Long-term disability outcomes in Hansen’s disease: A 20-year comparative study of Lepromatous vs. Tuberculoid Leprosy

Background: Leprosy remains an important cause of disability, even in non-endemic settings. Risk of neuropathy and functional impairment differs across the disease spectrum, yet contemporary U.S. data are limited. Objective: To compare disability-related outcomes among patients with lepromatous versus tuberculoid leprosy in a large U.S. electronic health record (EHR) network. Methods: Using the TriNetX U.S. Collaborative Research Network (2005–2025), patients with lepromatous (ICD-10-CM A30.4-A30.5) and tuberculoid (A30.1-A30.2) leprosy were identified. Disability-related outcomes were defined using ICD-10-CM and CPT codes. Patients with prior disability were excluded to assess incident events. Cohorts were propensity score-matched (1:1) on demographics and comorbidities. Odds ratios (OR) and hazard ratios (HR) with 95% confidence intervals (CI) were calculated. Results: A total of 341 lepromatous and 129 tuberculoid patients were identified (median follow-up 1,138 vs 1,021 days). Lepromatous leprosy was associated with higher risk of incident disability-related outcomes (OR 1.89, 95% CI 1.16-3.07). Kaplan-Meier analysis demonstrated lower outcome-free survival in the lepromatous cohort (HR 1.76, 95% CI 1.15-2.71). Conclusions: In this U.S.-based cohort, lepromatous leprosy was associated with greater disability-related morbidity compared to tuberculoid leprosy. However, meaningful risk was observed across both subtypes, supporting structured longitudinal follow-up for all patients. Author summary: Leprosy is often thought of as a disease of the past or limited to certain regions, but it continues to affect patients in the United States and can lead to long-term disability, particularly through nerve damage. Not all forms of leprosy behave the same way, and understanding these differences is important for improving patient care. In this study, we used a large U.S. electronic health record database to compare disability-related outcomes between two major forms of leprosy: lepromatous and tuberculoid. We found that patients with lepromatous leprosy had a higher risk of developing new disability-related complications over time compared to those with tuberculoid disease. However, patients in both groups experienced meaningful rates of disability, highlighting that all individuals with leprosy remain at risk. These findings suggest that while certain forms of leprosy may carry greater risk, careful and ongoing monitoring is important for every patient, regardless of subtype. Early recognition and management of complications may help reduce long-term disability and improve quality of life.