Revised estimates of leprosy disability weights for assessing the global burden of disease: A systematic review and individual patient data meta-analysis.

Shri Lak Nanjan Chandran,Bob Bowers,Anuj Tiwari,Juanita Haagsma,Hiroyuki Watanabe,Renata Bilion Ruiz Prado,Jan Hendrik Richardus,Saba Lambert,Betul Demir,Anselmo Alves Lustosa,Rachel Gimenes Rodrigues Albuquerque

doi:10.1371/journal.pntd.0009209

Abstract

Leprosy is a chronic bacterial infection caused by Mycobacterium leprae, which may lead to physical disability, stigma, and discrimination. The chronicity of the disease and disabilities are the prime contributors to the disease burden of leprosy. The current figures of the disease burden in the 2017 global burden of disease study, however, are considered to be under-estimated. In this study, we aimed to systematically review the literature and perform individual patient data meta-analysis to estimate new disability weights for leprosy, using Health-Related Quality of Life (HRQOL) data. The search strategy included all major databases with no restriction on language, setting, study design, or year of publication. Studies on human populations that have been affected by leprosy and recorded the HRQOL with the Short form tool, were included. A consortium was formed with authors who could share the anonymous individual-level data of their study. Mean disability weight estimates, sorted by the grade of leprosy disability as defined by WHO, were estimated for individual participant data and pooled using multivariate random-effects meta-analysis. Eight out of 14 studies from the review were included in the meta-analysis due to the availability of individual-level data (667 individuals). The overall estimated disability weight for grade 2 disability was 0.26 (95%CI: 0.18-0.34). For grade 1 disability the estimated weight was 0.19 (95%CI: 0.13-0.26) and for grade 0 disability it was 0.13 (95%CI: 0.06-0.19). The revised disability weight for grade 2 leprosy disability is four times higher than the published GBD 2017 weights for leprosy and the grade 1 disability weight is nearly twenty times higher. The global burden of leprosy is grossly underestimated. Revision of the current disability weights and inclusion of disability caused in individuals with grade 0 leprosy disability will contribute towards a more precise estimation of the global burden of leprosy.

Highlights

Leprosy is a chronic bacterial infection caused by Mycobacterium leprae, which may lead to physical disability, stigma, and discrimination
Based on the eligibility criteria, we identified studies that used any version of the Short Form (SF)-36 tool, to measure Health-Related Quality of Life (HRQOL) in leprosy patients
Following the screening of full text of the included articles, a total of 13 studies were included as they recorded and reported HRQOL scores from the SF-36 tool from people affected by leprosy

Summary

Introduction

Leprosy is a chronic bacterial infection caused by Mycobacterium leprae, which may lead to physical disability, stigma, and discrimination. Around 200,000 new leprosy cases are detected worldwide and 12,800 persons are diagnosed with advanced disfigurement (referred to as leprosy grade 2 disability), which is irreversible in nature [1]. Leprosy is often misunderstood to be eliminated or carry no significant disease burden because most cases have limited physical impairment. The burden of leprosy is beyond physical impairment and encompasses the mental and social wellbeing of affected persons [2, 3]. The chronicity of the disease and disabilities are the prime contributors to the disease burden of leprosy. We aimed to systematically review the literature and perform individual patient data meta-analysis to estimate new disability weights for leprosy, using Health-Related Quality of Life (HRQOL) data

Objectives

Methods

Results

Conclusion