Spatial clustering, social vulnerability and risk of leprosy in an endemic area in Northeast Brazil: an ecological study
Spatial clustering, social vulnerability and risk of leprosy in an endemic area in Northeast Brazil: an ecological study
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DOI：
10.1111/jdv.15596
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发表时间：
2019-08-01
影响因子：
9.2
通讯作者：
Santos, V. S.
中科院分区：
文献类型：
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作者：
de Souza, C. D. F.;Rocha, V. S.;Santos, V. S.
背景尽管全球麻风病例的发现率有所下降，但其发病率在某些环境中保持不变，需要确定与其持续存在相关的因素。我们研究了空间和时空分布的麻风病和社会脆弱性的影响，在巴西东北部的流行区的疾病的发生。方法我们对2001年至2015年巴西东北部塞尔吉佩州报告的所有麻风病例进行了生态研究，以检查社会脆弱性指数与该州城市麻风病流行率和持续性的关系。从巴西信息系统收集社会经济和麻风病监测信息，并使用贝叶斯经验当地模型来确定指标的波动。利用扫描空间统计检验确定空间和时空聚类，并测量城市的麻风相对危险度。结果麻风病聚集和疾病负担与城市社会脆弱性指数有很强的统计学相关性。社会脆弱性高的地区麻风发病率、多菌型麻风和新诊断的2级残疾病例均高于社会脆弱性低的地区。结论社会脆弱性与麻风病的传播和发病率的维持密切相关。麻风病控制方案应针对社会脆弱性高的人群。
Background Despite the global decline in the detection of leprosy cases, its incidence has remained unchanged in certain settings and requires the determination of the factors linked to its persistence. We examined the spatial and space-time distribution of leprosy and the influence of social vulnerability on the occurrence of the disease in an endemic area of Northeast Brazil. Methods We performed an ecological study of all leprosy cases reported by Sergipe state, Northeast Brazil from 2001 to 2015, to examine the association of the Social Vulnerability Index and the prevalence and persistence of leprosy among the State's municipalities. Socio-economic and leprosy surveillance information was collected from the Brazilian information systems, and a Bayesian empirical local model was used to identify fluctuations of the indicators. Spatial and space-time clusters were identified using scan spatial statistic tests and to measure the municipalities' relative risk of leprosy. Results Leprosy clusters and burden of disease had a strong statistical association with the municipalities' Social Vulnerability Index. Municipalities with a high social vulnerability had higher leprosy incidence, multibacillary leprosy and newly diagnosed cases with grade 2 disability than areas with low social vulnerability. Conclusion Social vulnerability is strongly associated with leprosy transmission and maintenance of disease incidence. Leprosy control programmes should be targeted to the populations with high social vulnerability.