The role of deforestation on American Cutaneous Leishmaniasis incidence: spatial-temporal distribution, environmental and socioeconomic factors associated in the Brazilian Amazon.

Objective To analyse the temporal and spatial distribution as well as the environmental and socioeconomic factors associated with cutaneous leishmaniasis incidence in the state of Amazonas, Brazil from 2007 to 2015. Methods Spatial and temporal distribution was evaluated from sequential thematic maps of the mean incidence rates of the disease. A negative binomial regression analysis was performed to evaluate the association of the factors studied with the mean incidence rate of ACL. Results The average proportion of deforestation was negatively associated with the average incidence rate of cutaneous leishmaniasis in municipalities (beta = -2.178; P = 0.019; 95%CI -3.996, -0.361), and the health system performance index (effectiveness) (beta = -0.852; P = 0.008; 95%CI -1.481, -0.225). Conversely, the municipal human development index (MHDI) was a factor positively related to the average incidence among the municipalities (beta = 7.728; P = 0.003; 95%CI 2.716, 12.738). Conclusion Our study shows the important impact of socioeconomic and environmental factors on ACL incidence in the Amazonas State.