Swiss Tropical and Public Health Institute, Basel, Switzerland ; University of Basel, Basel, Switzerland.
PLoS Negl Trop Dis. 2013 Sep 5;7(9):e2422. doi: 10.1371/journal.pntd.0002422. eCollection 2013.
Leprosy remains a public health problem in Brazil with new case incidence exceeding World Health Organization (WHO) goals in endemic clusters throughout the country. Migration can facilitate movement of disease between endemic and non-endemic areas, and has been considered a possible factor in continued leprosy incidence in Brazil. A study was conducted to investigate migration as a risk factor for leprosy. The study had three aims: (1) examine past five year migration as a risk factor for leprosy, (2) describe and compare geographic and temporal patterns of migration among past 5-year migrants with leprosy and a control group, and (3) examine social determinants of health associated with leprosy among past 5-year migrants. The study implemented a matched case-control design and analysis comparing individuals newly diagnosed with leprosy (n = 340) and a clinically unapparent control group (n = 340) without clinical signs of leprosy, matched for age, sex and location in four endemic municipalities in the state of Maranhão, northeastern Brazil. Fishers exact test was used to conduct bivariate analyses. A multivariate logistic regression analysis was employed to control for possible confounding variables. Eighty cases (23.5%) migrated 5-years prior to diagnosis, and 55 controls (16.2%) migrated 5-years prior to the corresponding case diagnosis. Past 5 year migration was found to be associated with leprosy (OR: 1.59; 95% CI 1.07-2.38; p = 0.02), and remained significantly associated with leprosy after controlling for leprosy contact in the family, household, and family/household contact. Poverty, as well as leprosy contact in the family, household and other leprosy contact, was associated with leprosy among past 5-year migrants in the bivariate analysis. Alcohol consumption was also associated with leprosy, a relevant risk factor in susceptibility to infection that should be explored in future research. Our findings provide insight into patterns of migration to localize focused control efforts in endemic areas with high population mobility.
麻风病仍然是巴西的一个公共卫生问题，全国各地的流行地区新发病例超过了世界卫生组织（WHO）的目标。移民可以促进疾病在流行地区和非流行地区之间的传播，并且被认为是巴西麻风病持续发生的一个可能因素。进行了一项研究，以调查移民是否是麻风病的一个危险因素。该研究有三个目的：（1）检查过去五年的移民情况是否是麻风病的一个危险因素；（2）描述和比较过去五年的移民中患有麻风病的人和对照组的地理和时间模式；（3）研究过去五年的移民中与麻风病相关的健康社会决定因素。该研究采用了匹配的病例对照设计和分析方法，比较了在巴西东北部马拉尼昂州四个流行地区新诊断出的麻风病患者（n=340）和无临床症状的临床无明显对照组（n=340），匹配年龄、性别和位置。Fisher 精确检验用于进行双变量分析。采用多变量逻辑回归分析控制可能的混杂变量。80 例（23.5%）在诊断前 5 年移民，55 例对照（16.2%）在与相应病例诊断前 5 年移民。过去 5 年的移民与麻风病有关（OR：1.59；95%CI 1.07-2.38；p=0.02），在控制家庭、家庭和家庭/家庭接触中的麻风病接触后，这一关联仍然与麻风病显著相关。贫困以及家庭、家庭和其他麻风病接触中的麻风病接触与过去 5 年移民中的麻风病有关，在双变量分析中。饮酒也与麻风病有关，这是一个与感染易感性相关的重要危险因素，应在未来的研究中进一步探讨。我们的研究结果提供了有关移民模式的见解，以便在人口流动率较高的流行地区进行有针对性的控制工作。
