International Journal of Epidemiology, Volume 33, Number 2, pp. 262-269
IJE vol.33 no.2 © International Epidemiological Association 2004; all rights reserved.
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Inequality and leprosy in Northeast Brazil: an ecological study
1 Departamento de Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará, R: Prof. Costa Mendes, 1608—5o. Andar, CEP: 60.190–080—Fortaleza—CE, Brazil.
2 Instituto de Saúde Coletiva, Universidade Federal da Bahia, Rua Padre Feijó, 29—Canela—Centro Pediátrico Prof. Hosanah de Oliveira, CEP: 40110–170—Salvador—BA, Brazil
3 Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro—NESC/UFRJ, Rua São Francisco Xavier, 524, pavilhão João Lyra Filho, 7o andar, blocos D—Maracanã, CEP 20559–900—Rio de Janeiro—RJ, Brazil
4 Fachbereich Humanmedizin, Freie Universität Berlin, Fabeckstr 60–62, 12203—Berlin, Germany
Correspondence: Ligia Regina Sansigolo Kerr-Pontes, Departamento de Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará, R: Prof. Costa Mendes, 1608—5o. Andar, CEP: 60.190–080—Fortaleza—CE, Brazil. E-mail: ligia{at}ufc.br
Background Leprosy is an important public health problem in many developing countries and many features of its determinants are still obscure.
Methods To investigate whether the incidence of leprosy is related to certain environmental and socioeconomic determinants, an ecological study was undertaken in 165 municipalities of the state of Ceará, Brazil. Social, economic, education, sanitation, demography, meteorology, and health data were collected. The dependent variable was the average incidence rate of leprosy from 1991 to 1999. Simple and multiple linear regressions were performed to assess the relationship between the dependent and the independent variables.
Results The average incidence rate for all the municipalities for the 1991–1999 period, varied from 0.06 to 14.68 per 10 000 persons per year. The level of inequality (ß = 1.67, P = 0.011), the mean years of study among the population 
25 years old (ß = 1.35, P < 0.001), the population growth from 1991 to 1996 (ß = 0.02, P = 0.007), the percentage of children 7–14 years old that did not go to the school (ß = 0.02, P = 0.028), and the presence of a railroad in the municipality (ß = 0.45, P = 0.038) were found to be predictors of the incidence rate of leprosy in Ceará.
Conclusion Our findings fit the assumption that, in Ceará, leprosy is associated with a high level of poverty and uncontrolled urbanization. We put forward the hypothesis that urbanization increases not only social inequality eventually leading to strong polarization, but also excludes people from social and material opportunities. Apparently, such deprivations render them susceptible for leprosy.
Keywords Leprosy, ecological study, inequality, Brazil
Accepted 15 July 2003
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