Socioeconomic risk markers of leprosy in high-burden countries: A systematic review and meta-analysis

Abstract

Over 200,000 new cases of leprosy are detected each year, of which approximately 7% are associated with grade-2 disabilities (G2Ds). For achieving leprosy elimination, one of the main challenges will be targeting higher risk groups within endemic communities. Nevertheless, the socioeconomic risk markers of leprosy remain poorly understood. To address this gap we systematically reviewed MEDLINE/PubMed, Embase, LILACS and Web of Science for original articles investigating the social determinants of leprosy in countries with > 1000 cases/year in at least five years between 2006 and 2016. Cohort, case-control, cross-sectional, and ecological studies were eligible for inclusion; qualitative studies, case reports, and reviews were excluded. Out of 1,534 non-duplicate records, 96 full-text articles were reviewed, and 39 met inclusion criteria. 17 were included in random-effects meta-analyses for sex, occupation, food shortage, household contact, crowding, and lack of clean (i.e., treated) water. The majority of studies were conducted in Brazil, India, or Bangladesh while none were undertaken in low-income countries. Descriptive synthesis indicated that increased age, poor sanitary and socioeconomic conditions, lower level of education, and food-insecurity are risk markers for leprosy. Additionally, in pooled estimates, leprosy was associated with being male (RR = 1.33, 95% CI = 1.06–1.67), performing manual labor (RR = 2.15, 95% CI = 0.97–4.74), suffering from food shortage in the past (RR = 1.39, 95% CI = 1.05–1.85), being a household contact of a leprosy patient (RR = 3.40, 95% CI = 2.24–5.18), and living in a crowded household (≥5 per household) (RR = 1.38, 95% CI = 1.14–1.67). Lack of clean water did not appear to be a risk marker of leprosy (RR = 0.94, 95% CI = 0.65–1.35). Additionally, ecological studies provided evidence that lower inequality, better human development, increased healthcare coverage, and cash transfer programs are linked with lower leprosy risks. These findings point to a consistent relationship between leprosy and unfavorable economic circumstances and, thereby, underscore the pressing need of leprosy control policies to target socially vulnerable groups in high-burden countries.

Leprosy in the North and Northeast regions of Brazil: an integrated spatiotemporal approach

“…A meta‐analysis conducted from 2006 to 2016 in countries with more than 1000 cases reported in at least five years of this period provided evidence for an association between unfavourable socioeconomic conditions and leprosy detection rates . In Brazil, the factors related to higher detection rates include a high percentage of children, a high average number of residents per municipality, poor water supply and lack of bathrooms .…”

Quantifying risk factors to guide progress towards leprosy elimination

“…Poverty has often been associated with an elevated risk of leprosy. 5 However, there is inadequate quantification of specific socioeconomic, demographic, and geographical variables that contribute to leprosy risk. Advancing our understanding of these risk factors can be applied to identify the communities in which surveillance and control efforts would be most effectively and efficiently focused.…”

Risk factor for <em>Mycobacterium leprae</em> detection in household contacts with leprosy patients: a study in Papua, East Indonesia

“…Association between house conditions and risk for leprosy development has been discussed in previous studies. According to Pescarini et al, 27 socio-economic status including house conditions strongly affects leprosy transmission. The results from another study conducted in a different population indicated that socio-economic conditions such as sanitation, house conditions, and economic status increase the risk of leprosy development.…”