Article
Conditional cash transfer program and Leprosy incidence: analysis of 12.9 million families from the 100 million Brazilian cohort
Registro en:
PESCARINI, Julia Moreira et al. Conditional Cash Transfer Program and Leprosy Incidence: Analysis of 12.9 Million Families From the 100 Million Brazilian Cohort. American Journal of Epidemiology, [Baltimore], v. 189, n. 12, p. 1547–1558, Jul. 2020.
0002-9262
10.1093/aje/kwaa127
Autor
Pescarini, Júlia Moreira
Williamson, Elizabeth
Ichihara, Maria Yury Travassos
Fiaccone, Rosemeire Leovigildo
Forastiere, Laura
Ramond, Anna
Nery, Joilda Silva
Penna, Maria Lucia Fernandes
Strina, Agostino
Reis, Sandra
Smeeth, Liam
Rodrigues, Laura Cunha
Brickley, Elizabeth B.
Penna, Gerson Oliveira
Barreto, Maurício Lima
Resumen
Conselho Nacional das Fundações Estaduais de Amparo à Pesquisa (CONFAP), Economic and Social Research Council (ESRC), Medical Research Council (MRC), Biotechnology and Biological Sciences Research Council (BBSRC), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Fundação de Apoio à Pesquisa do Distrito Federal (FAP-DF) for Neglected Diseases (FAP-DF 193.000.008/
2016 and MR/N017250/1), the Wellcome Trust (202912/B/16/Z), e Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES). Leprosy is a neglected tropical disease predominately affecting poor and marginalized populations. To test the
hypothesis that poverty-alleviating policies might be associated with reduced leprosy incidence, we evaluated
the association between the Brazilian Bolsa Familia (BFP) conditional cash transfer program and new leprosy
case detection using linked records from 12,949,730 families in the 100 Million Brazilian Cohort (2007–2014).
After propensity score matching BFP beneficiary to nonbeneficiary families, we used Mantel-Haenszel tests and
Poisson regressions to estimate incidence rate ratios for new leprosy case detection and secondary endpoints
related to operational classification and leprosy-associated disabilities at diagnosis. Overall, cumulative leprosy
incidence was 17.4/100,000 person-years at risk (95% CI: 17.1, 17.7) and markedly higher in “priority” (highburden)
versus “nonpriority” (low-burden) municipalities (22.8/100,000 person-years at risk, 95% confidence
interval (CI): 22.2, 23.3, compared with 14.3/100,000 person-years at risk, 95% CI: 14.0, 14.7). After matching,
BFP participation was not associated with leprosy incidence overall (incidence rate ratio (IRR)Poisson = 0.97,
95% CI: 0.90, 1.04) but was associated with lower leprosy incidence when restricted to families living in highburden
municipalities (IRRPoisson = 0.86, 95% CI: 0.77, 0.96). In high-burden municipalities, the association was
particularly pronounced for paucibacillary cases (IRRPoisson = 0.82, 95% CI: 0.68, 0.98) and cases with leprosyassociated
disabilities (IRRPoisson = 0.79, 95% CI: 0.65, 0.97). These findings provide policy-relevant evidence
that social policies might contribute to ongoing leprosy control efforts in high-burden communities.