Teixeira Camila S S, Pescarini Júlia M, Sanchez Mauro N, Ferreira Andrêa Jacqueline F, Fiaccone Rosemeire L, Ichihara Maria Yury, Flores-Ortiz Renzo, Brickley Elizabeth B, Craig Peter, Leyland Alastair H, Katikireddi Srinivasa Vittal, Penna Maria Lucia F, Penna Gerson O, de Cássia Ribeiro-Silva Rita, Barreto Maurício L
Oswaldo Cruz Foundation - Gonçalo Moniz Institute, Center for Data and Knowledge Integration for Health (CIDACS), Salvador, Bahia, 41 745 - 715, Brazil.
Institute of Public Health, Federal University of Bahia (UFBA), Salvador, Brazil.
BMC Public Health. 2025 Aug 4;25(1):2647. doi: 10.1186/s12889-025-22701-8.
Ensuring housing interventions can contribute to improved living conditions which are strong socioeconomic determinants of leprosy. We estimated the association between the social housing programme Minha Casa Minha Vida (MCMVP) and leprosy new cases.
We followed families registered in the 100 Million Brazilian Cohort linked with MCMVP receipt and nationwide registries of leprosy between 2010 and 2015. We used Cox regression weighted by stabilized inverse probability of treatment weighting (IPTW) to assess the hazard ratio (HR) for the effect of MCMVP on leprosy. Weights were obtained by propensity score using demographic and socioeconomic covariates at baseline. Sensitivity analyses were done considering potential delays to receiving MCMVP, municipality of residence population size and by controlling by the baseline risk of leprosy among potential recipients.
We followed up 24,584,768 individuals, of which 618,883 (2.5%) were MCMVP recipients, and detected 8,874 new leprosy cases during the study period. Leprosy incidence was higher among MCMVP recipients (13.32/100,000 pyr; 95%CI = 11.45-15.49) compared to non-recipients (11.72/100,000 pyr; 95%CI = 11.47-11.97). MCMVP recipients had higher leprosy incidence (HR = 1.66; 95%CI = 1.34-2.06), compared to non-recipients. Point estimates were lower when considering a delay of 6 or 12 months to moving into the new household (HR = 1.53; 95%CI = 1.20-1.95 and HR = 1.37; 95%CI = 1.05-1.78, respectively), in small/medium municipalities (≤ 300,000 inhabitants) (HR = 1.95; 95%CI = 1.51-2.52), and higher among individuals who subsequently became MCMVP beneficiaries before receiving the benefit (HR = 2.29; 95%CI = 1.93-2.72).
This study found a higher risk of leprosy associated with MCMVP that may reflect reverse causality. Our findings suggest the programme is, in fact, reaching the most vulnerable individuals, as intended in its objectives. Besides, the higher risk of leprosy among MCMVP beneficiaries even before receiving the benefit observed in sensitivity analysis may reflect residual confounding factors related.
确保住房干预措施有助于改善生活条件，而生活条件是麻风病重要的社会经济决定因素。我们估计了社会住房项目“我的房子我的生活”（MCMVP）与麻风病新发病例之间的关联。
我们对在“1亿巴西队列”中登记且与接受MCMVP相关的家庭以及2010年至2015年全国麻风病登记处进行了跟踪。我们使用经稳定化逆概率治疗权重（IPTW）加权的Cox回归来评估MCMVP对麻风病影响的风险比（HR）。权重通过倾向得分利用基线时的人口统计学和社会经济协变量获得。敏感性分析考虑了接受MCMVP的潜在延迟、居住市的人口规模，并通过控制潜在接受者中麻风病的基线风险来进行。
我们随访了24,584,768人，其中618,883人（2.5%）是MCMVP接受者，在研究期间检测到8874例新的麻风病病例。与非接受者（11.72/10万/年；95%CI = 11.47 - 11.97）相比，MCMVP接受者的麻风病发病率更高（13.32/10万/年；95%CI = 11.45 - 15.49）。与非接受者相比，MCMVP接受者的麻风病发病率更高（HR = 1.66；95%CI = 1.34 - 2.06）。当考虑入住新住房延迟6个月或12个月时，点估计值较低（HR分别为1.53；95%CI = 1.20 - 1.95和HR = 1.37；95%CI = 1.05 - 1.78），在中小城市（≤30万居民）中（HR = 1.95；95%CI = 1.51 - 2.52），并且在接受福利前后来成为MCMVP受益人的个体中更高（HR = 2.29；95%CI = 1.93 - 2.72）。
本研究发现与MCMVP相关的麻风病风险较高，这可能反映了反向因果关系。我们的研究结果表明该项目实际上正如其目标所预期的那样，惠及了最脆弱的个体。此外，在敏感性分析中观察到MCMVP受益人在接受福利之前甚至就有较高的麻风病风险，这可能反映了相关的残余混杂因素。
