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.

The Pan American Health Organization (PAHO) recognizes ethnicity as a structural determinant of health, yet ethnic–racial analyses of neglected tropical diseases remain scarce. This study investigated cumulative notification and mortality rates of American cutaneous leishmaniasis (ACL) in Brazil from 2016 to 2025 according to the official Brazilian race/color categories. Data were obtained from the Notifiable Diseases Information System (SINAN/DATASUS), and temporal and spatial patterns were analyzed. ACL showed marked geographic heterogeneity, with the highest cumulative notification rates concentrated in the North and Central-West regions. Indigenous and Asian populations presented the highest cumulative notification rates, whereas mortality rates were highest among Indigenous populations and remained elevated among Brown populations in several settings. Spatial clusters were concentrated mainly in the Brazilian Amazon, reinforcing the persistence of territorial inequalities in ACL distribution. Overall, the findings reveal substantial race/color and geographic disparities in both ACL occurrence and mortality in Brazil, underscoring the need for more equitable surveillance, prevention, and control strategies.