Richterman Aaron, Azman Andrew S, Constant Georgery, Ivers Louise C
Division of Infectious Disease, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA.
BMJ Glob Health. 2019 Sep 18;4(5):e001755. doi: 10.1136/bmjgh-2019-001755. eCollection 2019.
Individual and household-level evidence suggests a relationship between food insecurity and cholera risk. The relationship between national food security and the size of cholera outbreaks is unknown.
We analysed the relationship between national food security and annual cholera incidence rate from 2012 to 2015 across 30 countries. We used components of the Global Food Security Index (GFSI) as measures of food security. We included countries with available GFSI reporting cases of cholera during the study period, excluding high-income countries. We developed multivariable zero-inflated negative binomial models with annual cholera incidence rate as the outcome, GFSI components as the exposure of interest, fixed effects for country and year, and time-varying effects related to water, sanitation, and hygiene, oral cholera vaccine deployment, healthcare expenditure, conflict and extreme weather.
The 30 countries reported 550 106 total cases of cholera from 2012 to 2015, with a median annual incidence rate of 3.1 cases per 100 000 people (IQR 0.3-9.9). We found independent inverse relationships between cholera and Overall GFSI (incidence rate ratio (IRR) 0.57, 95% CI 0.43 to 0.78), GFSI-Availability (IRR 0.81, 95% CI 0.70 to 0.95) and GFSI-Affordability (IRR 0.76, 95% CI 0.62 to 0.92).
We identified a strong inverse relationship between national food security and annual incidence rate of cholera. In the context of prior evidence at the individual and household levels, this suggests that there is a linkage between food insecurity and cholera at the national level that should be further considered in assessing cholera risk in vulnerable regions and in designing cholera control interventions.
个人和家庭层面的证据表明，粮食不安全与霍乱风险之间存在关联。国家粮食安全与霍乱暴发规模之间的关系尚不清楚。
我们分析了2012年至2015年期间30个国家的国家粮食安全与年度霍乱发病率之间的关系。我们使用全球粮食安全指数（GFSI）的组成部分作为粮食安全的衡量指标。我们纳入了在研究期间有GFSI报告且有霍乱病例的国家，不包括高收入国家。我们建立了多变量零膨胀负二项式模型，以年度霍乱发病率为结果，GFSI组成部分为感兴趣的暴露因素，国家和年份的固定效应，以及与水、环境卫生和个人卫生、口服霍乱疫苗部署、医疗保健支出、冲突和极端天气相关的随时间变化的效应。
这30个国家在2012年至2015年期间共报告了550106例霍乱病例，年发病率中位数为每10万人3.1例（四分位间距0.3 - 9.9）。我们发现霍乱与总体GFSI（发病率比（IRR）0.57，95%置信区间0.43至0.78）、GFSI - 可获得性（IRR 0.81，95%置信区间0.70至0.95）和GFSI - 可负担性（IRR 0.76，95%置信区间0.62至0.92）之间存在独立的负相关关系。
我们确定了国家粮食安全与年度霍乱发病率之间存在强烈的负相关关系。鉴于个人和家庭层面的先前证据，这表明在国家层面上粮食不安全与霍乱之间存在联系，在评估脆弱地区的霍乱风险和设计霍乱控制干预措施时应进一步考虑这一点。
