Summary Background Although leprosy is recognised as a disease of poverty, there is little evidence on the specific socioeconomic factors associated with disease risk. To inform targeted strategies for disease elimination, we investigated socioeconomic markers of leprosy risk in Brazil. Methods Socioeconomic data from the 100 Million Brazilian Cohort were linked to the Brazilian national disease registry (Sistema de Informação de Agravos de Notificação) for leprosy from Jan 1, 2007, to Dec 31, 2014. Using Poisson regression, we assessed the association of socioeconomic factors with risk of incident leprosy in the full cohort and in children (aged 0–15 years), by leprosy subtype and region of residence. Findings In an analysis of 23 899 942 individuals including 18 518 patients with leprosy, increased levels of deprivation were associated with an increased risk of leprosy in Brazil. Directions of effect were consistent in children younger than 15 years and across disease subtypes. Individuals residing in regions with the highest poverty in the country (central-west, north, and northeast regions) had a risk of leprosy incidence five-to-eight times greater than did other individuals. Decreased levels of income and education and factors reflecting unfavourable living conditions were associated with an up to two-times increase in leprosy incidence (incidence rate ratio 1·46, 95% CI 1·32–1·62, for lowest vs highest quartile of income per capita; 2·09, 95% CI 1·62–2·72, for lowest vs highest level of education). Interpretation Within the poorest half of the Brazilian population, the most deprived individuals have the greatest risk of leprosy. Strategies focusing on early detection and treatment in the poorest populations could contribute substantially to global disease control. Funding Medical Research Council, Wellcome Trust, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Brazil), the Conselho Nacional das Fundações Estaduais de Amparo à Pesquisa, Economic and Social Research Council, Biotechnology and Biological Sciences Research Council, Conselho Nacional de Desenvolvimento Científico e Tecnológico, and Fundação de Apoio à Pesquisa do Distrito Federal.

Access to antiretroviral therapy (ART), universally provided in Brazil since 1996, resulted in a reduction in overall morbidity and mortality due to AIDS or AIDS-related complications, but in some municipalities of Rio de Janeiro, AIDS incidence remains high. Public health surveillance remains an invaluable tool for understanding current AIDS epidemiologic patterns and local socioeconomic and demographic factors associated with increased incidence. Geographically Weighted Poisson Regression (GWPR) explores spatial varying impacts of these factors across the study area focusing attention on local variations in ecological associations. The set of sociodemographic variables under consideration revealed significant associations with local AIDS incidence and these associations varied geographically across the study area. We find the effects of predictors on AIDS incidence are not constant across the state, contrary to assumptions in the global models. We observe and quantify different local factors driving AIDS incidence in different parts of the state.

Abstract. Despite increased funding for research on the human immunodeficiency virus (HIV) and the acquired immunodeficiency syndrome (AIDS), neither vaccine nor cure is yet in sight. Surveillance and prevention are essential for disease intervention, and it is recognised that spatio-temporal analysis of AIDS cases can assist the decision-making process for control of the disease. This study investigated the dynamic, spatial distribution of notified AIDS cases in the State of Rio de Janeiro, Brazil, between 2001 and 2010, based on the annual incidence in each municipality. Sequential choropleth maps were developed and used to analyse the incidence distribution and Moran's I spatial autocorrelation statistics was applied for characterisation of the spatio-temporal distribution pattern. A significant, positive spatial autocorrelation of AIDS incidence was observed indicating that municipalities with high incidence are likely to be close to other municipalities with similarly high incidence and, conversely, municipalities with low incidence are likely to be surrounded by municipalities with low incidence. Two clusters were identified; one hotspot related to the State Capital and the other with low to intermediate AIDS incidence comprising municipalities in the north-eastern region of the State of Rio de Janeiro.