title: Epidemiology of cutaneous leishmaniasis in central Amazonia: a comparison of sex-biased incidence among rural settlers and field biologists.
abstract: OBJECTIVE
  Cutaneous leishmaniasis (CL) is more frequently reported in men than in women; this may be due to male-biased exposure to CL vectors, female-biased resistance against the disease or both. We sought to determine whether gender-specific exposure to vector habitats explains male-biased CL incidence in two human populations of central Amazonia.
  
  
  METHODS
  We compared the CL incidence in one population of field researchers (N = 166), with similar exposure for males and females, and one population of rural settlers (N = 646), where exposure is overall male-biased. We used a combination of questionnaires and clinical data to quantify CL cases, and modelled disease incidence in a Bayesian framework.
  
  
  RESULTS
  There was a moderately higher incidence of CL among men than among women in both populations, but male bias decreased as exposure time increased. Disease incidence was overall higher among field researchers, suggesting that they are an important but understudied CL risk group.
  
  
  CONCLUSIONS
  Our comparison of two contrasting populations provided epidemiological evidence that CL incidence can be male-biased even when exposure is comparable in both sexes.
authors.affiliation: Biological Dynamics of Forest Fragments Project, Smithsonian Tropical Research Institute & Instituto Nacional de Pesquisas da Amazônia, Manaus AM, Brazil; Graduate Program in Ecology, Instituto Nacional de Pesquisas da Amazônia, Manaus AM, Brazil; Department of Biology, University of Missouri St Louis, St Louis, MO, USA.
authors.forename: Letícia
authors.initials: L
authors.lastname: Soares
authors.forename: Fernando
authors.initials: F
authors.lastname: Abad-Franch
authors.forename: Gonçalo
authors.initials: G
authors.lastname: Ferraz
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D001499:Bayes Theorem; D017753:Ecosystem; D004781:Environmental Exposure; D005260:Female; D006801:Humans; D015994:Incidence; D016773:Leishmaniasis, Cutaneous / Q000453:epidemiology*; D008297:Male; D012108:Research Personnel; D045483:Rivers; D012424:Rural Population; D012737:Sex Factors; D013020:South America / Q000453:epidemiology; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Bayesian analysis; Exposición Ambiental; Leishmania (Viannia) guyanensis; Phlebotominae; analyse bayésienne; análisis Bayesiano; environmental exposure; exposition à l'environnement; phlébotomie