Global Health and Development, Medical University of Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria.
Doctor Typhagne Memorial Charitable Trust, S.M.M.I. Convent Staff Quarters, St. Mary's Hospital Campus, Arisipalayam, Salem, Tamil Nadu 636009, India.
Int J Environ Res Public Health. 2018 Dec 6;15(12):2769. doi: 10.3390/ijerph15122769.
A consistent relationship has been found between leprosy and inequities in social determinants of health. It, however, remains unclear which aspect of these social determinants contributes most to the risk of infection, and even less clear are the risk factors for the development of leprosy-related disabilities. The objective of this study was to elicit the differential impact of social determinants of health in leprosy-affected persons, and determine whether structural inequities in accessibility to societal resources and lower socioeconomic parameters correlated with higher severity of disabilities. This analysis was based on a sampled population affected by leprosy in Salem, Tamil Nadu, India. Persons enrolled in the study were covered by a nongovernmental lifelong care program, had completed a multidrug therapy for leprosy and/or were slit-skin-smear negative, and showed Grade 1 or higher disabilities due to leprosy. Multiple stepwise linear regression analysis was performed. The Eyes-Hands-Feet (EHF) score was the outcome variable, and gender, age, time after release from treatment, monthly income, and living space were explanatory variables. There were 123 participants, comprised of 41 (33.33%) women and 82 (66.67%) men. All study participants belonged to India's Backward classes; 81.30% were illiterate and the average monthly income was 1252 Indian rupee (INR) (US$19.08 or €17.16). The average EHF score was 7.016 (95% CI, 6.595 to 7.437). Stepwise multiple linear regression analysis built a significant model, where (2, 120) = 13.960, ≤ 0.001, effect size (Cohen's f2) = 0.81, explaining 18.9% of the variance in EHF scores (² = 0.189). Significant predictors of a higher EHF score in persons affected by leprosy were found to be higher age (beta = 0.340, 95% CI, 0.039 to 0.111, < 0.001), as well as less living space (beta = -0.276, 95% CI, -0.041 to -0.011, = 0.001). Our results suggest that inequalities in social determinants of health correspond to higher disability scores, which indicates that poor living standards are a common phenomenon in those living with leprosy-related disabilities. Further research is needed to dissect the exact development of impairments after release from treatment (RFT) in order to take targeted actions against disability deterioration.
已发现麻风病与健康社会决定因素的不平等之间存在一致关系。然而，尚不清楚这些社会决定因素的哪些方面对感染风险的贡献最大，更不清楚麻风病相关残疾的危险因素有哪些。本研究的目的是探讨健康社会决定因素对麻风病患者的不同影响，并确定社会资源获取方面的结构性不平等以及较低的社会经济参数是否与残疾严重程度相关。这项分析基于在印度泰米尔纳德邦塞勒姆受麻风病影响的人群样本。参与研究的人参加了一个非政府的终身护理计划，已经完成了麻风病多药治疗，或皮肤切片检查结果为阴性，并且因麻风病而出现 1 级或更高残疾。进行了多次逐步线性回归分析。眼睛-手-脚（EHF）评分是因变量，性别、年龄、治疗后时间、月收入和居住空间是解释变量。共有 123 名参与者，其中 41 名（33.33%）为女性，82 名（66.67%）为男性。所有研究参与者都属于印度的落后阶层；81.30%的人是文盲，平均月收入为 1252 印度卢比（INR）（19.08 美元或 17.16 欧元）。平均 EHF 得分为 7.016（95%CI，6.595 至 7.437）。逐步多元线性回归分析建立了一个显著的模型，其中（2,120）= 13.960， ≤ 0.001，效果大小（Cohen's f2）= 0.81，解释 EHF 评分方差的 18.9%（² = 0.189）。在受麻风病影响的人群中，年龄较高（β=0.340，95%CI，0.039 至 0.111， ＜0.001）和居住空间较小（β=-0.276，95%CI，-0.041 至 -0.011， = 0.001）是 EHF 评分较高的显著预测因素。我们的结果表明，健康社会决定因素的不平等与更高的残疾评分相对应，这表明生活水平较差是那些患有麻风病相关残疾的人的常见现象。为了针对残疾恶化采取有针对性的行动，需要进一步研究以剖析治疗后释放（RFT）后损伤的确切发展。
