Socioeconomic risk markers of leprosy in high-burden countries: A systematic review and meta-analysis

被引:76
|
作者
Pescarini, Julia Moreira [1 ]
Strina, Agostino [1 ,2 ]
Nery, Joilda Silva [1 ,3 ]
Skalinski, Lacita Menezes [4 ,5 ]
Freitas de Andrade, Kaio Vinicius [4 ,6 ]
Penna, Maria Lucia F. [7 ]
Brickley, Elizabeth B. [2 ]
Rodrigues, Laura C. [2 ]
Barreto, Mauricio Lima [1 ,4 ]
Penna, Gerson Oliveira [8 ]
机构
[1] Fundacao Oswaldo Cruz, Ctr Integracao Dados & Conhecimentos Saude Cidacs, Salvador, BA, Brazil
[2] London Sch Hyg & Trop Med, Dept Infect Dis Epidemiol, London, England
[3] Univ Fed Vale Sao Francisco UNIVASF, Paulo Afonso, Brazil
[4] Univ Fed Bahia, Inst Saude Colet, Salvador, BA, Brazil
[5] Univ Estadual Santa Cruz, Ilheus, Brazil
[6] Univ Estadual Feira de Santana, Feira de Santana, Brazil
[7] Univ Fed Fluminense, Inst Saude Comunidade, Niteroi, RJ, Brazil
[8] Univ Brasilia UNB, Ctr Med Trop, Brasilia, DF, Brazil
来源
PLOS NEGLECTED TROPICAL DISEASES | 2018年 / 12卷 / 07期
基金
英国惠康基金; 英国医学研究理事会; 英国生物技术与生命科学研究理事会; 欧盟地平线“2020”;
关键词
SOCIAL DETERMINANTS; NORTHEAST BRAZIL; EPIDEMIOLOGY; HEALTH; TRANSMISSION; INFORMATION; PREVALENCE; INEQUALITY; CONTACT; DISEASE;
D O I
10.1371/journal.pntd.0006622
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Over 200,000 new cases of leprosy are detected each year, of which approximately 7% are associated with grade-2 disabilities (G2Ds). For achieving leprosy elimination, one of the main challenges will be targeting higher risk groups within endemic communities. Nevertheless, the socioeconomic risk markers of leprosy remain poorly understood. To address this gap we systematically reviewed MEDLINE/PubMed, Embase, LILACS and Web of Science for original articles investigating the social determinants of leprosy in countries with > 1000 cases/year in at least five years between 2006 and 2016. Cohort, case-control, cross-sectional, and ecological studies were eligible for inclusion; qualitative studies, case reports, and reviews were excluded. Out of 1,534 non-duplicate records, 96 full-text articles were reviewed, and 39 met inclusion criteria. 17 were included in random-effects meta-analyses for sex, occupation, food shortage, household contact, crowding, and lack of clean (i.e., treated) water. The majority of studies were conducted in Brazil, India, or Bangladesh while none were undertaken in low-income countries. Descriptive synthesis indicated that increased age, poor sanitary and socioeconomic conditions, lower level of education, and food-insecurity are risk markers for leprosy. Additionally, in pooled estimates, leprosy was associated with being male (RR = 1.33, 95% CI = 1.06-1.67), performing manual labor (RR = 2.15, 95% CI = 0.97-4.74), suffering from food shortage in the past (RR = 1.39, 95% CI = 1.05-1.85), being a household contact of a leprosy patient (RR = 3.40, 95% CI = 2.24-5.18), and living in a crowded household (>= 5 per household) (RR = 1.38, 95% CI = 1.14-1.67). Lack of clean water did not appear to be a risk marker of leprosy (RR = 0.94, 95% CI = 0.65-1.35). Additionally, ecological studies provided evidence that lower inequality, better human development, increased healthcare coverage, and cash transfer programs are linked with lower leprosy risks. These findings point to a consistent relationship between leprosy
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页数:20
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