Geospatial inequalities in severe leprosy disability in Pernambuco before and during COVID-19

Objective The present study therefore aimed to compare and contextualize leprosy indicators in the State of Pernambuco during the pre-pandemic and pandemic periods, to assess the burden of disease using Years Lived with Disability, and to examine its distribution across Pernambuco's various health regions.Methods This ecological study used secondary data to compare epidemiological indicators and the burden of leprosy-related disease in the State of Pernambuco, Brazil, before (2017‒2019) and during (2020‒2022) the COVID-19 pandemic, and to examine its distribution among health regions.Results The detection rate of new cases decreased from 33.44 to 24.54 per 100,000 inhabitants, although endemicity remained high in most regions and hyperendemic in Petrolina. The detection rate of new cases with grade 2 disability increased from 7.22 to 8.64 per 1000,000 inhabitants, particularly in the regions of Recife, Caruaru, and Petrolina. Years lived with grade 2 disability increased from 352.76 to 463.06 years.Conclusion During the period from 2020 to 2022, the COVID-19 pandemic was associated with significant changes in most leprosy indicators, suggesting an increase in morbidity in the state of Pernambuco, Brazil. Despite the reduction in new leprosy cases due to mobility restrictions, the overburdening of the public health system, and the suspension of active case finding, particularly affecting children and vulnerable populations, there was an increase in hidden prevalence, treatment delays, and disabilities. The behavior of the epidemic in the state of Pernambuco was similar to that observed in Brazil, reinforcing the country's position as the second most affected by leprosy in the world.