Male circumcision, religion, and infectious diseases: an ecologic analysis of 118 developing countries.
Male circumcision, religion, and infectious diseases: an ecologic analysis of 118 developing countries.
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男性包皮环切术，宗教和传染病：对118个发展中国家的生态分析。
DOI：
10.1186/1471-2334-6-172
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发表时间：
2006-11-30
影响因子：
3.7
通讯作者：
Bailey, Robert C.
中科院分区：
文献类型：
--
作者：
Drain, Paul K.;Halperin, Daniel T.;Hughes, James P.;Klausner, Jeffrey D.;Bailey, Robert C.
宗教习俗和男性包皮环切术 (MC) 都与艾滋病毒和其他性传播传染病有关。大多数研究规模有限，并且没有充分控制宗教，因此这些关系仍不清楚。我们使用 118 个发展中国家的具体国家数据评估了 MC 患病率、穆斯林和基督教以及 7 种传染病之间的关系。我们使用多元线性回归来描述 MC 与宫颈癌发病率之间的关联，以及在 HIV 主要通过性传播的国家中 MC 与 HIV 患病率之间的关联。 53 个、14 个和 51 个发展中国家的 MC 患病率分别为高（>80%）、中（20-80%）和低（<20%）。在单变量分析中，MC 与较低的 HIV 患病率和较低的宫颈癌发病率相关，但与 HSV-2、梅毒无关，也与预期的丙型肝炎、结核病或疟疾无关。在按宗教群体对国家进行分层后的多变量分析中，MC 患病率的每一次分类增加都与每年宫颈癌发病率下降 3.65/100,000 名女性（95% CI 0.54-6.76，p = 0.02）相关，并且与成人 HIV 患病率下降 1.84 倍（95% CI 1.36-2.48，p < 0.001）相关。撒哈拉以南非洲国家。在控制宗教的非撒哈拉以南非洲国家的单独多变量分析中，在以异性性行为为主的国家中，较高的 MC 患病率与成人 HIV 患病率下降 8.94 倍（95% CI 4.30-18.60）相关，但在以同性恋或注射吸毒为主的国家中，情况并非如此（p = 0.35）。在撒哈拉以南非洲地区，男性包皮环切术与降低宫颈癌发病率和降低艾滋病毒感染率显着相关，与穆斯林和基督教宗教无关。正如预测的那样，在以异性性行为为主的艾滋病毒传播国家中，男性包皮环切术也与较低的艾滋病毒感染率密切相关，但在以同性恋或注射吸毒为主的艾滋病毒传播国家中则不然。这些发现强化了 MC 与一些性传播传染病（包括 HIV 和宫颈癌）之间的生物学联系。
Both religious practices and male circumcision (MC) have been associated with HIV and other sexually-transmitted infectious diseases. Most studies have been limited in size and have not adequately controlled for religion, so these relationships remain unclear. We evaluated relationships between MC prevalence, Muslim and Christian religion, and 7 infectious diseases using country-specific data among 118 developing countries. We used multivariate linear regression to describe associations between MC and cervical cancer incidence, and between MC and HIV prevalence among countries with primarily sexual HIV transmission. Fifty-three, 14, and 51 developing countries had a high (>80%), intermediate (20–80%), and low (<20%) MC prevalence, respectively. In univariate analyses, MC was associated with lower HIV prevalence and lower cervical cancer incidence, but not with HSV-2, syphilis, nor, as expected, with Hepatitis C, tuberculosis, or malaria. In multivariate analysis after stratifying the countries by religious groups, each categorical increase of MC prevalence was associated with a 3.65/100,000 women (95% CI 0.54-6.76, p = 0.02) decrease in annual cervical cancer incidence, and a 1.84-fold (95% CI 1.36-2.48, p < 0.001) decrease in the adult HIV prevalence among sub-Saharan African countries. In separate multivariate analyses among non-sub-Saharan African countries controlling for religion, higher MC prevalence was associated with a 8.94-fold (95% CI 4.30-18.60) decrease in the adult HIV prevalence among countries with primarily heterosexual HIV transmission, but not, as expected, among countries with primarily homosexual or injection drug use HIV transmission (p = 0.35). Male circumcision was significantly associated with lower cervical cancer incidence and lower HIV prevalence in sub-Saharan Africa, independent of Muslim and Christian religion. As predicted, male circumcision was also strongly associated with lower HIV prevalence among countries with primarily heterosexual HIV transmission, but not among countries with primarily homosexual or injection drug use HIV transmission. These findings strengthen the reported biological link between MC and some sexually transmitted infectious diseases, including HIV and cervical cancer.
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3.8
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通讯作者：
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