Ethnic-Racial and Spatial Inequalities of American Cutaneous Leishmaniasis in Brazil: A Nationwide Analysis of Prevalence and Mortality

PAHO have urged member countries to recognize ethnicity as a structural deter-minant of health, emphasizing the need for evidence-based public policies to address inequalities, however, studies that systematically explore the epidemiological profile of neglected tropical diseases from this perspective remain scarce. In this sense, this study aimed to analyze the prevalence and mortality rates of ACL across the Brazilian na-tional territory, stratified by ethnic-racial groups (Brown, Black, Asian, and Indige-nous; corresponding to the Brazilian categories pardo, preto, amarelo, and indígena) and study temporal trends and spatial distribution of these indicators by states and macro-regional levels, as well as to assess the potential impact of incomplete race/color information on the observed patterns. Data was extracted from the SINAN, accessed through DATASUS, in the period from 2016 to 2025. It was observed pronounced temporal fluctuations, with a significant reduction in the number of cases from 2017 to 2025 and marked spatial heterogeneity in the distribution of ACL across Brazil, with a clear concentration in North, Central-West and Northeast and inland regions. In addi-tion, ACL prevalence is higher among Asian and Indigenous populations, mortality disproportionately affects Brown and Indigenous groups, highlighting the indigenous population's high vulnerability to morbidity and mortality from ACL. It is also worth noting that it was observed consistent patterns of territorial and ethnic-racial inequal-ity in both the burden and severity of ACL in Brazil. This work is very important be-cause identify disparities in disease burden and outcomes, contributing to a more comprehensive understanding of ACL-related vulnerabilities in Brazil.