02147nas a2200253   4500000000100000008004100001653002600042653002700068653002300095653001200118653002400130653001700154100001600171700001100187700002000198700001400218700001700232245007600249856007900325300000700404490000700411520146100418022001401879       2017                            d10aSocioeconomic Factors10aPrevention and control10aNeglected Diseases10aleprosy10aHealth inequalities10aEpidemiology1 aMonteiro LD1 aMota R1 aMartins-Melo FR1 aAlencar C1 aHeukelbach J00aSocial determinants of leprosy in a hyperendemic State in North Brazil.  uhttp://www.scielo.br/pdf/rsp/v51/0034-8910-rsp-S1518-87872017051006655.pdf  a700 v513 a<p><strong>OBJECTIVE: </strong>To identify the socioeconomic, demographic, operational, and health service-related factors associated with the occurrence of leprosy in a hyperendemic State in North Brazil.</p>

<p><strong>METHODS: </strong>This is an ecological study based on secondary data from the Sistema de Informações de Agravos de Notificação in municipalities of the State of Tocantins from 2001 to 2012. Units of analysis were the 139 municipalities of the State. Negative binomial log linear regression models were used to estimate incidence rate ratios.</p>

<p><strong>RESULTS: </strong>In bivariate analysis, the incidence rate ratios were significantly higher for municipalities with higher income ratio of the poorest 20.0% (1.47; 95%CI 1.19-1.81) and better Municipal Human Development Index (1.53; 95%CI 1.14-2.06). In multivariate analysis, the incidence rate ratios were significantly higher in municipalities with higher proportion of immigrants (1.31; 95%CI 1.11-1.55) and higher proportion of households with waste collection (1.37; 95%CI 1.11-1.69). There was a significant reduction in the incidence rate ratio with increased coverage of the Bolsa Família Program (0.98; 95%CI 0.96-0.99).</p>

<p><strong>CONCLUSIONS: </strong>Control programs need to focus on activities in municipalities of greater social vulnerability with intersectoral investment for the improvement of the living conditions of the population.</p>
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