Temporal trends and regional heterogeneity of leprosy in an Amazonian Brazilian state: Tocantins, 2014–2024

Leprosy remains a persistent public health challenge in Brazil, particularly in the Legal Amazon, where its distribution reflects social inequities, environmental vulnerabilities, and heterogeneous access to health services. This study analyzed the sociodemographic profile, temporal trends, and regional heterogeneity of leprosy in the state of Tocantins between 2014 and 2024. A total of 15,734 confirmed cases were obtained from the Brazilian national surveillance system. Annual detection rates and temporal trends were assessed using log-linear regression models to estimate the Annual Percent Change, and regional heterogeneity was examined across the eight health regions of the state. The disease predominantly affected men, adults aged 30-59 years, individuals with low educational attainment, and persons self-identified as of mixed race. Despite year-to-year fluctuations, including a marked decline during the COVID-19 pandemic, detection rates remained consistently high throughout the study period. Substantial heterogeneity was observed across health regions, with persistently high detection rates in Capim Dourado, Amor Perfeito, and Cantão, while statistically significant decreasing trends were identified in Bico do Papagaio, Médio Norte Araguaia, and Ilha do Bananal. The continuous detection of cases among individuals under 15 years of age and the increase in relapse proportions in recent years indicate ongoing transmission and operational challenges in early diagnosis and surveillance. These findings highlight the need for regionally tailored strategies, strengthened contact tracing, and prioritization of high-risk territories to advance leprosy control in the Brazilian Amazon.