Analysis of Social Determinants of Health and Disability Scores in Leprosy-Affected Persons in Salem, Tamil Nadu, India

Abstract

A consistent relationship has been found between leprosy and inequities in social determinants of health. It, however, remains unclear which aspect of these social determinants contributes most to the risk of infection, and even less clear are the risk factors for the development of leprosy-related disabilities. The objective of this study was to elicit the differential impact of social determinants of health in leprosy-affected persons, and determine whether structural inequities in accessibility to societal resources and lower socioeconomic parameters correlated with higher severity of disabilities. This analysis was based on a sampled population affected by leprosy in Salem, Tamil Nadu, India. Persons enrolled in the study were covered by a nongovernmental lifelong care program, had completed a multidrug therapy for leprosy and/or were slit-skin-smear negative, and showed Grade 1 or higher disabilities due to leprosy. Multiple stepwise linear regression analysis was performed. The Eyes-Hands-Feet (EHF) score was the outcome variable, and gender, age, time after release from treatment, monthly income, and living space were explanatory variables. There were 123 participants, comprised of 41 (33.33%) women and 82 (66.67%) men. All study participants belonged to India’s Backward classes; 81.30% were illiterate and the average monthly income was 1252 Indian rupee (INR) (US$19.08 or €17.16). The average EHF score was 7.016 (95% CI, 6.595 to 7.437). Stepwise multiple linear regression analysis built a significant model, where F(2, 120) = 13.960, p ≤ 0.001, effect size (Cohen’s f2) = 0.81, explaining 18.9% of the variance in EHF scores (R2 = 0.189). Significant predictors of a higher EHF score in persons affected by leprosy were found to be higher age (beta = 0.340, 95% CI, 0.039 to 0.111, p < 0.001), as well as less living space (beta = −0.276, 95% CI, −0.041 to −0.011, p = 0.001). Our results suggest that inequalities in social determinants of health correspond to higher disability scores, which indicates that poor living standards are a common phenomenon in those living with leprosy-related disabilities. Further research is needed to dissect the exact development of impairments after release from treatment (RFT) in order to take targeted actions against disability deterioration.

Assessing the Impact of the Twin Track Socio-Economic Intervention on Reducing Leprosy-Related Stigma in Cirebon District, Indonesia

“…In a way there is a double burden: Poverty and leprosy both produce stigma. Even worse, if the people affected by leprosy delay seeking care, for example due to poverty and stigma, they might develop an impairment which might lead to disability and even more stigma and poverty [18].…”

Profile of functionality of persons affected by leprosy

“…Pesquisas realizadas em Alagoas (23,7%) e no Pará (57,6%) corroboram a caracterização socioeconômica encontrada neste estudo (14)(15) . Além disso, foi apontado, na literatura, que desigualdades sociais impactam em maiores escores de deficiência, o que indica que os padrões de vida precários são comuns em pessoas que vivem com as incapacidades relacionadas à doença (17)(18) .…”

Mortalidade relacionada à hanseníase no Estado do Piauí, Brasil: tendências temporais e padrões espaciais, 2000-2015

“…A região Meio-norte, onde se localiza a capital do Estado do Piauí, apresentou relevante mortalidade relacionada à hanseníase, embora a capital não tenha apresentado um aumento de óbitos pela doença. Esse incremento na região Meio-norte pode estar relacionado a municípios com vulnerabilidade social que dependem da capital do estado 25 .…”

“…Ademais, as desigualdades nos determinantes sociais de saúde podem aumentar a vulnerabilidade de as pessoas desenvolverem hanseníase e apresentarem incapacidades físicas decorrentes da doença 25 , bem como evoluírem para óbito pela incapacidade física e/ou por complicações sistêmicas 8 .…”