Preprint
Conditional Cash Transfer Program and Leprosy Incidence: Analysis of 12.9 Million Families From the 100 Million Brazilian Cohort (Preprint)
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, p. 1-25, 2020.
0002-9262
10.1093/aje/kwaa127
Autor
Pescarini, Julia Moreira
Williamson, Elizabeth
Ichihara, Maria Y.
Fiaccone, Rosemeire L.
Forastiere, Laura
Ramond, Anna
Nery, Joilda Silva
Penna, Maria Lucia F.
Strina, Agostino
Reis, Sandra
Smeeth, Liam
Rodrigues, Laura C.
Brickley, Elizabeth B.
Penna, Gerson Oliveira
Barreto, Mauricio Lima
Resumen
CONFAP/ESRC/MRC/BBSRC/CNPq/FAPDF–Doencas Negligenciadas
(FAP-DF 193.000.008/2016), the UK Medical Research Council (MR/N017250/1), the Wellcome Trust
(202912/B/16/Z), and CAPES. Leprosy is a neglected tropical disease predominately affecting poor and marginalized populations. To test the hypothesis that poverty-alleviating policies may be associated with reduced leprosy incidence, we evaluated the association between the Brazilian Bolsa Familia conditional cash transfer Program (BFP) 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 non-beneficiary families, we used Mantel-Haenszel tests and Poisson regressions to estimate incidence rate ratios (IRRs) 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 pyr (95%CI: 17.1, 17.7), and markedly higher in "priority" (high-burden) versus "non-priority" (low-burden) municipalities (22.8/100,000 pyr, 95%CI: 22.2, 23.3 versus 14.3/100,000, 95%CI: 14.0, 14.7). After matching, BFP participation was not associated with leprosy incidence overall (IRRPoisson 0.97, 95%CI: 0.90, 1.04) but was associated with lower leprosy incidence when restricted to families living in high-burden 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 leprosy-associated disabilities (IRRPoisson 0.79, 95%CI: 0.65, 0.97). These findings provide policy-relevant evidence that social policies may contribute to on-going leprosy control efforts in high-burden communities.