Long-term disability outcomes in Hansen’s disease: A 20-year comparative study of Lepromatous vs. Tuberculoid Leprosy

BACKGROUND: Leprosy remains an important cause of disability, even in non-endemic settings. Risk of neuropathy and functional impairment differs across the disease spectrum, yet contemporary U.S. data are limited. OBJECTIVE: To compare disability-related outcomes among patients with lepromatous versus tuberculoid leprosy in a large U.S. electronic health record (EHR) network. METHODS: Using the TriNetX U.S. Collaborative Research Network (2005-2025), patients with lepromatous (ICD-10-CM A30.4-A30.5) and tuberculoid (A30.1-A30.2) leprosy were identified. Disability-related outcomes were defined using ICD-10-CM and CPT codes. Patients with prior disability were excluded to assess incident events. Cohorts were propensity score-matched (1:1) on demographics and comorbidities. Odds ratios (OR) and hazard ratios (HR) with 95% confidence intervals (CI) were calculated. RESULTS: A total of 341 lepromatous and 129 tuberculoid patients were identified (median follow-up 1,138 vs 1,021 days). Lepromatous leprosy was associated with higher risk of incident disability-related outcomes (OR 1.89, 95% CI 1.16-3.07). Kaplan-Meier analysis demonstrated lower outcome-free survival in the lepromatous cohort (HR 1.76, 95% CI 1.15-2.71). CONCLUSIONS: In this U.S.-based cohort, lepromatous leprosy was associated with greater disability-related morbidity compared to tuberculoid leprosy. However, meaningful risk was observed across both subtypes, supporting structured longitudinal follow-up for all patients.