Graduate Program in Public Health Nursing, Nursing College of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
Graduate Program Interunit Doctoral Program in Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil.
PLoS Negl Trop Dis. 2018 Apr 6;12(4):e0006407. doi: 10.1371/journal.pntd.0006407. eCollection 2018 Apr.
Brazil is the only country in Latin America that has adopted a national health system. This causes differences in access to health among Latin American countries and induces noticeable migration to Brazilian regions to seek healthcare. This phenomenon has led to difficulties in the control and elimination of diseases related to poverty, such as leprosy. The aim of this study was to evaluate social determinants and their relationship with the risk of leprosy, as well as to examine the temporal trend of its occurrence in a Brazilian municipality located on the tri-border area between Brazil, Paraguay and Argentina.
This ecological study investigated newly-diagnosed cases of leprosy between 2003 and 2015. Exploratory analysis of the data was performed through descriptive statistics. For spatial analysis, geocoding of the data was performed using spatial scan statistic techniques to obtain the Relative Risk (RR) for each census tract, with their respective 95% confidence intervals calculated. The Bivariate Moran I test, Ordinary Least Squares (OLS) and Geographically Weighted Regression (GWR) models were applied to analyze the spatial relationships of social determinants and leprosy risk. The temporal trend of the annual coefficient of new cases was obtained through the Prais-Winsten regression. A standard error of 5% was considered statistically significant (p < 0.05).
Of the 840 new cases identified in the study, there was a predominance of females (n = 427, 50.8%), of white race/color (n = 685, 81.6%), age range 15 to 59 years (n = 624, 74.3%), and incomplete elementary education (n = 504, 60.0%). The results obtained from multivariate analysis revealed that the proportion of households with monthly nominal household income per capita greater than 1 minimum wage (β = 0.025, p = 0.036) and people of brown race (β = -0.101, p = 0.024) were statistically-significantly associated with risk of illness due to leprosy. These results also confirmed that social determinants and risk of leprosy were significantly spatially non-stationary. Regarding the temporal trend, a decrease of 4% (95% CI [-0.053, -0.033], p = 0.000) per year was observed in the rate of detection of new cases of leprosy.
The social determinants income and race/color were associated with the risk of leprosy. The study's highlighting of these social determinants can contribute to the development of public policies directed toward the elimination of leprosy in the border region.
巴西是拉丁美洲唯一采用全民健康系统的国家。这导致了拉丁美洲各国之间在获得医疗保健方面的差异，并促使人们大量迁移到巴西的地区寻求医疗保健。这种现象给与贫困相关的疾病（如麻风病）的控制和消除带来了困难。本研究旨在评估社会决定因素及其与麻风病风险的关系，并研究巴西一个位于巴西、巴拉圭和阿根廷三国边界地区的城市的麻风病发生的时间趋势。
本生态研究调查了 2003 年至 2015 年间新诊断的麻风病例。通过描述性统计方法对数据进行了探索性分析。对于空间分析，通过空间扫描统计技术对数据进行了地理编码，以获得每个普查区的相对风险（RR）及其各自的 95%置信区间。应用双变量 Moran I 检验、普通最小二乘法（OLS）和地理加权回归（GWR）模型来分析社会决定因素与麻风病风险的空间关系。通过 Prais-Winsten 回归获得了每年新病例数的年度系数的时间趋势。统计显著性水平设为 5%（p < 0.05）。
在本研究中，共确定了 840 例新病例，其中女性（n = 427，50.8%）、白种人（n = 685，81.6%）、年龄在 15 至 59 岁之间（n = 624，74.3%）和未完成小学教育（n = 504，60.0%）占主导地位。多变量分析结果表明，月人均名义家庭收入大于 1 最低工资的家庭比例（β = 0.025，p = 0.036）和棕色人种（β = -0.101，p = 0.024）与麻风病的发病风险呈统计学显著相关。这些结果还证实，社会决定因素与麻风病的发病风险存在显著的空间非平稳性。关于时间趋势，每年新发现的麻风病病例数减少了 4%（95%CI [-0.053，-0.033]，p = 0.000）。
收入和种族/肤色等社会决定因素与麻风病的发病风险有关。本研究强调这些社会决定因素可以为消除边境地区的麻风病制定公共政策提供依据。
