similar results were evidenced in other investigations&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;8&#44;9</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">In the gender-stratified analyses&#44; men presented higher proportions of the multibacillary forms when compared to the female population &#40;3509&#47;76&#46;12&#37; and 2352&#47;55&#46;56&#37;&#44; respectively&#41;&#46; The lepromatous clinical form corresponded to 22&#46;71&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1047&#41; of the registered cases in the male population and only 11&#46;86&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>502&#41; of the registered cases in the female gender &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; These data suggest that diagnosis occurs later in men&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> possibly due to two factors&#58; less access to health services and the effects of negligence regarding symptoms of the disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;8&#44;9</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The presence of physical disabilities was another element that was highlighted in the analyses&#46; Of the total number of new cases&#44; 30&#46;15&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2666&#41; already had some incapacity at the time of diagnosis and&#44; in 8&#46;31&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>735&#41;&#44; these disabilities were permanent&#46; The proportion of men with permanent physical incapacity was 2&#46;04 times higher than that of women &#40;11&#46;00&#37;&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>507 and 5&#46;39&#37;&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>228&#44; respectively&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; This scenario highlights what has been mentioned previously&#44; indicating the severe consequences of the disease in the elderly population&#44;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;9</span></a> especially in the male population&#44; and in the maintenance of the chain of transmission in the community&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Although the results presented are already capable of justifying the authors&#8217; concern about leprosy in the elderly population&#44; the high proportions of unfilled and&#47;or ignored fields in the evaluation of the degree of physical disability at the time of diagnosis reflect not only on the operational problems in disease vigilance&#44;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;6&#44;9</span></a> but also indicate that the number of disabled may be even higher than that presented&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Leprosy in the elderly must be viewed with concern&#44; since this population is stricken by more multibacillary forms of the disease and has an increased risk of developing physical disabilities&#46; In addition&#44; the precarious access to health services &#8211; which makes these patients invisible &#8211; keeps the disease&#39;s chain of transmission active&#44; making it persistent in the community&#46;</p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Financial support</span><p id="par0090" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Authors&#8217; contributions</span><p id="par0070" class="elsevierStylePara elsevierViewall">Carlos Dornels Freire de Souza&#58; Statistical analysis&#59; approval of the final version of the manuscript&#59; conception and planning of the study&#59; composition of the manuscript&#59; collection&#44; analysis&#44; and interpretation of data&#59; participation in the design of the study&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct in the studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">T&#226;nia Rita Moreno de Oliveira Fernandes&#58; Approval of the final version of the manuscript&#59; conception and planning of the study&#59; composition of the manuscript&#59; participation in the design of the study&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct in the studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Thais Silva Matos&#58; Statistical analysis&#59; approval of the final version of the manuscript&#59; conception and planning of the study&#59; composition of the manuscript&#59; collection&#44; analysis&#44; and interpretation of the data&#59; participation in the design of the study&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct in the studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Cl&#243;dis Maria Tavares&#58; Approval of the final version of the manuscript&#59; conception and planning of the study&#59; composition of the manuscript&#59; participation in the design of the study&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct in the studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">This ecological study aims to analyze both the tendency and the characteristics of leprosy in the elderly population in the state of Bahia&#44; 2001&#8211;2017&#46; The tendency was analyzed through joinpoint regression&#46; Epidemiological variables were also included in the study&#46; The average detection rate was 38&#46;73&#47;100&#44;000&#44; with prevalence of men &#40;45&#46;19&#47;100&#44;000&#41;&#46; A downward trend occurred in both genders&#44; from 2004&#44; with a greater magnitude in women &#40;annual percent change &#91;APC&#93;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;3&#46;4&#37;&#41;&#46; Men presented higher proportions of the multibacillary forms and physical disabilities&#46; The epidemiological scenario indicates the need of implementation of actions that stimulate early diagnosis and treatment of the elderly population&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article&#58; Souza CDF&#44; Fernandes TRMO&#44; Matos TS&#44; Tavares CM&#46; Leprosy in the elderly population in an endemic state in the Brazilian Northeast &#40;2001&#8211;2017&#41;&#58; epidemiological scenario&#46; An Bras Dermatol&#46; 2020&#59;95&#58;91&#8211;4&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Universidade Federal de Alagoas&#44; AL&#44; Brazil&#46;</p>"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Trend of the detection rates of new cases of leprosy in the elderly population&#44; stratified by gender&#46; Bahia&#44; Brazil&#44; 2001&#8211;2017&#46; APC&#44; annual percent change&#59; AAPC&#44; average annual percent change&#59; CI&#44; confidence interval&#46;</p>"
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>60&#8211;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">2691 &#40;58&#46;37&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">2426 &#40;57&#46;31&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">5117 &#40;57&#46;86&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1423 &#40;30&#46;87&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1263 &#40;29&#46;84&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>80 or more&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">496 &#40;10&#46;76&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">544 &#40;12&#46;85&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1040 &#40;11&#46;76&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">965 &#40;20&#46;93&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">897 &#40;21&#46;19&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Black&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">754 &#40;16&#46;36&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">646 &#40;15&#46;26&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1400 &#40;15&#46;83&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Yellow&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Elementary school&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Middle school&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>High school&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ignored&#47;left blank&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dimorphous&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Virchow&#39;s&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ignored&#47;left blank&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">947 &#40;20&#46;54&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Paucibacillary&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1087 &#40;23&#46;58&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1859 &#40;43&#46;92&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2946 &#40;33&#46;31&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Multibacillary&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">3509 &#40;76&#46;12&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2352 &#40;55&#46;56&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Sociodemographic and clinical characterization of leprosy cases diagnosed in the elderly population&#46; Bahia&#44; Brazil&#44; 2001&#8211;2017&#46;</p>"
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                0 => array:1 [
                  "referenciaCompleta" => "Word Health Organization &#40;WHO&#41;&#46; Weekly epidemiological record&#46; Global leprosy update&#44; 2017&#58; reducing the disease burden due to leprosy&#46; 2018&#59; 35&#58;445&#8211;56&#46; Available from&#58; <a target="_blank" href="https://zeroleprosy.org/who_wer/">https&#58;&#47;&#47;zeroleprosy&#46;org&#47;who&#95;wer&#47;</a> &#91;cited 10&#46;01&#46;19&#93;&#46;"
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                      "titulo" => "Grau de incapacidade f&#237;sica na popula&#231;&#227;o idosa afetada pela hansen&#237;ase no estado da Bahia&#44; Brasil"
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                            3 => "J&#46;M&#46;R&#46; Filho"
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Tropical/Infectoparasitary Dermatology
Leprosy in the elderly population of an endemic state in the Brazilian Northeast (2001–2017): epidemiological scenario
Carlos Dornels Freire de Souzaa,b,
Autor para correspondência
carlos.freire@arapiraca.ufal.br

Corresponding author.
, Tânia Rita Moreno de Oliveira Fernandesc,d, Thais Silva Matose,f, Clódis Maria Tavaresg,h
a Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
b Medical Program of Universidade Federal de Alagoas, Arapiraca, AL, Brazil
c Universidade Federal de São Paulo, São Paulo, SP, Brazil
d Medical Program of Universidade Federal do Vale do São Francisco, Petrolina, PE, Brazil
e Program of Biological Sciences and Health of Universidade Federal do Vale do São Francisco, Petrolina, PE, Brazil
f Dr. Altino Lemos Santiago Leprosy Reference Center, Juazeiro, BA, Brazil
g Universidade de São Paulo, São Paulo, SP, Brazil
h School of Nursery and Pharmacy, Universidade Federal de Alagoas, Maceió, AL, Brazil
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Trend of the detection rates of new cases of leprosy in the elderly population&#44; stratified by gender&#46; Bahia&#44; Brazil&#44; 2001&#8211;2017&#46; APC&#44; annual percent change&#59; AAPC&#44; average annual percent change&#59; CI&#44; confidence interval&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Brazil contributed with 92&#46;3&#37; of new leprosy cases in the Americas region&#46; The three countries &#40;Brazil&#44; Indian&#44; and Indonesia&#41; with the highest burdens accounted for 80&#46;2&#37; of the new case load globally in 2017&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> In 2017&#44; Brazil recorded 26&#44;875 new cases of the disease&#44; 2225 of which &#40;8&#46;28&#37;&#41; occurred in Bahia&#39;s residents&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Aging is characterized by important physical&#44; functional&#44; biological and psychosocial transformations that increase the risk of developing some diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> Therefore&#44; the aging process of the Brazilian population&#44; a consequence of the demographic transition&#44; justifies the need of understanding how leprosy has been affecting this age range&#46; Moreover&#44; the gender-stratified analyses&#44; according to the World Health Organization &#40;WHO&#41; recommendation&#44; have a special relevance&#44; because they document the nuances of the disease process in each population subgroup&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Thus&#44; the objective was to analyze epidemiological tendency and characteristics of leprosy in the elderly population&#44; from 2001&#8211;2017&#44; in the state of Bahia&#44; Brazil&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">An ecological study was conducted&#46; The data related to the new cases were obtained from the National System of Notification Diseases &#40;Sistema Nacional de Agravos de Notifica&#231;&#227;o &#91;SINAN&#93;&#41;&#44; and the population data from the Brazilian Institute of Geography and Statistics &#40;Instituto Brasileiro de Geografia e Estat&#237;stica &#91;IBGE&#93;&#41;&#44; accessed in March 2018&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The first step consisted of the analysis of the tendency of detection rate of new cases&#44; stratified according to gender&#46; The joinpoint regression model was used&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> The tendency was classified as increasing&#44; decreasing&#44; or stationary&#46; In addition&#44; the annual percent change &#40;APC&#41; and the average annual percent change &#40;AAPC&#41; were calculated with 95&#37; confidence intervals &#40;95&#37; CI&#41;&#46; Authorization by the Research Ethics Committee was not required&#44; because the data used are secondary&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The second step consisted of the epidemiological analysis of the following variables&#58; gender&#44; age&#44; race&#47;color&#44; schooling&#44; clinical form&#44; operational classification&#44; detection mode&#44; and degree of physical incapacity at the time of diagnosis&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">There were 8843 new cases of leprosy recorded in the elderly Bahia population&#46; The average detection rate was 38&#46;73&#47;100&#44;000 inhabitants&#44; with greater detection in men &#40;45&#46;19&#47;100&#44;000 inhabitants&#41; when compared to the women &#40;33&#46;54&#47;100&#44;000 inhabitants&#41;&#46; Considering that the number of leprosy cases in Brazil has been contested by researchers&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> the actual epidemiological scenario of leprosy in the elderly may be even more worrying&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The joinpoint model showed two distinct temporal trends&#46; The first indicated growth &#40;2001&#8211;2004&#41;&#44; and the second demonstrated reduction &#40;2004&#8211;2017&#41;&#44; with a greater magnitude of reduction in women than men &#40;APC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;3&#46;4 and &#8722;2&#46;2&#37;&#44; respectively&#41;&#44; corroborating other studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;6&#44;7</span></a> At the same time&#44; when considering the tendency of the total period &#40;2001&#8211;2017&#41;&#44; the observed trend was stationary &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">With regard to the epidemiological characteristics&#44; a slight predominance of cases in the male population was detected &#40;52&#46;13&#37;&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4610&#41;&#44; age between 60 and 69 years old &#40;57&#46;86&#37;&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5117&#41;&#44; brown-skinned &#40;50&#46;42&#37;&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4459&#41;&#44; and low level of schooling&#44; with 27&#46;77&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2456&#41; being illiterate&#46; 52&#46;26&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4621&#41; were diagnosed by means of referral &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Similar results were evidenced in other investigations&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;8&#44;9</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">In the gender-stratified analyses&#44; men presented higher proportions of the multibacillary forms when compared to the female population &#40;3509&#47;76&#46;12&#37; and 2352&#47;55&#46;56&#37;&#44; respectively&#41;&#46; The lepromatous clinical form corresponded to 22&#46;71&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1047&#41; of the registered cases in the male population and only 11&#46;86&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>502&#41; of the registered cases in the female gender &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; These data suggest that diagnosis occurs later in men&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> possibly due to two factors&#58; less access to health services and the effects of negligence regarding symptoms of the disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;8&#44;9</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The presence of physical disabilities was another element that was highlighted in the analyses&#46; Of the total number of new cases&#44; 30&#46;15&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2666&#41; already had some incapacity at the time of diagnosis and&#44; in 8&#46;31&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>735&#41;&#44; these disabilities were permanent&#46; The proportion of men with permanent physical incapacity was 2&#46;04 times higher than that of women &#40;11&#46;00&#37;&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>507 and 5&#46;39&#37;&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>228&#44; respectively&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; This scenario highlights what has been mentioned previously&#44; indicating the severe consequences of the disease in the elderly population&#44;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;9</span></a> especially in the male population&#44; and in the maintenance of the chain of transmission in the community&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Although the results presented are already capable of justifying the authors&#8217; concern about leprosy in the elderly population&#44; the high proportions of unfilled and&#47;or ignored fields in the evaluation of the degree of physical disability at the time of diagnosis reflect not only on the operational problems in disease vigilance&#44;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;6&#44;9</span></a> but also indicate that the number of disabled may be even higher than that presented&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Leprosy in the elderly must be viewed with concern&#44; since this population is stricken by more multibacillary forms of the disease and has an increased risk of developing physical disabilities&#46; In addition&#44; the precarious access to health services &#8211; which makes these patients invisible &#8211; keeps the disease&#39;s chain of transmission active&#44; making it persistent in the community&#46;</p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Financial support</span><p id="par0090" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Authors&#8217; contributions</span><p id="par0070" class="elsevierStylePara elsevierViewall">Carlos Dornels Freire de Souza&#58; Statistical analysis&#59; approval of the final version of the manuscript&#59; conception and planning of the study&#59; composition of the manuscript&#59; collection&#44; analysis&#44; and interpretation of data&#59; participation in the design of the study&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct in the studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">T&#226;nia Rita Moreno de Oliveira Fernandes&#58; Approval of the final version of the manuscript&#59; conception and planning of the study&#59; composition of the manuscript&#59; participation in the design of the study&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct in the studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Thais Silva Matos&#58; Statistical analysis&#59; approval of the final version of the manuscript&#59; conception and planning of the study&#59; composition of the manuscript&#59; collection&#44; analysis&#44; and interpretation of the data&#59; participation in the design of the study&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct in the studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Cl&#243;dis Maria Tavares&#58; Approval of the final version of the manuscript&#59; conception and planning of the study&#59; composition of the manuscript&#59; participation in the design of the study&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct in the studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">This ecological study aims to analyze both the tendency and the characteristics of leprosy in the elderly population in the state of Bahia&#44; 2001&#8211;2017&#46; The tendency was analyzed through joinpoint regression&#46; Epidemiological variables were also included in the study&#46; The average detection rate was 38&#46;73&#47;100&#44;000&#44; with prevalence of men &#40;45&#46;19&#47;100&#44;000&#41;&#46; A downward trend occurred in both genders&#44; from 2004&#44; with a greater magnitude in women &#40;annual percent change &#91;APC&#93;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;3&#46;4&#37;&#41;&#46; Men presented higher proportions of the multibacillary forms and physical disabilities&#46; The epidemiological scenario indicates the need of implementation of actions that stimulate early diagnosis and treatment of the elderly population&#46;</p></span>"
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">5117 &#40;57&#46;86&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Elementary school&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Middle school&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>High school&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ignored&#47;left blank&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">921 &#40;21&#46;76&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">404 &#40;8&#46;76&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">949 &#40;10&#46;73&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1085 &#40;25&#46;63&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1761 &#40;19&#46;91&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dimorphous&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1536 &#40;33&#46;32&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1290 &#40;30&#46;47&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">754 &#40;16&#46;35&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Sociodemographic and clinical characterization of leprosy cases diagnosed in the elderly population&#46; Bahia&#44; Brazil&#44; 2001&#8211;2017&#46;</p>"
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