Socioeconomic determinants of leprosy new case detection in the 100 Million Brazilian Cohort: a population-based linkage study.
Journal
The Lancet. Global health
ISSN: 2214-109X
Titre abrégé: Lancet Glob Health
Pays: England
ID NLM: 101613665
Informations de publication
Date de publication:
09 2019
09 2019
Historique:
received:
19
02
2019
revised:
17
05
2019
accepted:
17
05
2019
pubmed:
25
7
2019
medline:
27
5
2020
entrez:
24
7
2019
Statut:
ppublish
Résumé
Although leprosy is recognised as a disease of poverty, there is little evidence on the specific socioeconomic factors associated with disease risk. To inform targeted strategies for disease elimination, we investigated socioeconomic markers of leprosy risk in Brazil. Socioeconomic data from the 100 Million Brazilian Cohort were linked to the Brazilian national disease registry (Sistema de Informação de Agravos de Notificação) for leprosy from Jan 1, 2007, to Dec 31, 2014. Using Poisson regression, we assessed the association of socioeconomic factors with risk of incident leprosy in the full cohort and in children (aged 0-15 years), by leprosy subtype and region of residence. In an analysis of 23 899 942 individuals including 18 518 patients with leprosy, increased levels of deprivation were associated with an increased risk of leprosy in Brazil. Directions of effect were consistent in children younger than 15 years and across disease subtypes. Individuals residing in regions with the highest poverty in the country (central-west, north, and northeast regions) had a risk of leprosy incidence five-to-eight times greater than did other individuals. Decreased levels of income and education and factors reflecting unfavourable living conditions were associated with an up to two-times increase in leprosy incidence (incidence rate ratio 1·46, 95% CI 1·32-1·62, for lowest vs highest quartile of income per capita; 2·09, 95% CI 1·62-2·72, for lowest vs highest level of education). Within the poorest half of the Brazilian population, the most deprived individuals have the greatest risk of leprosy. Strategies focusing on early detection and treatment in the poorest populations could contribute substantially to global disease control. Medical Research Council, Wellcome Trust, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Brazil), the Conselho Nacional das Fundações Estaduais de Amparo à Pesquisa, Economic and Social Research Council, Biotechnology and Biological Sciences Research Council, Conselho Nacional de Desenvolvimento Científico e Tecnológico, and Fundação de Apoio à Pesquisa do Distrito Federal.
Sections du résumé
BACKGROUND
Although leprosy is recognised as a disease of poverty, there is little evidence on the specific socioeconomic factors associated with disease risk. To inform targeted strategies for disease elimination, we investigated socioeconomic markers of leprosy risk in Brazil.
METHODS
Socioeconomic data from the 100 Million Brazilian Cohort were linked to the Brazilian national disease registry (Sistema de Informação de Agravos de Notificação) for leprosy from Jan 1, 2007, to Dec 31, 2014. Using Poisson regression, we assessed the association of socioeconomic factors with risk of incident leprosy in the full cohort and in children (aged 0-15 years), by leprosy subtype and region of residence.
FINDINGS
In an analysis of 23 899 942 individuals including 18 518 patients with leprosy, increased levels of deprivation were associated with an increased risk of leprosy in Brazil. Directions of effect were consistent in children younger than 15 years and across disease subtypes. Individuals residing in regions with the highest poverty in the country (central-west, north, and northeast regions) had a risk of leprosy incidence five-to-eight times greater than did other individuals. Decreased levels of income and education and factors reflecting unfavourable living conditions were associated with an up to two-times increase in leprosy incidence (incidence rate ratio 1·46, 95% CI 1·32-1·62, for lowest vs highest quartile of income per capita; 2·09, 95% CI 1·62-2·72, for lowest vs highest level of education).
INTERPRETATION
Within the poorest half of the Brazilian population, the most deprived individuals have the greatest risk of leprosy. Strategies focusing on early detection and treatment in the poorest populations could contribute substantially to global disease control.
FUNDING
Medical Research Council, Wellcome Trust, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Brazil), the Conselho Nacional das Fundações Estaduais de Amparo à Pesquisa, Economic and Social Research Council, Biotechnology and Biological Sciences Research Council, Conselho Nacional de Desenvolvimento Científico e Tecnológico, and Fundação de Apoio à Pesquisa do Distrito Federal.
Identifiants
pubmed: 31331811
pii: S2214-109X(19)30260-8
doi: 10.1016/S2214-109X(19)30260-8
pmc: PMC6688099
pii:
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e1226-e1236Subventions
Organisme : Medical Research Council
ID : MR/N017250/1
Pays : United Kingdom
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.
Références
Lepr Rev. 2000 Dec;71(4):492-8
pubmed: 11201904
Int J Epidemiol. 2006 Aug;35(4):994-1000
pubmed: 16645029
Lepr Rev. 2006 Mar;77(1):48-61
pubmed: 16715690
Lepr Rev. 2007 Jun;78(2):131-6
pubmed: 17824483
Lepr Rev. 2008 Jun;79(2):171-82
pubmed: 18711939
BMC Infect Dis. 2008 Sep 23;8:126
pubmed: 18811971
Cad Saude Publica. 2009 May;25(5):972-84
pubmed: 19488482
PLoS Negl Trop Dis. 2011 Mar 15;5(3):e1013
pubmed: 21423643
Lancet Infect Dis. 2011 Jun;11(6):464-70
pubmed: 21616456
Lancet Infect Dis. 2014 Feb;14(2):96-8
pubmed: 24457165
BMJ. 2014 Feb 07;348:g1136
pubmed: 24508610
An Bras Dermatol. 2014 Mar-Apr;89(2):205-18
pubmed: 24770495
PLoS Negl Trop Dis. 2014 Nov 20;8(11):e3357
pubmed: 25412418
Wkly Epidemiol Rec. 2015 Sep 4;90(36):461-74
pubmed: 26343055
PLoS Negl Trop Dis. 2016 May 12;10(5):e0004546
pubmed: 27171166
Asia Pac J Public Health. 2016 Oct;28(7):586-591
pubmed: 27605468
Int J Equity Health. 2016 Nov 17;15(1):150
pubmed: 27852269
Glob Health Action. 2017 Jan - Dec;10(sup2):1360550
pubmed: 28853325
Wkly Epidemiol Rec. ;92(35):501-19
pubmed: 28861986
Rev Saude Publica. 2018;52:20
pubmed: 29489990
PLoS Negl Trop Dis. 2018 Jul 9;12(7):e0006622
pubmed: 29985930
Bull World Health Organ. 1980;58(1):81-9
pubmed: 6445792
Indian J Lepr. 1995 Oct-Dec;67(4):411-25
pubmed: 8849918