{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T23:57:30Z","timestamp":1773705450065,"version":"3.50.1"},"reference-count":31,"publisher":"FapUNIFESP (SciELO)","license":[{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Mem. Inst. Oswaldo Cruz"],"abstract":"<jats:p> BACKGROUND  Leprosy, a neglected tropical disease caused by Mycobacterium leprae, presents significant public health challenges in Brazil due to its slow progression, dermato-neurological manifestations, and potential for disability. Understanding leprosy\u2019s spatial distribution and temporal trends is important for effective control and elimination strategies.  OBJECTIVES  This study aimed to identify clusters of leprosy in Brazilian states using agglomerative hierarchical clustering and to analyse their temporal trends from 2012 to 2022.  METHODS  An ecological study was conducted using data from the National System of Notifiable Diseases (SINAN). The agglomerative hierarchical clustering method was used to group states using the new case detection rate (NCDR) of leprosy per 100,000 inhabitants, the proportion of new cases of leprosy with grade 2 physical disability at the time of diagnosis (G2R), and the Gini index, a measure of socioeconomic inequality. Temporal trends within the clusters were assessed using Prais-Winsten regression analysis.  FINDINGS  In the period 2012-2022, 293,030 new cases of leprosy were reported in Brazil. Five distinct clusters were identified. Cluster 4, comprising Mato Grosso and Tocantins, had the highest NCDR and stable temporal trends (APC: 3.2%, 95% CI: -0.1%, 6.7%). Clusters 1 and 3 had the highest proportions of grade 2 disability, indicating late diagnosis. Clusters 4 and 5 had the lowest percentages of individuals with incomplete\/complete higher education (7.6% and 7.4%, respectively). Cluster 4 had the highest percentage of individuals with the Diforma clinical form (69.8%) and with cases classified as multibacillary (84.5%).  MAIN CONCLUSIONS  The use of agglomerative hierarchical clustering, a novel application of a non-supervised algorithm in this context, highlighting the integration of multiple epidemiological and socioeconomic variables for a better understanding the dynamics of leprosy transmission in Brazil. Significant variations in the spatial distribution and temporal trends of leprosy were observed across Brazilian states. To improve leprosy surveillance and control in Brazil, targeted interventions are needed, particularly in high-endemicity regions with late diagnosis.<\/jats:p>","DOI":"10.1590\/0074-02760240163","type":"journal-article","created":{"date-parts":[[2025,4,16]],"date-time":"2025-04-16T18:13:59Z","timestamp":1744827239000},"source":"Crossref","is-referenced-by-count":1,"title":["Agglomerative hierarchical cluster analysis and temporal trend of leprosy indicators in Brazilian states, 2012-2022"],"prefix":"10.1590","volume":"120","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0080-2858","authenticated-orcid":false,"given":"L\u00facia Rolim Santana","family":"de Freitas","sequence":"first","affiliation":[{"name":"Universidade de Bras\u00edlia,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fernanda Fernandez","family":"N\u00f3brega","sequence":"additional","affiliation":[{"name":"Universidade de Bras\u00edlia,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"530","published-online":{"date-parts":[[2025]]},"reference":[{"issue":"10","key":"ref1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3126\/ajms.v13i10.47519","article-title":"Neglected tropical disease why we need to prioritize them more","volume":"13","author":"Dhar R","year":"2022","journal-title":"Asian J Med Sci"},{"key":"ref2","article-title":"27 - Neglected tropical diseases: public health control programs and mass drug administration","author":"Hotez PJ","year":"2020","journal-title":"Hunt Trop Med Emerg Infect Dis"},{"issue":"1","key":"ref3","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1186\/s40249-023-01084-1","article-title":"Neglected tropical diseases risk correlates with poverty and early ecosystem destruction","volume":"12","author":"Magalh\u00e3es AR","year":"2023","journal-title":"Infect Dis Poverty"},{"key":"ref4","article-title":"Towards zero leprosy","year":"2023","journal-title":"Global leprosy (Hansen's Disease) strategy"},{"key":"ref5","series-title":"Estrat\u00e9gia nacional para enfrentamento \u00e0 hansen\u00edase 2024-2030","year":"2024"},{"issue":"1","key":"ref6","doi-asserted-by":"crossref","first-page":"7","DOI":"10.4103\/ijmr.ijmr_220_22","article-title":"Guiding policy towards zero leprosy challenges for modelling & economic evaluation","volume":"155","author":"Blok DJ","year":"2022","journal-title":"Indian J Med Res"},{"issue":"17","key":"ref7","doi-asserted-by":"crossref","first-page":"10845","DOI":"10.3390\/su141710845","article-title":"Including sustainable development goals (SDGs) transversally in education","volume":"14","author":"Zamora-Polo F","year":"2022","journal-title":"Sustainability"},{"key":"ref8","series-title":"Global leprosy (Hansen disease) update, 2023: elimination of leprosy disease is possible - Time to act! 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