Núcleo de Medicina Tropical, Universidade de Brasília, Avenida L3 Norte, s/n°, Campus Universitário Darcy Ribeiro, Gleba A, Brasília, Distrito Federal, CEP 70297-400, Brazil.
Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Rua Mundo, s/n° Parque Tecnológico da Bahia - Trobogy, Salvador, CEP 41745-715, Brazil.
BMC Infect Dis. 2021 Mar 22;21(1):290. doi: 10.1186/s12879-021-05846-w.
Leprosy continues to be an important cause of physical disability in endemic countries such as Brazil. Knowledge of determinants of these events may lead to better control measures and targeted interventions to mitigate its impact on affected individuals. This study investigated such factors among the most vulnerable portion of the Brazilian population.
A large cohort was built from secondary data originated from a national registry of applicants to social benefit programs, covering the period 2001-2015, including over 114 million individuals. Data were linked to the leprosy notification system utilizing data from 2007 until 2014. Descriptive and bivariate analyses lead to a multivariate analysis using a multinomial logistic regression model with cluster-robust standard errors. Associations were reported as Odds Ratios with their respective 95% confidence intervals.
Among the original cohort members 21,565 new leprosy cases were identified between 2007 and 2014. Most of the cases (63.1%) had grade zero disability. Grades 1 and 2 represented 21 and 6%, respectively. Factors associated with increasing odds of grades 1 and 2 disability were age over 15 years old (ORs 2.39 and 1.95, respectively), less schooling (with a clear dose response effect) and being a multibacillary patient (ORs 3.5 and 8.22). Protective factors for both grades were being female (ORs 0.81 and 0.61) and living in a high incidence municipality (ORs 0.85 and 0.67).
The findings suggest that the developing of physical disabilities remains a public health problem which increases the burden of leprosy, mainly for those with severe clinical features and worse socioeconomic conditions. Early diagnosis is paramount to decrease the incidence of leprosy-related disability and our study points to the need for strengthening control actions in non-endemic areas in Brazil, where cases may be missed when presented at early stages in disease. Both actions are needed, to benefit patients and to achieve the WHO goal in reducing physical disabilities among new cases of leprosy.
麻风病在巴西等流行国家仍然是导致身体残疾的一个重要原因。了解这些事件的决定因素可能会导致更好的控制措施和有针对性的干预措施，以减轻其对受影响个人的影响。本研究调查了巴西人口中最脆弱部分的这些因素。
从国家社会福利计划申请人登记处的二级数据构建了一个大型队列，该队列涵盖 2001 年至 2015 年期间的 1.14 亿多人。利用 2007 年至 2014 年的麻风病报告系统的数据对数据进行了链接。描述性和双变量分析导致使用具有聚类稳健标准误差的多项逻辑回归模型进行多变量分析。关联以优势比（OR）及其相应的 95%置信区间报告。
在原始队列成员中，2007 年至 2014 年间发现了 21565 例新的麻风病例。大多数病例（63.1%）为零级残疾。一级和二级残疾分别占 21%和 6%。与一级和二级残疾几率增加相关的因素包括年龄在 15 岁以上（OR 分别为 2.39 和 1.95）、受教育程度较低（具有明显的剂量反应效应）和多菌型患者（OR 分别为 3.5 和 8.22）。两级残疾的保护因素均为女性（OR 分别为 0.81 和 0.61）和居住在高发病率市（OR 分别为 0.85 和 0.67）。
研究结果表明，身体残疾的发展仍然是一个公共卫生问题，主要增加了麻风病的负担，尤其是那些具有严重临床特征和较差社会经济条件的患者。早期诊断对于降低麻风病相关残疾的发生率至关重要，我们的研究表明需要加强巴西非流行地区的控制措施，因为在疾病早期，这些地区的病例可能会被遗漏。这两种措施都需要，以造福患者，并实现世界卫生组织减少新病例麻风病身体残疾的目标。
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