Spatial epidemiology of cutaneous leishmaniasis in Colombia: socioeconomic and demographic factors associated with a growing epidemic

Background: Despite the identification of some environmental factors linked to the cutaneous leishmaniasis (CL) epidemic, little is known about the impact of environmental disturbances caused by human activities. We assessed the association between socioeconomic and demographic factors with the spatial structure of the CL epidemic in Colombia. Methods: Using data from more than 65 000 CL cases collected across the entire country from publicly available sources, we conducted a spatial clustering analysis to identify high burden areas (clusters) of CL. Associations between CL clusters and socioeconomic variables were investigated. Results: We identified seven statistically significant clusters of CL located across all Colombian biomes. Deforestation and livestock were statistically significantly associated with the spatial clustering of CL. Urbanization, time spent traveling to main cities and water bodies were other factors linked with the clustering of CL. Conclusions: This study found that human activities such as deforestation linked to agriculture, livestock production and mining activities are key drivers of the spatial distribution of the CL epidemic. The intensity of these human activities, which are projected to increase because of social and economic transformations in progress in Colombia, will potentially exacerbate the already growing CL epidemic in the country.