Social determinants, their relationship with leprosy risk and temporal trends in a tri-border region in Latin America

Abstract

BackgroundBrazil is the only country in Latin America that has adopted a national health system. This causes differences in access to health among Latin American countries and induces noticeable migration to Brazilian regions to seek healthcare. This phenomenon has led to difficulties in the control and elimination of diseases related to poverty, such as leprosy. The aim of this study was to evaluate social determinants and their relationship with the risk of leprosy, as well as to examine the temporal trend of its occurrence in a Brazilian municipality located on the tri-border area between Brazil, Paraguay and Argentina.MethodsThis ecological study investigated newly-diagnosed cases of leprosy between 2003 and 2015. Exploratory analysis of the data was performed through descriptive statistics. For spatial analysis, geocoding of the data was performed using spatial scan statistic techniques to obtain the Relative Risk (RR) for each census tract, with their respective 95% confidence intervals calculated. The Bivariate Moran I test, Ordinary Least Squares (OLS) and Geographically Weighted Regression (GWR) models were applied to analyze the spatial relationships of social determinants and leprosy risk. The temporal trend of the annual coefficient of new cases was obtained through the Prais-Winsten regression. A standard error of 5% was considered statistically significant (p < 0.05).ResultsOf the 840 new cases identified in the study, there was a predominance of females (n = 427, 50.8%), of white race/color (n = 685, 81.6%), age range 15 to 59 years (n = 624, 74.3%), and incomplete elementary education (n = 504, 60.0%). The results obtained from multivariate analysis revealed that the proportion of households with monthly nominal household income per capita greater than 1 minimum wage (β = 0.025, p = 0.036) and people of brown race (β = -0.101, p = 0.024) were statistically-significantly associated with risk of illness due to leprosy. These results also confirmed that social determinants and risk of leprosy were significantly spatially non-stationary. Regarding the temporal trend, a decrease of 4% (95% CI [-0.053, -0.033], p = 0.000) per year was observed in the rate of detection of new cases of leprosy.ConclusionThe social determinants income and race/color were associated with the risk of leprosy. The study’s highlighting of these social determinants can contribute to the development of public policies directed toward the elimination of leprosy in the border region.

Trends and forecasts of leprosy for a hyperendemic city from Brazil’s northeast: Evidence from an eleven-year time-series analysis

“…Considering the demographic and social characteristics of the study context, the city is presenting rapid demographic growth, attracting immigrants from the north and northeast of the country due to its local economy, which may be influencing the hyperendemicity of the region under study [25,26]. In this context, largest proportion of cases were male, which is in agreement with data provided in the literature, in which those affected by the disease in most world regions are predominately male, including in Brazil [27][28][29]. The time series of the ratio between the detection rates of men and women showed, over time, the detection rates in men are higher than that of women, reaching, at the end of the study period, a ratio of about 4: 1.…”

High-risk areas of leprosy in Brazil between 2001-2015

“…Often, the disease is related to indicators of poverty, such as low income and schooling (30) . The northeast region, among the less developed regions, stands out in this scenario.…”

Spatial clustering, social vulnerability and risk of leprosy in an endemic area in Northeast Brazil: an ecological study

“…[23][24][25] This study identified that these areas have a higher proportion of patients with advanced forms of leprosy, vis a vis MB leprosy and individuals with grade 2 disability, likely reflecting a late diagnosis and barriers to access health services. Brazil, 5,17,22,26,27 Bangladesh 16 and India [28][29][30] have long reported the well-established relationship between poverty and the occurrence of advanced forms of leprosy and that patients in areas with good primary healthcare services are diagnosed earlier. 22,31,32 Socioeconomic differences influence not only access, but also the quality and utilization of health services.…”