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Original Investigation
August 7, 2019

Risk Factors for Physical Disability in Patients With Leprosy: A Systematic Review and Meta-analysis

Author Affiliations
  • 1Centre for Epidemiology and Public Health, Federal University of Alagoas, Arapiraca, Alagoas, Brazil
  • 2Investigative Pathology Laboratory, Federal University of Sergipe, Aracaju, Sergipe, Brazil
  • 3Postgraduate Program in Health Science, Federal University of Sergipe, Aracaju, Sergipe, Brazil
  • 4Spatial Epidemiology Laboratory, Federal University of Pará, Castanhal, Pará, Brazil
  • 5Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
JAMA Dermatol. Published online August 7, 2019. doi:10.1001/jamadermatol.2019.1768
Key Points

Question  What are the risk factors for physical disability in patients with leprosy?

Findings  This systematic review and meta-analysis of 32 studies found a strong association between the presence of physical disabilities and male sex, multibacillary leprosy, leprosy reactions, and lepromatous presentation.

Meaning  These findings can guide the early identification of individuals at higher risk of developing physical disabilities and the development of targeted preventive interventions.

Abstract

Importance  The World Health Organization (WHO) 2016-2020 Global Leprosy Strategy aims to reinvigorate efforts to control leprosy and avert leprosy disability to less than 1 per million population.

Objective  To systematically identify clinical factors associated with physical disability in patients with leprosy.

Data Source  Searches were conducted in Scopus, PubMed, and Web of Science databases to identify studies published from January 23, 1988, to May 23, 2018, using the keywords leprosy and physical disability and related terms.

Study Selection  Studies that evaluated patients using the WHO leprosy disability grading system and reported the number of patients with and without disability by clinical characteristics were included.

Data Extraction and Synthesis  The odds ratio (OR) was used as a measure of association between the clinical features and physical disability. Summary estimates were calculated using random-effects models.

Main Outcomes and Measures  The primary outcome was physical disability according to the WHO disability classification. The association between clinical features and physical disability was evaluated.

Results  The search identified 2447 reports. After screening titles and abstracts, 177 full-text articles were assessed for eligibility, and 32 studies were included in the systematic review; 24 of the 32 studies included sex information (39 571 patients), of whom 24 218 (61.2%) were male. Male patients with leprosy were more likely to have physical disability than female patients with leprosy (pooled OR, 1.66; 95% CI, 1.43-1.93; I2, 81.3%; P < .001). Persons with multibacillary leprosy were 4-fold more likely to have physical disability than those with paucibacillary leprosy (pooled OR, 4.32; 95% CI, 3.37-5.53; I2, 88.9%, P < .001). Patients having leprosy reactions were more likely to have disability (pooled OR, 2.43; 95% CI, 1.35-4.36; I2, 92.1%; P < .001). Patients with lepromatous leprosy experienced 5- to 12-fold higher odds of disability.

Conclusions and Relevance  This systematic review and meta-analysis confirms the association between the presence of physical disabilities and male sex, multibacillary leprosy, leprosy reactions, and lepromatous presentation. These findings can guide the development of targeted interventions for early identification of individuals at greater risk of developing physical disabilities and education campaigns to promote early consultation to institute treatment for leprosy reactions and prevent physical disability.

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