[Physical disability due to leprosy in the state of Bahia, Brazil (2001-2023): occurrence, change from diagnosis to discharge, and associated factors].

This study aimed to analyze the occurrence, evolution, and factors associated with physical disability due to leprosy at diagnosis and discharge from multidrug therapy (MDT) in the state of Bahia, Brazil, 2001-2023. A cross-sectional population-based study was conducted of the degree of physical disability (DPD) at diagnosis and discharge from MDT in new cases of lepropsy. Poisson regression analysis with robust variance was used to calculate proportions and prevalence ratios (PR) with 95% confidence intervals (95%CI). A total of 58,168 new cases of leprosy were detected. The proportion of cases with the assessment of DPD was 85% at diagnosis (n = 49,434) and 48% at discharge (n = 27,860). Among the cases with DPD 0 at admission, 5.9% (n = 1,077) and 1.2% (n = 212) worsened to DPD 1 and DPD 2, respectively, at discharge. Among the new cases with DPD 1, 44.5% (n = 2,231) maintained the grade and 4% (n = 201) worsened to DPD 2. Among those with DPD 2 at diagnosis, 53.8% (n = 830) maintained the grade. The lowest detection rate of new cases with DPD 2 per 1,000,000 residents occurred in 2020 and the highest proportion of cases at admission occurred in 2023 (7.8%, post-COVID-19). Associations were found between DPD 1/2 and the male sex (adjPR = 1.17; 95%CI: 1.06-1.27; p-value = 0.001), the absence of schooling (adjPR = 1.85; 95%CI: 1.29-2.63; p-value = 0.001), multibacillary classification (adjPR = 1.52; 95%CI: 1.20-1.91; p-value = 0.001), and type 1 and 2 reactions (adjPR = 1.27; 95%CI: 1.12-1.43; p-value < 0.001). An association was found between the worsening of DPD and type 1 and 2 reactions (adjPR = 1.34; 95%CI: 1.02-1.76; p-value = 0.039). Leprosy still causes a high burden of physical disability in Bahia, underscoring the need for early diagnosis, the longitudinal monitoring of DPD, and the integration between surveillance and care, with special attention to socially vulnerable individuals.