451
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Belhassen M, Nolin M, Nibber A, Ginoux M, Devouassoux G, Van Ganse E. Changes in Persistent Asthma Care and Outcomes From 2006 to 2016 in France. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:1858-1867. [PMID: 30836232 DOI: 10.1016/j.jaip.2019.02.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 02/15/2019] [Accepted: 02/15/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Changes in asthma care need to be documented at arrival of biotherapies. OBJECTIVES To characterize changes in asthma care and outcomes in patients with persistent asthma. METHODS Repeated transversal analyses were conducted on a historical cohort using the French national claims data over 10 years. Patients aged 18 to 40 years with either 1 or more (any-use population) or 4 or more (high-use population) yearly dispensings of controller therapy were selected. Clinical and demographic features were characterized, and comparisons were made between 2006 and 2016 to assess temporal changes in asthma therapy, health care resource utilization, and outcomes. RESULTS In 2016, prevalent use of controller therapy was 5.2% (any-use population) and 0.8% (high-use population) of the population aged 18 to 40 years. In the any-use population, the use of long-acting β2-agonists in monotherapy, and inhaled corticosteroids decreased (1.7% and 40.3% in 2016, respectively), whereas the use of fixed-dose combinations increased (56.4%). In both populations, visits to respiratory or hospital physicians and pulmonary function testing increased with time, in parallel to a decreasing number of general practitioner visits; in addition, oral corticosteroid use and incidence of emergency room visits increased. However, asthma hospitalizations and mortality remained low in both populations. CONCLUSIONS Changes in persistent asthma care included replacement of inhaled corticosteroids by fixed-dose combinations, decreased use of long-acting β2-agonists as a monotherapy, and increased involvement of secondary care physicians. In parallel, despite low figures for hospital admissions and mortality, overall use of oral corticosteroids and incidence of emergency room visits have increased over the last decade.
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Affiliation(s)
| | - Maëva Nolin
- PELyon, PharmacoEpidemiology Lyon, Lyon, France
| | - Anjan Nibber
- University of Oxford Medical School, Oxford, United Kingdom
| | | | - Gilles Devouassoux
- Respiratory Medicine, Croix Rousse University Hospital, and EA7426 University Claude Bernard Lyon-1, Lyon, France
| | - Eric Van Ganse
- PELyon, PharmacoEpidemiology Lyon, Lyon, France; Respiratory Medicine, Croix Rousse University Hospital, and EA7426 University Claude Bernard Lyon-1, Lyon, France; HESPER 7425, Health Services and Performance Research, University Claude Bernard Lyon 1, Lyon, France
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452
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Laanani M, Coste J, Blotière PO, Carbonnel F, Weill A. Patient, Procedure, and Endoscopist Risk Factors for Perforation, Bleeding, and Splenic Injury After Colonoscopies. Clin Gastroenterol Hepatol 2019; 17:719-727.e13. [PMID: 30099110 DOI: 10.1016/j.cgh.2018.08.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 07/27/2018] [Accepted: 08/01/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS We investigated perforations, bleeding, and splenic injuries after screening or diagnostic colonoscopies to identify patient-, procedure-, endoscopist-, and facility-associated risk factors. METHODS We analyzed data from the SNIIRAM-PMSI national claims databases in France. A total of 4,088,799 patients, 30 years or older, undergoing a first screening or diagnostic colonoscopy from 2010 through 2015 were identified. Rates of severe adverse events (SAEs) were estimated using stringent and broad definitions. Risk factors associated with perforations and major bleeding were estimated using multilevel logistic regression models, adjusted for patient, colonoscopy, and endoscopist characteristics. RESULTS Perforation rates ranged from 3.5 (stringent definition) to 7.3 (broad definition) per 10,000 procedures, bleeding rates ranged from 6.5 to 23.1 per 10,000 procedures, and splenic injury rates ranged from 0.20 to 0.34 per 10,000 procedures. Rates of 30-day mortality were 13.2 per 1000 bleeds, 29.2 per 1000 perforations, and 36.1 per 1000 splenic injuries (stringent definitions). Patient characteristics associated with SAEs were increasing age (especially for perforation), cancer, and cardiovascular comorbidities. Procedure characteristics associated with SAEs included polypectomy-especially of polyps larger than 1 cm with an increased risk of perforation (odds ratio, 4.1; 95% CI, 3.4-5.0) and bleeding (odds ratio, 13.3; 95% CI, 11.7-15.1). Less-experienced endoscopists and endoscopists who performed a smaller number of colonoscopies were independently associated with a risk of SAEs. CONCLUSION In an analysis of national claims databases in France, we found SAEs related to screening and diagnostic colonoscopies to be more frequent in older patients, in patients with comorbidities, and with less-experienced endoscopists. Patients at risk of SAE should be identified and colonoscopies should be performed or supervised by experienced endoscopists.
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Affiliation(s)
- Moussa Laanani
- Department of Public Health Studies, French National Health Insurance, Paris, France
| | - Joël Coste
- Department of Public Health Studies, French National Health Insurance, Paris, France
| | | | - Franck Carbonnel
- Gastroenterology unit, Hôpitaux Universitaires Paris Sud, Université Paris-Sud and Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Alain Weill
- Department of Public Health Studies, French National Health Insurance, Paris, France.
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453
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Konrad R, Zhang W, Bjarndóttir M, Proaño R. Key considerations when using health insurance claims data in advanced data analyses: an experience report. Health Syst (Basingstoke) 2019; 9:317-325. [PMID: 33354323 PMCID: PMC7738306 DOI: 10.1080/20476965.2019.1581433] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 02/06/2019] [Accepted: 02/06/2019] [Indexed: 10/27/2022] Open
Abstract
Health claims have become a popular source of data for healthcare analytics, with numerous applications ranging from disease burden estimation and policy evaluation to drug event detection and advanced predictive analytics. Independent of the application, a researcher utilising claims information will likely encounter challenges in using the data, which include dealing with several coding systems and coding irregularities. We highlight some of these challenges and approaches for successful analysis that may reduce implementation time and help in avoiding common pitfalls. We describe the experiences of a group of academic researchers in using an extensive seven-year repository of US medical and pharmaceutical claims data in a research study, and provide an overview of the challenges encountered with handling claims records for data analysis while sharing suggestions on how to address these challenges. To illustrate our experiences, we use the example of defining episodes of care for a bundled payment reimbursement system in the US context.
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Affiliation(s)
- Renata Konrad
- Fosie School of Business, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Wenchang Zhang
- Robert H. Smith School of Business, University of Maryland College Park, College Park, MD, USA
| | - Margrét Bjarndóttir
- Robert H. Smith School of Business, University of Maryland College Park, College Park, MD, USA
| | - Ruben Proaño
- Industrial Systems Engineering, Rochester Institute of Technology, USA
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454
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Binda F, Fougnot S, De Monchy P, Fagot-Campagna A, Pulcini C, Thilly N. Impact of selective reporting of antibiotic susceptibility test results in urinary tract infections in the outpatient setting: a protocol for a pragmatic, prospective quasi-experimental trial. BMJ Open 2019; 8:e025810. [PMID: 30798294 PMCID: PMC6278878 DOI: 10.1136/bmjopen-2018-025810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 09/03/2018] [Accepted: 09/28/2018] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Antibiotic resistance is a serious and increasing worldwide threat to global public health. One of antibiotic stewardship programmes' objectives are to reduce inappropriate broad-spectrum antibiotics' prescription. Selective reporting of antibiotic susceptibility test (AST) results, which consists of reporting to prescribers only few (n=5-6) antibiotics, preferring first-line and narrow-spectrum agents, is one possible strategy advised in recommendations. However, selective reporting of AST has never been evaluated using an experimental design. METHODS AND ANALYSIS This study is a pragmatic, prospective, multicentre, controlled (selective reporting vs usual complete reporting of AST), before-after (year 2019 vs 2017) study. Selective reporting of AST is scheduled to be implemented from September 2018 in the ATOUTBIO group of 21 laboratories for all Escherichia coli identified in urine cultures in adult outpatients, and to be compared with the usual complete AST performed in the EVOLAB group of 20 laboratories. The main objective is to assess the impact of selective reporting of AST for E. coli-positive urine cultures in the outpatient setting on the prescription of broad-spectrum antibiotics frequently used for urinary tract infections (amoxicillin-clavulanate, third-generation cephalosporins and fluoroquinolones). The primary end point is the after (2019)-before (2017) difference in prescription rates for the previously mentioned antibiotics/classes that will be compared between the two laboratory groups, using linear regression models. Secondary objectives are to evaluate the feasibility of selective reporting of AST implementation by French laboratories and their acceptability by organising focus groups and individual semi-structured interviews with general practitioners and laboratory professionals. ETHICS AND DISSEMINATION This protocol was approved by French national ethics committees (Comité d'expertise pour les recherches, les études et les évaluations dans le domaine de la santé (TPS 29064) and Commission Nationale de l'Informatique et des Libertés (Décision DR-2018-141)). Findings of this study will be widely disseminated through conference presentations, reports, factsheets and academic publications and generalisation will be further discussed. TRIAL REGISTRATION NUMBER NTC03612297.
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Affiliation(s)
- Francesca Binda
- Université de Lorraine, APEMAC, Nancy, France
- Département des sciences cliniques et biomédicales «Luigi Sacco», Université de Milan, Milan, Italy
| | | | | | | | - Céline Pulcini
- Université de Lorraine, APEMAC, Nancy, France
- Université de Lorraine, CHRU-Nancy, Service des maladies infectieuses et tropicales, Nancy, France
| | - Nathalie Thilly
- Université de Lorraine, APEMAC, Nancy, France
- Université de Lorraine, CHRU-Nancy, Plateforme d’Aide à la Recherche Clinique, Nancy, France
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455
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Ferrier C, Dhombres F, Khoshnood B, Randrianaivo H, Perthus I, Guilbaut L, Durand-Zaleski I, Jouannic JM. Trends in resource use and effectiveness of ultrasound detection of fetal structural anomalies in France: a multiple registry-based study. BMJ Open 2019; 9:e025482. [PMID: 30772861 PMCID: PMC6398629 DOI: 10.1136/bmjopen-2018-025482] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To analyse trends in the number of ultrasound examinations in relation to the effectiveness of prenatal detection of birth defects using population-based data in France. DESIGN A multiple registry-based study of time trends in resource use (number of ultrasounds) and effectiveness (proportion of cases prenatally diagnosed). SETTING Three registries of congenital anomalies and claims data on ultrasounds for all pregnant women in France. PARTICIPANTS There were two samples of pregnant women. Effectiveness was assessed using data from three French birth defect registries. Resource use for ultrasound screening was based on the French national healthcare database. MAIN OUTCOME MEASURES The main outcome measures were prenatal diagnosis (effectiveness) and the average number of ultrasounds (resource use). Statistical analyses included linear and logistic regression models to assess trends in resource use and effectiveness of prenatal testing, respectively. RESULTS The average number of ultrasound examinations per pregnancy significantly increased over the study period, from 2.47 in 2006 to 2.98 in 2014 (p=0.005). However, there was no significant increase in the odds of prenatal diagnosis. The probability of prenatal diagnosis was substantially higher for cases associated with a chromosomal anomaly (91.2%) than those without (51.8%). However, there was no evidence of an increase in prenatal detection of either over time. CONCLUSIONS The average number of ultrasound examinations per pregnancy increased over time, whereas the probability of prenatal diagnosis of congenital anomalies did not. Hence, there is a need to implement policies such as high-quality training programmes which can improve the efficiency of ultrasound examinations for prenatal detection of congenital anomalies.
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Affiliation(s)
- Clément Ferrier
- Fetal Medicine Department, Sorbonne University, AP-HP, Armand Trousseau Hospital, Paris, France
| | - Ferdinand Dhombres
- Fetal Medicine Department, Sorbonne University, AP-HP, Armand Trousseau Hospital, Paris, France
| | - Babak Khoshnood
- INSERM U1142, LIMICS, Sorbonne University, Paris, France
- Paris registry of congenital anomalies, Port-Royal Hospital, Paris, France
| | - Hanitra Randrianaivo
- Reunion registry of congenital anomalies, St Pierre, Saint Pierre de la Réunion, France
| | - Isabelle Perthus
- Study center for congenital anomalies, CEMC-Auvergne, Clermont-Ferrand, France
| | - Lucie Guilbaut
- Fetal Medicine Department, Sorbonne University, AP-HP, Armand Trousseau Hospital, Paris, France
| | - Isabelle Durand-Zaleski
- INSERM CRESS UMR 1153, Paris, France
- AP-HP, URCEco Ile de France, Hôtel-Dieu Hospital, Paris, France
| | - Jean-Marie Jouannic
- Fetal Medicine Department, Sorbonne University, AP-HP, Armand Trousseau Hospital, Paris, France
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456
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Laviolle B, Perche O, Gueyffier F, Bégué É, Bilbault P, Espérou H, Gaillard-Bigot F, Grenet G, Guérin JF, Guillot C, Longeray PH, Morere J, Perrier L, Sanlaville D, Thevenon J, Varoqueaux N. Apport de la génomique dans la médecine de demain, applications cliniques et enjeux. Therapie 2019; 74:1-8. [DOI: 10.1016/j.therap.2018.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 11/13/2018] [Indexed: 11/24/2022]
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457
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Laviolle B, Denèfle P, Gueyffier F, Bégué É, Bilbault P, Espérou H, Gaillard-Bigot F, Grenet G, Guérin JF, Guillot C, Longeray PH, Morere J, Perche O, Perrier L, Sanlaville D, Thevenon J, Varoqueaux N. The contribution of genomics in the medicine of tomorrow, clinical applications and issues. Therapie 2019; 74:9-15. [DOI: 10.1016/j.therap.2018.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 11/13/2018] [Indexed: 10/27/2022]
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458
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Meyer A, Rudant J, Drouin J, Weill A, Carbonnel F, Coste J. Effectiveness and Safety of Reference Infliximab and Biosimilar in Crohn Disease: A French Equivalence Study. Ann Intern Med 2019; 170:99-107. [PMID: 30534946 DOI: 10.7326/m18-1512] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND CT-P13 is a biosimilar of the reference product (RP) infliximab, with demonstrated efficacy and safety for some inflammatory arthritides. It was approved for the treatment of Crohn disease (CD) on that basis, without specific studies examining its effects in CD. OBJECTIVE To compare the effectiveness and safety of CT-P13 and RP in infliximab-naive patients with CD. DESIGN Comparative equivalence cohort study. SETTING Système National des Données de Santé (SNDS), a French nationwide health administrative database (1 March 2015 to 30 June 2017). PATIENTS 5050 infliximab-naive patients with CD who were older than 15 years, had started treatment with RP (n = 2551) or CT-P13 (n = 2499), and had no other indications for infliximab. MEASUREMENTS The primary outcome was a composite end point of death, CD-related surgery, all-cause hospitalization, and reimbursement of another biologic therapy. Equivalence was defined as a 95% CI of the hazard ratio (HR) of CT-P13 versus RP in a multivariable marginal Cox model situated within prespecified margins (0.80 to 1.25). RESULTS Overall, 1147 patients in the RP group and 952 patients in the CT-P13 group met the composite end point (including 838 and 719 hospitalizations, respectively). In multivariable analysis of the primary outcome, CT-P13 was equivalent to RP (HR, 0.92 [95% CI, 0.85 to 0.99]). No differences in safety outcomes were observed between the 2 groups: serious infections (HR, 0.82 [CI, 0.61 to 1.11]), tuberculosis (HR, 1.10 [CI, 0.36 to 3.34]), and solid or hematologic cancer (HR, 0.66 [CI, 0.33 to 1.32]). LIMITATION The SNDS does not contain all relevant clinical data (for example, disease activity). CONCLUSION This analysis of real-world data indicates that the effectiveness of CT-P13 is equivalent to that of RP for infliximab-naive patients with CD. No difference was observed for safety outcomes. PRIMARY FUNDING SOURCE Caisse Nationale de l'Assurance Maladie.
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Affiliation(s)
- Antoine Meyer
- Caisse Nationale de l'Assurance Maladie, Paris, and Hôpital Bicêtre, Le Kremlin-Bicêtre, France. (A.M.)
| | - Jérémie Rudant
- Caisse Nationale de l'Assurance Maladie, Paris, France (J.R., J.D., A.W.)
| | - Jérôme Drouin
- Caisse Nationale de l'Assurance Maladie, Paris, France (J.R., J.D., A.W.)
| | - Alain Weill
- Caisse Nationale de l'Assurance Maladie, Paris, France (J.R., J.D., A.W.)
| | | | - Joël Coste
- Caisse Nationale de l'Assurance Maladie, Paris, and Hôpital Bicêtre, Le Kremlin-Bicêtre, France (J.C.)
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459
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Bouget J, Balusson F, Scailteux LM, Maignan M, Roy PM, L'her E, Pavageau L, Nowak E. Major bleeding with antithrombotic agents: a 2012-2015 study using the French nationwide Health Insurance database linked to emergency department records within five areas - rationale and design of SACHA study. Fundam Clin Pharmacol 2019; 33:443-462. [PMID: 30537335 DOI: 10.1111/fcp.12444] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 11/27/2018] [Accepted: 12/06/2018] [Indexed: 12/29/2022]
Abstract
Bleeding represents the most recognized and feared complications of antithrombotic drugs including oral anticoagulants. Previous studies showed inconsistent results on the safety profile. Among explanations, bleeding definition could vary and classification bias exists related to the lack of medical evaluation. To quantify the risk of major haemorrhagic event and event-free survival associated with antithrombotic drugs (vitamin K antagonist [VKA], non-VKA anticoagulant [NOAC], antiplatelet agent, parenteral anticoagulant) in 2012-2015, we linked the French nationwide Health Insurance database (SNIIRAM) with a local 'emergency database' (clinical and biological data collected in clinical records). In the VKA-NOAC comparison, a Cox regression analysis will be used to estimate the hazard ratio of major haemorrhagic event adjusted on gender, modified HAS-BLED score and comorbidities. A distinction on the type of major haemorrhagic event (intracranial, gastrointestinal and other haemorrhagic events) was made. We present here the study protocol and the database linkage results. Using six linkage keys, among 3 837 557 hospital visits identified in SNIIRAM, 5264 have been matched with a major haemorrhagic event identified in the 'emergency database', thus clinically confirmed. The 1090 unmatched haemorrhagic events could be explained by the fact that patients were not extracted in the SNIIRAM database (patients living in accommodation establishment with internal use of pharmacy, military people with specific insurance…). We showed the value of SNIIRAM enrichment with a clinical database, a necessary step to categorize haemorrhagic events by a clinically relevant definition and medical validation; it will allow to estimate more accuracy each type of haemorrhagic event.
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Affiliation(s)
- Jacques Bouget
- Univ Rennes, REPERES [Pharmacoepidemiology and Heath Services Research] - EA 7449, Univ Rennes, Rennes, F-35000, France.,Emergency Department, University hospital, Rennes, F-35033, France
| | - Frédéric Balusson
- Univ Rennes, REPERES [Pharmacoepidemiology and Heath Services Research] - EA 7449, Univ Rennes, Rennes, F-35000, France
| | - Lucie-Marie Scailteux
- Univ Rennes, REPERES [Pharmacoepidemiology and Heath Services Research] - EA 7449, Univ Rennes, Rennes, F-35000, France.,Pharmacovigilance, Pharmacoepidemiology and drug information center, Rennes, F-35033, France
| | - Maxime Maignan
- Emergency Department, University Hospital, Grenoble, F-38043, France
| | - Pierre-Marie Roy
- Emergency Department, University hospital, Angers, F-49033, France
| | - Erwan L'her
- Emergency Department, University hospital, Brest, F-29609, France
| | - Laure Pavageau
- Emergency Department, University hospital, Nantes, F-44093, France
| | - Emmanuel Nowak
- CHU de Brest, Brest, F-29200, France.,Inserm CIC 1412, IFR 148, Université de Brest, Brest, F-29200, France
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460
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Landré B, Aegerter P, Zins M, Goldberg M, Ankri J, Herr M. Association between Hospitalization and Change of Frailty Status in the GAZEL Cohort. J Nutr Health Aging 2019; 23:466-473. [PMID: 31021364 DOI: 10.1007/s12603-019-1186-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To assess the relationship between changes of frailty status and intervening hospitalizations, using information of the GAZEL cohort, matched with the data of the French National Health Data System. DESIGN Observational cohort study. PARTICIPANTS Community-dwelling adults of the GAZEL cohort (n = 12145; aged between 58 and 73 years in 2012). MEASUREMENTS Frailty was determined with the Strawbridge questionnaire in 2012, 2013 and 2014. Data regarding hospitalizations (notably their number, length of stay, emergency department use, and main diagnosis) were collected from the French National Health Data System. The relationship between intervening hospitalizations and changes of frailty status over time was assessed with multivariate Markov models. RESULTS The prevalence of frailty was 14% in 2012 and 2013 and 17% in 2014. A total of 2715 changes in frailty status were observed from 2012 to 2014. At least one hospitalization was recorded for 1453 people (12%) between the 2012 and 2013 questionnaires, and 1472 (13%) between the 2013 and 2014 questionnaires. No association was found between intervening hospitalizations and changes of frailty status (aHR 1.14 [0.97-1.35] for robust to frail transition and aHR 0.89 [0.73-1.08] for frail to robust transition). However, repeated hospitalizations, hospitalizations after emergency department use, surgery and several diagnosis groups were significantly associated with transitions towards frailty or its recovery. CONCLUSION Hospitalizations encompass a wide range of clinical situations, some of them being associated with incident frailty. An early recognition of these situations could help to better prevent and manage frailty in the early old age.
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Affiliation(s)
- B Landré
- Marie Herr ; UMR 1168, UFR des Sciences de la Santé Simone Veil, 2 avenue de la source de la Bièvre, 78180 Montigny-le-Bretonneux, France ;
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461
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Identifying diabetes cases in health administrative databases: a validation study based on a large French cohort. Int J Public Health 2018; 64:441-450. [PMID: 30515552 DOI: 10.1007/s00038-018-1186-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/03/2018] [Accepted: 11/26/2018] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVES In the French national health insurance information system (SNDS) three diabetes case definition algorithms are applied to identify diabetic patients. The objective of this study was to validate those using data from a large cohort. METHODS The CONSTANCES cohort (Cohorte des consultants des Centres d'examens de santé) comprises a randomly selected sample of adults living in France. Between 2012 and 2014, data from 45,739 participants recorded in a self-administrated questionnaire and in a medical examination were linked to the SNDS. Two gold standards were defined: known diabetes and pharmacologically treated diabetes. Sensitivity, specificity, positive and negative predictive values (PPV, NPV) and kappa coefficients (k) were estimated. RESULTS All three algorithms had specificities and NPV over 99%. Their sensitivities ranged from 73 to 77% in algorithm A, to 86 and 97% in algorithm B and to 93 and 99% in algorithm C, when identifying known and pharmacologically treated diabetes, respectively. Algorithm C had the highest k when using known diabetes as the gold standard (0.95). Algorithm B had the highest k (0.98) when testing for pharmacologically treated diabetes. CONCLUSIONS The SNDS is an excellent source for diabetes surveillance and studies on diabetes since the case definition algorithms applied have very good test performances.
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462
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Abstract
Introduction Postmarketing pharmacovigilance reports have raised concerns about non-bleeding adverse events associated with direct oral anticoagulants (DOACs), but only limited results are available from large claims databases. Objective The aim of this study was to assess the potential association between DOAC initiation and the onset of four types of non-bleeding adverse events by sequence symmetry analysis (SSA). Methods SSA was performed using nationwide data from the French National Healthcare databases (Régime Général, 50 million beneficiaries) to assess a cohort of 386,081 DOAC new users for the first occurrence of four types of non-bleeding outcomes: renal, hepatic, skin outcomes identified by using hospitalization discharge diagnoses, and gastrointestinal outcomes by using medication reimbursement. Asymmetry in the distribution of each investigated outcome occurring before and after initiation of DOAC therapy was used to test the association between DOAC therapy and these outcomes. SSA inherently controls for time-constant confounders, and adjusted sequence ratios were computed after correcting for temporal trends. Negative (glaucoma) and positive (bleeding, depressive disorders) control outcomes were used and analyses were replicated on a cohort of 310,195 patients initiating a vitamin K antagonist (VKA). Results This study demonstrated the expected positive association between either DOAC or VKA therapy and hospitalised bleeding and initiation of antidepressant therapy, while no association was observed between either DOAC or VKA therapy and initiation of antiglaucoma medications. For DOAC therapy, signals were the associations with hepatic outcomes, including acute liver injury [for the 3-month time window, aSR3 = 2.71, 95% confidence interval (CI) 1.79–4.52]; gastrointestinal outcomes, including initiation of drugs for constipation and antiemetic drugs (aSR3 = 1.31, 95% CI 1.27–1.36; and 1.17, 95% CI 1.12–1.22, respectively); and kidney diseases (aSR3 = 1.33, 95% CI 1.29–1.37). Conclusion Results of this nationwide study suggest that DOACs are associated with rare but severe liver injury and more frequent gastrointestinal disorders. A low risk of kidney injury with DOAC therapy can also not be excluded. Electronic supplementary material The online version of this article (10.1007/s40264-018-0668-9) contains supplementary material, which is available to authorized users.
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463
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Chaignot C, Zureik M, Rey G, Dray‐Spira R, Coste J, Weill A. Risk of hospitalisation and death related to baclofen for alcohol use disorders: Comparison with nalmefene, acamprosate, and naltrexone in a cohort study of 165 334 patients between 2009 and 2015 in France. Pharmacoepidemiol Drug Saf 2018; 27:1239-1248. [PMID: 30251424 PMCID: PMC6282718 DOI: 10.1002/pds.4635] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 07/07/2018] [Accepted: 07/12/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE Baclofen is widely used off-label for alcohol use disorders (AUD) in France, despite its uncertain efficacy and safety, particularly at high doses. This study was designed to evaluate the safety of this off-label use compared to the main approved drugs for AUD (acamprosate, naltrexone, nalmefene). METHODS This cohort study from the French Health Insurance claims database included patients, aged 18 to 70 years, with no serious comorbidity (assessed by the Charlson score) initiating baclofen or approved drugs for AUD between 2009 and 2015. The risk of hospitalisation or death associated with baclofen, at variable doses over time (from low doses <30 mg/day to high doses ≥180 mg/day), compared to approved drugs, was evaluated by a Cox model adjusted to sociodemographic and medical characteristics. RESULTS The cohort included 165 334 patients, 47 614 of whom were exposed to baclofen. Patients exposed to baclofen differed from those treated with approved drugs in terms of sociodemographic and medical characteristics (more females, higher socioeconomic status, fewer hospitalisations for alcohol-related problems), but these differences tended to fade at higher doses of baclofen. Baclofen exposure was significantly associated with hospitalisation (hazard ratio [HR] = 1.13 [95%CI: 1.09-1.17]) and death (HR = 1.31 [95%CI: 1.08-1.60]). The risk increased with dose, reaching 1.46 [1.28-1.65] for hospitalisation and 2.27 [1.27-4.07] for death at high doses. Similar results were in patients with a history of hospitalisation for alcohol-related problems. CONCLUSIONS This study raises concerns about the safety of baclofen for AUD, particularly at high doses, with higher risks of hospitalisation and mortality than approved drugs.
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Affiliation(s)
| | - Mahmoud Zureik
- ANSM (French National Agency for Medicines and Health Products Safety)Saint‐DenisFrance
| | - Grégoire Rey
- Inserm, CépiDc (Epidemiology Centre on Medical Causes of Death)Kremlin‐BicêtreFrance
| | - Rosemary Dray‐Spira
- ANSM (French National Agency for Medicines and Health Products Safety)Saint‐DenisFrance
| | - Joël Coste
- Cnam (French National Health Insurance)ParisFrance
| | - Alain Weill
- Cnam (French National Health Insurance)ParisFrance
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Bousquet PJ, Lefeuvre D, Tuppin P, BenDiane MK, Rocchi M, Bouée-Benhamiche E, Viguier J, Le Bihan-Benjamin C. Cancer care and public health policy evaluations in France: Usefulness of the national cancer cohort. PLoS One 2018; 13:e0206448. [PMID: 30379946 PMCID: PMC6209307 DOI: 10.1371/journal.pone.0206448] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 10/13/2018] [Indexed: 01/31/2023] Open
Abstract
Background In the context of the national Cancer Plans of France that have changed the healthcare landscape, it has become necessary to better document and assess the related actions, and to promote research and understanding. The national cancer cohort, an exhaustive population-based cohort, was set up on the basis of the National Health Data System (SNDS) by the French National Cancer Institute. Objectives The aim is to describe the French national cancer cohort. Methods All people living in France (67 million population) with universal insurance coverage and diagnosed, treated or followed up for a cancer, such as survivors, are included and will be followed up for 25 years. It contains all healthcare consumptions and reimbursements (i.e. hospitalization, outpatient care, medication…) since 2010. Every year, around 650 000 new cases are included. Results From 2010 to 2015, 6.2 million subjects have been included. Most subjects were entered in 2010, in 2015 it concerned 0.6 million. In 2015, the median age was 65 [54–76]; 51% were women. The primary cancer organ could be attributed with certitude to 87% of the people. The most frequent locations were skin (16%), breast (15%), prostate (12%), colon-rectum (11%) and lung (9%). In 2015, 40% of included subjects underwent surgery for cancer, 16% chemotherapy at hospital and 11% at least one session of radiotherapy. Conclusion Based on SNDS, the cancer cohort has been designed to study cancer care use in the short-, medium- and long-term, and evaluate healthcare and public health policies.
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Affiliation(s)
- Philippe Jean Bousquet
- Survey, Monitoring and Assessment Department, Public Health and Healthcare Division, Institut National du Cancer (French National Cancer Institute—INCa), Boulogne Billancourt, France
- Economy and social science, health care systems and societies, Faculté de médecine, Marseille, France
- * E-mail:
| | - Delphine Lefeuvre
- Survey, Monitoring and Assessment Department, Public Health and Healthcare Division, Institut National du Cancer (French National Cancer Institute—INCa), Boulogne Billancourt, France
| | - Philippe Tuppin
- Caisse nationale d'assurance maladie des travailleurs salariés, département des études sur les pathologies et les patients (DEPP), Paris, France
| | - Marc Karim BenDiane
- Economy and social science, health care systems and societies, Faculté de médecine, Marseille, France
| | - Mathieu Rocchi
- Survey, Monitoring and Assessment Department, Public Health and Healthcare Division, Institut National du Cancer (French National Cancer Institute—INCa), Boulogne Billancourt, France
| | - Elsa Bouée-Benhamiche
- Survey, Monitoring and Assessment Department, Public Health and Healthcare Division, Institut National du Cancer (French National Cancer Institute—INCa), Boulogne Billancourt, France
| | - Jérôme Viguier
- Public Health and Healthcare Division, Institut National du Cancer (French National Cancer Institute—INCa), Boulogne Billancourt, France
| | - Christine Le Bihan-Benjamin
- Survey, Monitoring and Assessment Department, Public Health and Healthcare Division, Institut National du Cancer (French National Cancer Institute—INCa), Boulogne Billancourt, France
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Thereaux J, Lesuffleur T, Czernichow S, Basdevant A, Msika S, Nocca D, Millat B, Fagot-Campagna A. Multicentre cohort study of antihypertensive and lipid-lowering therapy cessation after bariatric surgery. Br J Surg 2018; 106:286-295. [PMID: 30325504 DOI: 10.1002/bjs.10999] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 07/05/2018] [Accepted: 08/17/2018] [Indexed: 12/13/2022]
Abstract
Abstract
Background
Few studies have assessed changes in antihypertensive and lipid-lowering therapy after bariatric surgery. The aim of this study was to assess the 6-year rates of continuation, discontinuation or initiation of antihypertensive and lipid-lowering therapy after bariatric surgery compared with those in a matched control group of obese patients.
Methods
This nationwide observational population-based cohort study used data extracted from the French national health insurance database. All patients undergoing gastric bypass or sleeve gastrectomy in France in 2009 were matched with control patients. Mixed-effect logistic regression models were used to analyse factors that influenced discontinuation or initiation of treatment over a 6-year interval.
Results
In 2009, 8199 patients underwent primary gastric bypass (55·2 per cent) or sleeve gastrectomy (44·8 per cent). After 6 years, the proportion of patients receiving antihypertensive and lipid-lowering therapy had decreased more in the bariatric group than in the control group (antihypertensives: –40·7 versus –11·7 per cent respectively; lipid-lowering therapy: –53·6 versus –20·2 per cent; both P < 0·001). Gastric bypass was the main predictive factor for discontinuation of therapy for hypertension (odds ratio (OR) 9·07, 95 per cent c.i. 7·72 to 10·65) and hyperlipidaemia (OR 11·91, 9·65 to 14·71). The proportion of patients not receiving treatment at baseline who were subsequently started on medication was lower after bariatric surgery than in controls for hypertension (5·6 versus 15·8 per cent respectively; P < 0·001) and hyperlipidaemia (2·2 versus 9·1 per cent; P < 0·001). Gastric bypass was the main protective factor for antihypertensives (OR 0·22, 0·18 to 0·26) and lipid-lowering medication (OR 0·12, 0·09 to 0·15).
Conclusion
Bariatric surgery is associated with a good discontinuation of antihypertensive and lipid-lowering therapy, with gastric bypass being more effective than sleeve gastrectomy.
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Affiliation(s)
- J Thereaux
- Department of Statistics, Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Paris, France
- Department of General, Digestive and Metabolic Surgery, La Cavale Blanche University Hospital, and Groupe d'Étude de la Thrombose de Bretagne Occidentale, EA 3878, University of Bretagne Occidentale, Brest, France
| | - T Lesuffleur
- Department of Statistics, Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Paris, France
| | - S Czernichow
- Department of Nutrition, Hôpital Européen Georges Pompidou, Centre Spécialisé Obésité Ile de France Sud, Assistance Publique–Hôpitaux de Paris (AP-HP) and University Paris Descartes, Paris, France
| | - A Basdevant
- Department of Heart and Nutrition, Institute of Cardiometabolism and Nutrition, ICAN, AP-HP, Pitié-Salpêtrière Hospital, and France Sorbonne Universities, University Pierre et Marie Curie-Paris 6, Paris, France
| | - S Msika
- Department of General, Digestive and Metabolic Surgery, Louis Mourier Hospital, AP-HP, Diderot Paris 7 University, Colombes, France
| | - D Nocca
- Department of Surgery, Faculty of Medicine of Montpellier, Centre Hospitalier Universitaire Montpellier, Montpellier, France
| | - B Millat
- Department of Statistics, Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Paris, France
| | - A Fagot-Campagna
- Department of Statistics, Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Paris, France
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Sbidian E, Mezzarobba M, Weill A, Coste J, Rudant J. Persistence of treatment with biologics for patients with psoriasis: a real‐world analysis of 16 545 biologic‐naïve patients from the French National Health Insurance database (SNIIRAM). Br J Dermatol 2018; 180:86-93. [DOI: 10.1111/bjd.16809] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2018] [Indexed: 01/04/2023]
Affiliation(s)
- E. Sbidian
- Département d’études en santé publique Direction de la stratégie, des études et des statistiques Caisse Nationale d'Assurance Maladie des Travailleurs Salariés (CNAM) Paris F‐75020 France
- AP‐HP Hôpitaux universitaires Henri Mondor Département de Dermatologie UPEC 51, av du Maréchal de Lattre de Tassigny Créteil F‐94010 France
- INSERM Centre d'Investigation Clinique 1430 Créteil F‐94010 France
- EA 7379 EpidermE Université Paris‐Est Créteil UPEC Créteil F‐94010 France
| | - M. Mezzarobba
- Département d’études en santé publique Direction de la stratégie, des études et des statistiques Caisse Nationale d'Assurance Maladie des Travailleurs Salariés (CNAM) Paris F‐75020 France
| | - A. Weill
- Département d’études en santé publique Direction de la stratégie, des études et des statistiques Caisse Nationale d'Assurance Maladie des Travailleurs Salariés (CNAM) Paris F‐75020 France
| | - J. Coste
- Département d’études en santé publique Direction de la stratégie, des études et des statistiques Caisse Nationale d'Assurance Maladie des Travailleurs Salariés (CNAM) Paris F‐75020 France
| | - J. Rudant
- Département d’études en santé publique Direction de la stratégie, des études et des statistiques Caisse Nationale d'Assurance Maladie des Travailleurs Salariés (CNAM) Paris F‐75020 France
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467
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Rudant J, Dupont A, Mikaeloff Y, Bolgert F, Coste J, Weill A. Surgery and risk of Guillain-Barré syndrome: A French nationwide epidemiologic study. Neurology 2018; 91:e1220-e1227. [PMID: 30143563 DOI: 10.1212/wnl.0000000000006246] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 06/28/2018] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To assess the association between Guillain-Barré syndrome (GBS) and recent surgery based on French nationwide data. METHODS Data were extracted from the French health administrative databases (SNIIRAM/PMSI). All patients hospitalized for GBS between 2009 and 2014 were identified by ICD-10 code G61.0 as main diagnosis. Patients previously hospitalized for GBS in 2006, 2007, and 2008 were excluded. Surgical procedures were identified from the hospital database. Hospitalizations for surgery with no infection diagnosis code entered during the hospital stay were also identified. The association between GBS and a recent surgical procedure was estimated using a case-crossover design. Case and referent windows were defined as 1-60 days and 366-425 days before GBS hospitalization, respectively. Analyses were adjusted for previous episodes of gastroenteritis and respiratory tract infection, identified by drug dispensing data. RESULTS Of the 8,364 GBS cases included, 175 and 257 patients had undergone a surgical procedure in the referent and case windows, respectively (adjusted odds ratio [OR] = 1.53, 95% confidence interval [CI]: 1.25-1.88). A slightly weaker association was observed for surgical procedures with no identified infection during the hospitalization (OR = 1.40, 95% CI: 1.12-1.73). Regarding the type of surgery, only surgical procedures on bones and digestive organs were significantly associated with GBS (OR and 95% CI = 2.78 [1.68-4.60] and 2.36 [1.32-4.21], respectively). CONCLUSION In this large nationwide epidemiologic study, GBS was moderately associated with any type of recent surgery and was more strongly associated with bone and digestive organ surgery.
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Affiliation(s)
- Jérémie Rudant
- From Caisse Nationale de l'Assurance Maladie (J.R., A.D., J.C., A.W.), Direction de la Stratégie des Études et des Statistiques, Département Études en Santé Publique, Paris; Assistance Publique-Hôpitaux de Paris (Y.M.), Hôpital Bicêtre, Unité de Rééducation Neurologique Infantile, Bicêtre; Université Paris-Saclay (Y.M.), Université Paris-Sud, CESP, Inserm, Villejuif; and Assistance Publique-Hôpitaux de Paris (F.B.), Hôpital Pitié-Salpêtrière, Réanimation Neurologique, Neurologie 1, Paris, France.
| | - Axelle Dupont
- From Caisse Nationale de l'Assurance Maladie (J.R., A.D., J.C., A.W.), Direction de la Stratégie des Études et des Statistiques, Département Études en Santé Publique, Paris; Assistance Publique-Hôpitaux de Paris (Y.M.), Hôpital Bicêtre, Unité de Rééducation Neurologique Infantile, Bicêtre; Université Paris-Saclay (Y.M.), Université Paris-Sud, CESP, Inserm, Villejuif; and Assistance Publique-Hôpitaux de Paris (F.B.), Hôpital Pitié-Salpêtrière, Réanimation Neurologique, Neurologie 1, Paris, France
| | - Yann Mikaeloff
- From Caisse Nationale de l'Assurance Maladie (J.R., A.D., J.C., A.W.), Direction de la Stratégie des Études et des Statistiques, Département Études en Santé Publique, Paris; Assistance Publique-Hôpitaux de Paris (Y.M.), Hôpital Bicêtre, Unité de Rééducation Neurologique Infantile, Bicêtre; Université Paris-Saclay (Y.M.), Université Paris-Sud, CESP, Inserm, Villejuif; and Assistance Publique-Hôpitaux de Paris (F.B.), Hôpital Pitié-Salpêtrière, Réanimation Neurologique, Neurologie 1, Paris, France
| | - Francis Bolgert
- From Caisse Nationale de l'Assurance Maladie (J.R., A.D., J.C., A.W.), Direction de la Stratégie des Études et des Statistiques, Département Études en Santé Publique, Paris; Assistance Publique-Hôpitaux de Paris (Y.M.), Hôpital Bicêtre, Unité de Rééducation Neurologique Infantile, Bicêtre; Université Paris-Saclay (Y.M.), Université Paris-Sud, CESP, Inserm, Villejuif; and Assistance Publique-Hôpitaux de Paris (F.B.), Hôpital Pitié-Salpêtrière, Réanimation Neurologique, Neurologie 1, Paris, France
| | - Joël Coste
- From Caisse Nationale de l'Assurance Maladie (J.R., A.D., J.C., A.W.), Direction de la Stratégie des Études et des Statistiques, Département Études en Santé Publique, Paris; Assistance Publique-Hôpitaux de Paris (Y.M.), Hôpital Bicêtre, Unité de Rééducation Neurologique Infantile, Bicêtre; Université Paris-Saclay (Y.M.), Université Paris-Sud, CESP, Inserm, Villejuif; and Assistance Publique-Hôpitaux de Paris (F.B.), Hôpital Pitié-Salpêtrière, Réanimation Neurologique, Neurologie 1, Paris, France
| | - Alain Weill
- From Caisse Nationale de l'Assurance Maladie (J.R., A.D., J.C., A.W.), Direction de la Stratégie des Études et des Statistiques, Département Études en Santé Publique, Paris; Assistance Publique-Hôpitaux de Paris (Y.M.), Hôpital Bicêtre, Unité de Rééducation Neurologique Infantile, Bicêtre; Université Paris-Saclay (Y.M.), Université Paris-Sud, CESP, Inserm, Villejuif; and Assistance Publique-Hôpitaux de Paris (F.B.), Hôpital Pitié-Salpêtrière, Réanimation Neurologique, Neurologie 1, Paris, France
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468
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Constantinou P, Tuppin P, Fagot-Campagna A, Gastaldi-Ménager C, Schellevis FG, Pelletier-Fleury N. Two morbidity indices developed in a nationwide population permitted performant outcome-specific severity adjustment. J Clin Epidemiol 2018; 103:60-70. [PMID: 30016643 DOI: 10.1016/j.jclinepi.2018.07.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 05/31/2018] [Accepted: 07/05/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The objective of the study was to develop and validate two outcome-specific morbidity indices in a population-based setting: the Mortality-Related Morbidity Index (MRMI) predictive of all-cause mortality and the Expenditure-Related Morbidity Index (ERMI) predictive of health care expenditure. STUDY DESIGN AND SETTING A cohort including all beneficiaries of the main French health insurance scheme aged 65 years or older on December 31, 2013 (N = 7,672,111), was randomly split into a development population for index elaboration and a validation population for predictive performance assessment. Age, gender, and selected lists of conditions identified through standard algorithms available in the French health insurance database (SNDS) were used as predictors for 2-year mortality and 2-year health care expenditure in separate models. Overall performance and calibration of the MRMI and ERMI were measured and compared to various versions of the Charlson Comorbidity Index (CCI). RESULTS The MRMI included 16 conditions, was more discriminant than the age-adjusted CCI (c-statistic: 0.825 [95% confidence interval: 0.824-0.826] vs. 0.800 [0.799-0.801]), and better calibrated. The ERMI included 19 conditions, explained more variance than the cost-adapted CCI (21.8% vs. 13.0%), and was better calibrated. CONCLUSION The proposed MRMI and ERMI indices are performant tools to account for health-state severity according to outcomes of interest.
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Affiliation(s)
- Panayotis Constantinou
- French National Health Insurance (Cnam), 50, Avenue du Professeur André Lemierre, 75986 Paris Cedex 20, France; Centre for Research in Epidemiology and Population Health, French National Institute of Health and Medical Research (INSERM U1018), Université Paris-Saclay, Université Paris-Sud, UVSQ, 16, Avenue Paul Vaillant Couturier, 94807 Villejuif Cedex, France.
| | - Philippe Tuppin
- French National Health Insurance (Cnam), 50, Avenue du Professeur André Lemierre, 75986 Paris Cedex 20, France
| | - Anne Fagot-Campagna
- French National Health Insurance (Cnam), 50, Avenue du Professeur André Lemierre, 75986 Paris Cedex 20, France
| | - Christelle Gastaldi-Ménager
- French National Health Insurance (Cnam), 50, Avenue du Professeur André Lemierre, 75986 Paris Cedex 20, France
| | - François G Schellevis
- NIVEL (Netherlands Institute for Health Services Research), PO Box 1568, 3500 BN Utrecht, The Netherlands; Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, 1081BT, Amsterdam, The Netherlands
| | - Nathalie Pelletier-Fleury
- Centre for Research in Epidemiology and Population Health, French National Institute of Health and Medical Research (INSERM U1018), Université Paris-Saclay, Université Paris-Sud, UVSQ, 16, Avenue Paul Vaillant Couturier, 94807 Villejuif Cedex, France
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469
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Simon M, Rigou A, Le Moal J, Zeghnoun A, Le Tertre A, De Crouy-Chanel P, Kaguelidou F, Leger J. Epidemiology of Childhood Hyperthyroidism in France: A Nationwide Population-Based Study. J Clin Endocrinol Metab 2018; 103:2980-2987. [PMID: 29846622 DOI: 10.1210/jc.2018-00273] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 05/23/2018] [Indexed: 12/29/2022]
Abstract
CONTEXT Hyperthyroidism affects all age groups, but epidemiological data for children are scarce. OBJECTIVE To perform a nationwide epidemiological survey of hyperthyroidism in children and adolescents. DESIGN A cross-sectional descriptive study. SETTING Identification of entries corresponding to reimbursements for antithyroid drugs in the French national insurance database. PARTICIPANTS All cases of childhood hyperthyroidism (6 months to 17 years of age) in 2015. MAIN OUTCOME MEASURES National incidence rate estimated with a nonlinear Poisson model and spatial distribution of cases. RESULTS A total of 670 cases of childhood hyperthyroidism were identified. Twenty patients (3%) had associated autoimmune or genetic disease, with type 1 diabetes and Down syndrome the most frequent. The annual incidence for 2015 was 4.58/100,000 person-years (95% CI 3.00 to 6.99/100,000). Incidence increased with age, in both sexes. This increase accelerated after the age of 8 in girls and 10 in boys and was stronger in girls. About 10% of patients were affected before the age of 5 years (sex ratio 1.43). There was an interaction between age and sex, the effect of being female increasing with age: girls were 3.2 times more likely to be affected than boys in the 10 to 14 years age group and 5.7 times more likely to be affected in the 15 to 17 years age group. No conclusions about spatial pattern emerged. CONCLUSION These findings shed light on the incidence of hyperthyroidism and the impact of sex on this incidence during childhood and adolescence. The observed incidence was higher than expected from the results published for earlier studies in Northern European countries.
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Affiliation(s)
- Marie Simon
- Santé publique France, Environmental Health Direction, Saint-Maurice, France
| | - Annabel Rigou
- Santé publique France, Environmental Health Direction, Saint-Maurice, France
| | - Joëlle Le Moal
- Santé publique France, Environmental Health Direction, Saint-Maurice, France
| | - Abdelkrim Zeghnoun
- Santé publique France, Environmental Health Direction, Saint-Maurice, France
| | - Alain Le Tertre
- Santé publique France, Environmental Health Direction, Saint-Maurice, France
| | | | - Florentia Kaguelidou
- Department of Pediatric Pharmacology and Pharmacogenetics, Hôpital Universitaire Robert Debré, Assistance Publique-Hôpitaux de Paris, Paris, France
- Clinical Investigations Center, INSERM CIC 1426, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, UMR-1123 ECEVE, Paris, France
| | - Juliane Leger
- Department of Pediatric Endocrinology and Diabetes, Reference Centre for Endocrine Growth and Development Diseases, Hôpital Universitaire Robert Debré, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- UMR 1141, DHU Protect, Institut National de la Santé et de la Recherche Médicale (Inserm), Paris, France
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470
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Bouyer B, Rudnichi A, Dray-Spira R, Zureik M, Coste J. Thromboembolic risk after lumbar spine surgery: a cohort study on 325 000 French patients. J Thromb Haemost 2018; 16:1537-1545. [PMID: 29893460 DOI: 10.1111/jth.14205] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Indexed: 01/24/2023]
Abstract
Essentials The risk of venous thromboembolism (VTE) after lumbar spine surgery (LBS) is not precisely known. More than 320 000 patients who underwent LBS in France between 2009 and 2014 were followed-up. The overall risk of VTE after LBS is less than 1% but modulated by patient and procedural factors. Surgical device implantation, anterior approach and complex surgery increase the risk of VTE. SUMMARY: Background Postoperative venous thromboembolism (VTE) is a severe complication, the risk of which after lumbar spine surgery (LBS) is not precisely known. Objective To estimate the incidence of VTE after LBS, and to identify individual and surgical risk factors. Methods All patients aged >18 years who underwent LBS in France between 2009 and 2014 were identified. Among 477 024 patients screened, exclusions concerned recent VTE or surgery, and multiple surgeries during the same hospital stay. Results In 323 737 patients (mean age 52.9 years, 51.4% male), we observed 2911 events (0.91%) after a median time of 12 days (Q1-Q3: 5-72 days). The multivariate adjusted Cox model showed increased risks associated with age (4% per year of age; 95% confidence interval [CI] 3.8-4.3), obesity (hazard ratio [HR] 1.32, 95% CI 1.18-1.46), active cancer (HR 1.65, 95% CI 1.5-1.82), previous thromboembolism (HR 5.41, 95% CI 4.74-6.17), severe paralysis (HR 1.47, 95% CI 1.17-1.84), renal disease (HR 1.28, 95% CI 1.04-1.6), psychiatric disease (HR 1.21, 95% CI 1.1-1.32), use of antidepressants (HR 1.13, 95% CI 1.03-1.24), use of contraceptives (HR 1.56, 95% CI 1.19-2.03), extended surgery for scoliosis (HR 3.61, 95% CI 2.96-4.4), implantation of pedicular screws with a 'dose-effect' association, and an anterior approach (HR 1.97, 95% CI 1.6-2.43) or a combined approach (HR 2.03, 95% CI 1.44-2.84). Conclusions The overall VTE risk after LBS is moderate (< 1%) but is widely modulated by several easily identifiable risk factors. The surgical community should be aware of this heterogeneity, adapt prevention according to patients and to the procedure, and use drug prophylaxis in the event of a high risk being present.
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Affiliation(s)
- B Bouyer
- French National Agency for Medicines and Health Products Safety, Saint Denis, France
- AP-HP and Paris-Descartes University, Paris, France
- Paris-Sud University, Paris, France
| | - A Rudnichi
- French National Agency for Medicines and Health Products Safety, Saint Denis, France
| | - R Dray-Spira
- French National Agency for Medicines and Health Products Safety, Saint Denis, France
| | - M Zureik
- French National Agency for Medicines and Health Products Safety, Saint Denis, France
- Versailles Saint-Quentin-en-Yvelines University, Versailles, France
| | - J Coste
- AP-HP and Paris-Descartes University, Paris, France
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471
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Mouly D, Goria S, Mounié M, Beaudeau P, Galey C, Gallay A, Ducrot C, Le Strat Y. Waterborne Disease Outbreak Detection: A Simulation-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15071505. [PMID: 30018195 PMCID: PMC6068474 DOI: 10.3390/ijerph15071505] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 07/07/2018] [Accepted: 07/10/2018] [Indexed: 11/16/2022]
Abstract
Waterborne disease outbreaks (WBDOs) remain a public health issue in developed countries, but to date the surveillance of WBDOs in France, mainly based on the voluntary reporting of clusters of acute gastrointestinal infections (AGIs) by general practitioners to health authorities, is characterized by low sensitivity. In this context, a detection algorithm using health insurance data and based on a space–time method was developed to improve WBDO detection. The objective of the present simulation-based study was to evaluate the performance of this algorithm for WBDO detection using health insurance data. The daily baseline counts of acute gastrointestinal infections were simulated. Two thousand simulated WBDO signals were then superimposed on the baseline data. Sensitivity (Se) and positive predictive value (PPV) were both used to evaluate the detection algorithm. Multivariate regression was also performed to identify the factors associated with WBDO detection. Almost three-quarters of the simulated WBDOs were detected (Se = 73.0%). More than 9 out of 10 detected signals corresponded to a WBDO (PPV = 90.5%). The probability of detecting a WBDO increased with the outbreak size. These results underline the value of using the detection algorithm for the implementation of a national surveillance system for WBDOs in France.
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Affiliation(s)
- Damien Mouly
- Santé Publique France, the French National Public Health Agency, 94 410 Saint-Maurice, France.
| | - Sarah Goria
- Santé Publique France, the French National Public Health Agency, 94 410 Saint-Maurice, France.
| | - Michael Mounié
- Unité D'évaluation Médico-Economique, Université Paul Sabatier, CHU 31059 Toulouse, France.
| | - Pascal Beaudeau
- Santé Publique France, the French National Public Health Agency, 94 410 Saint-Maurice, France.
| | - Catherine Galey
- Santé Publique France, the French National Public Health Agency, 94 410 Saint-Maurice, France.
| | - Anne Gallay
- Santé Publique France, the French National Public Health Agency, 94 410 Saint-Maurice, France.
| | - Christian Ducrot
- Institut National de la Recherche Agronomique, UR346-Unité d'Épidémiologie Animale, 63 122 Saint Genès Champanelle, France.
| | - Yann Le Strat
- Santé Publique France, the French National Public Health Agency, 94 410 Saint-Maurice, France.
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472
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Abstract
Healthcare is considered as one of the most promising areas where big data can be applied to foster innovation for the benefit of patients and of the whole system. Healthcare analytics have the potential to accelerate R&D, increase knowledge on diseases and risk factors, improve treatments, develop personalised medicine, help physicians with decision support systems… The access to data is also a driving force for patients' empowerment and for the democratic debate. However, there are also concerns about the societal, economic and ethic impacts of this wave of digitization and of the growing use of data, algorithms and artificial intelligence. Given the issues at stake, collecting and analysing data generated by health care systems is a strategic challenge in all countries; in that respect the French National System of Health Data (a national data warehouse linking data from several sources and giving a vision of the care pathways for the entire population, with a ten-year history) is an asset, but it has to be completed and enriched with data from electronic health records.
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Affiliation(s)
- Dominique Polton
- Institut national des données de santé (INDS), 19, rue A. Croquette, 94220 Charenton, France
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473
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Sitruk L, Couchoud C, Hourmant M, Tuppin P, Macher MA, Legeai C. [Description of immunosuppressive maintenance treatments post kidney transplant through the National System of Health Insurance]. Nephrol Ther 2018; 14:523-530. [PMID: 29887268 DOI: 10.1016/j.nephro.2018.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 03/02/2018] [Accepted: 03/18/2018] [Indexed: 01/08/2023]
Abstract
The aim of this study was to describe the drug dispensing of maintenance immunosuppression treatment in 2014 for patients who received a kidney transplant in 2012, based on the data of the French national health insurance and to compare those results with the information collected in the national database for kidney recipients. For each patient, are considered all drugs dispensing with their dates of issue, the molecules and their presentations (number of pills and dosage). Among 2463 transplanted adults in 2012, 73% have received tacrolimus monohydrate, 59% mycophenolate mofetil, 54% prednisone and 20% cyclosporin in 2014. The daily doses but not the number of tablets per day declined with age. The most frequent association was tacrolimus monohydrate-mycophenolate mofetil-steroids in 34% of the cases. The use of mTOR inhibitors, rare generally (7%), is more common in patients aged 66-85 years. Associations did not differ significantly according to diabetic status, for patients with a kidney from an elderly donor or according to the number of mismatch. The daily doses estimated from the deliverance in pharmacy are respectively similar, understated and over-estimate for tacrolimus, mycophenolate mofetil and cyclosporin compared to the national database. This study confirms the difficulty of apprehending drug consumption based only on dispensing in pharmacies or punctual recording even if it allows a fairly comprehensive view of French practices.
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Affiliation(s)
- Lola Sitruk
- Agence de la biomédecine, 1, avenue du Stade-de-France, 93212 Saint-Denis-La-Plaine cedex, France
| | - Cécile Couchoud
- Agence de la biomédecine, 1, avenue du Stade-de-France, 93212 Saint-Denis-La-Plaine cedex, France
| | - Maryvonne Hourmant
- Service de néphrologie et d'immunologie clinique, CHU, 30, boulevard Jean-Monnet, immeuble Jean-Monnet, 44093 Nantes cedex 1, France
| | - Philippe Tuppin
- Caisse nationale de l'Assurance maladie des travailleurs salariés, Direction de la stratégie des études et des statistiques, 26-50, avenue du Professeur-André-Lemierre, 75986 Paris cedex 20, France
| | - Marie-Alice Macher
- Agence de la biomédecine, 1, avenue du Stade-de-France, 93212 Saint-Denis-La-Plaine cedex, France
| | - Camille Legeai
- Agence de la biomédecine, 1, avenue du Stade-de-France, 93212 Saint-Denis-La-Plaine cedex, France.
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474
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Management of pregnancy based on healthcare consumption of women who delivered in France in 2015: Contribution of the national health data system (SNDS). J Gynecol Obstet Hum Reprod 2018; 47:299-307. [PMID: 29870831 DOI: 10.1016/j.jogoh.2018.05.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 05/28/2018] [Accepted: 05/30/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study was designed to further our knowledge of the management of pregnant women based on the national health data system (SNDS). MATERIAL AND METHODS Women covered by the national health insurance general scheme or a local mutualist section, who delivered in 2015. RESULTS Among the 672,182 women included (mean age: 31 years, SD 5.3), 0.3% were under the age of 18 years, 4% lived in a French overseas department (<18 years: 21%), 17% had complementary universal health insurance coverage (<18 years: 75%), 1.2% presented a mental illness, 0.6% had a cancer, and 0.4% had cardiovascular disease. At least one outpatient visit with a gynaecologist or midwife was detected for 93% of women (first trimester (T1): 75%), specific or nonspecific pelvic ultrasound was performed in 98% (T1: 92%), blood glucose assay was performed in 78% (T1: 61%), and an oral glucose tolerance test was performed in 58%. Before delivery, 0.2% of women had at least one admission to the intensive care unit and 22% had at least one hospital stay (<18 years: 38%), for which the principal diagnoses were: false labour (4.5%), threatened preterm labour (2.5%), surveillance of high-risk pregnancy (2.6%), diabetes (2.6%), and hypertension (0.7%). The preterm delivery rate was 6.7% (<18 years: 14%, ≥40 years: 9%). Although 20% of deliveries were performed by caesarean section, 16% of vaginal deliveries required instrumental extraction. DISCUSSION SNDS data enrich the data derived from periodic national perinatal surveys, such as the poor follow-up of adolescent girls. These data can promote the elaboration and monitoring of annual indicators.
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475
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Droitcourt C, Kerbrat S, Rault C, Botrel MA, Happe A, Garlantezec R, Guillot B, Schleich JM, Oger E, Dupuy A. Safety of Oral Propranolol for Infantile Hemangioma. Pediatrics 2018; 141:peds.2017-3783. [PMID: 29844139 DOI: 10.1542/peds.2017-3783] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/30/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The safety of oral propranolol for infantile hemangioma has not yet been studied at population level since the pediatric use marketing authorization was obtained in Europe. METHODS A survey of a nationwide, claim-based observational cohort of children <3 years old, with at least 1 delivery of oral propranolol between July 2014 and June 2016, was performed by using the database of the French National Health Insurance system. Standardized morbidity ratios (SMRs) were calculated by using, from the same database, a representative random sample of nonexposed subjects. The main outcomes were hospitalizations for cardiovascular (conduction disorders, bradycardia, and hypotension), respiratory (bronchial hyperactivity and bronchospasm), or metabolic events (hypoglycemia and hyperkalaemia), identified through the hospitalization diagnostic codes of the International Classification of Diseases, 10th Revision. The main analysis was conducted separately on "healthy" children (N = 1484), that is, free from of any prespecified underlying disease and on children with 1 of these underlying diseases (N = 269). RESULTS In all, 1753 patients <3 years of age had at least 2 deliveries of oral propranolol. In the healthy population, we observed 2 cardiovascular events (SMR = 2.8 [0-6.7]), 51 respiratory events (SMR = 1.7 [1.2-2.1]), and 3 metabolic events (SMR = 5.1 [0-10.9]). In the population with an underlying disease (mainly congenital heart disease), we observed 11 cardiovascular events leading to an SMR of 6.0 (2.5-9.6). SMRs were not significantly raised for respiratory or metabolic events in this "nonhealthy" population. CONCLUSIONS In this study on a large continuous nationwide claims database, we confirm the safety profile of oral propranolol in healthy children to be good.
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Affiliation(s)
- Catherine Droitcourt
- University of Rennes, Rennes, France; .,Departments of Dermatology.,Institut National de la Santé et de la Recherche Médicale, Centre d'Investigation Clinique 1414, Rennes, France.,University of Rennes, EA 7449 REPERES Pharmacoepidemiology and Health Services Research, Rennes, France
| | - Sandrine Kerbrat
- University of Rennes, EA 7449 REPERES Pharmacoepidemiology and Health Services Research, Rennes, France
| | - Caroline Rault
- University of Rennes, EA 7449 REPERES Pharmacoepidemiology and Health Services Research, Rennes, France
| | - Marie-Anne Botrel
- University of Rennes, EA 7449 REPERES Pharmacoepidemiology and Health Services Research, Rennes, France
| | - André Happe
- University of Rennes, EA 7449 REPERES Pharmacoepidemiology and Health Services Research, Rennes, France
| | - Ronan Garlantezec
- University of Rennes, Rennes, France.,Public Health.,Institut de Recherche en Santé, Environnement et Travail, Unité Mixte de Recherche 1085, Rennes, France; and
| | - Bernard Guillot
- Department of Dermatology, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | | | - Emmanuel Oger
- University of Rennes, Rennes, France.,University of Rennes, EA 7449 REPERES Pharmacoepidemiology and Health Services Research, Rennes, France.,Centre of Pharmacovigilance, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Alain Dupuy
- University of Rennes, Rennes, France.,Departments of Dermatology.,University of Rennes, EA 7449 REPERES Pharmacoepidemiology and Health Services Research, Rennes, France
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476
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Poulalhon C, Rotelli-Bihet L, Moine S, Fagot-Campagna A, Aubry R, Tuppin P. Use of hospital palliative care according to the place of death and disease one year before death in 2013: a French national observational study. BMC Palliat Care 2018; 17:75. [PMID: 29764435 PMCID: PMC5954461 DOI: 10.1186/s12904-018-0327-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 04/30/2018] [Indexed: 11/30/2022] Open
Abstract
Background Only limited data are available concerning the diseases managed before death and hospital palliative care (HPC) use according to place of death in France. We therefore conducted an observational study based on administrative health data in a large population to identify the diseases treated one year before death in 2013, the place of stay with or without hospital palliative care, and the place of death. Methods French health insurance general scheme beneficiaries were identified in the National Health data Information System (Snds) with a selection of information. Diseases were identified by algorithms from reimbursement data recorded in the Snds database. Results 347,253 people were included in this study (61% of all people who died in France). Place of death was short stay hospital for 51%, Rehab (7%), hospital at home (3%), skilled nursing home (13%) and other (26%). Chronic diseases managed in 2013 before death were cardiovascular/neurovascular diseases (56%), cancers (42%), and neurological and degenerative diseases (25%). During the year before death, 84% of people were hospitalized at least once, and 29% had received HPC. HPC was used by 52% of cancer patients (lung cancer: 62%; prostate cancer: 41%). In the absence of cancer, the use of HPC varied according to the disease: acute stroke: 24%, heart failure: 17%, dementia: 17%, multiple sclerosis: 23%. Conclusions Health administrative data can refine the knowledge of the care pathway prior to death and the HPC utilisation and can be useful to evaluate heath policies and improve monitoring and assessment of HPC use. Electronic supplementary material The online version of this article (10.1186/s12904-018-0327-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Claire Poulalhon
- National sickness insurance fund, 26-50, avenue du Professeur André Lemierre, 75986, Paris cedex 20, France
| | | | - Sébastien Moine
- Health Education and Practices Laboratory, Paris XIII University EA 3412, 93017, Bobigny cedex, France
| | - Anne Fagot-Campagna
- National sickness insurance fund, 26-50, avenue du Professeur André Lemierre, 75986, Paris cedex 20, France
| | - Régis Aubry
- Pain and palliative Care Department, Teaching Hospital, 25030, Besançon, France
| | - Philippe Tuppin
- National sickness insurance fund, 26-50, avenue du Professeur André Lemierre, 75986, Paris cedex 20, France.
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477
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Blotière PO, Weill A, Dalichampt M, Billionnet C, Mezzarobba M, Raguideau F, Dray-Spira R, Zureik M, Coste J, Alla F. Development of an algorithm to identify pregnancy episodes and related outcomes in health care claims databases: An application to antiepileptic drug use in 4.9 million pregnant women in France. Pharmacoepidemiol Drug Saf 2018; 27:763-770. [PMID: 29763992 PMCID: PMC6055607 DOI: 10.1002/pds.4556] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 03/20/2018] [Accepted: 04/12/2018] [Indexed: 11/27/2022]
Abstract
Purpose Access to claims databases provides an opportunity to study medication use and safety during pregnancy. We developed an algorithm to identify pregnancy episodes in the French health care databases and applied it to study antiepileptic drug (AED) use during pregnancy between 2007 and 2014. Methods The algorithm searched the French health care databases for discharge diagnoses and medical procedures indicative of completion of a pregnancy. To differentiate claims associated with separate pregnancies, an interval of at least 28 weeks was required between 2 consecutive pregnancies resulting in a birth and 6 weeks for terminations of pregnancy. Pregnancy outcomes were categorized into live births, stillbirths, elective abortions, therapeutic abortions, spontaneous abortions, and ectopic pregnancies. Outcome dates and gestational ages were used to calculate pregnancy start dates. Results According to our algorithm, live birth was the most common pregnancy outcome (73.9%), followed by elective abortion (17.2%), spontaneous abortion (4.2%), ectopic pregnancy (1.1%), therapeutic abortion (1.0%), and stillbirth (0.4%). These results were globally consistent with French official data. Among 7 559 701 pregnancies starting between 2007 and 2014, corresponding to 4 900 139 women, 6.7 per 1000 pregnancies were exposed to an AED. The number of pregnancies exposed to older AEDs, comprising the most teratogenic AEDs, decreased throughout the study period (−69.4%), while the use of newer AEDs increased (+73.4%). Conclusions We have developed an algorithm that allows identification of a large number of pregnancies and all types of pregnancy outcomes. Pregnancy outcome and start dates were accurately identified, and maternal data could be linked to neonatal data.
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Affiliation(s)
- Pierre-Olivier Blotière
- Department of Studies in Public Health, French National Health Insurance (CNAMTS), Paris, France.,Université de Lorraine, université Paris-Descartes, Apemac, EA 4360, Nancy, France
| | - Alain Weill
- Department of Studies in Public Health, French National Health Insurance (CNAMTS), Paris, France
| | - Marie Dalichampt
- Department of Studies in Public Health, French National Health Insurance (CNAMTS), Paris, France
| | - Cécile Billionnet
- Department of Studies in Public Health, French National Health Insurance (CNAMTS), Paris, France
| | - Myriam Mezzarobba
- Department of Studies in Public Health, French National Health Insurance (CNAMTS), Paris, France
| | - Fanny Raguideau
- Department of Epidemiology of Health Products, The French National Agency for Medicines and Health Products Safety, Saint-Denis, France
| | - Rosemary Dray-Spira
- Department of Epidemiology of Health Products, The French National Agency for Medicines and Health Products Safety, Saint-Denis, France
| | - Mahmoud Zureik
- Department of Epidemiology of Health Products, The French National Agency for Medicines and Health Products Safety, Saint-Denis, France
| | - Joël Coste
- Department of Studies in Public Health, French National Health Insurance (CNAMTS), Paris, France
| | - François Alla
- Université de Lorraine, université Paris-Descartes, Apemac, EA 4360, Nancy, France.,Université Bordeaux et CHU Bordeaux, CIC-EC 1401, Inserm U1219, Bordeaux, France
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478
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Kaguelidou F, Sommet A, Lapeyre-Mestre M. Use of French healthcare insurance databases in pediatric pharmacoepidemiology. Therapie 2018; 73:127-133. [DOI: 10.1016/j.therap.2017.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 11/15/2017] [Indexed: 01/24/2023]
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479
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Neumann A, Maura G, Weill A, Alla F, Danchin N. Clinical Events After Discontinuation of β‐Blockers in Patients Without Heart Failure Optimally Treated After Acute Myocardial Infarction. Circ Cardiovasc Qual Outcomes 2018; 11:e004356. [DOI: 10.1161/circoutcomes.117.004356] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 02/16/2018] [Indexed: 02/03/2023]
Abstract
Background:
β-blockers have been among the first medications shown to improve outcomes after acute myocardial infarction (AMI). With the advent of reperfusion therapy and other secondary-prevention medications, their role has become uncertain, and large-scale experience after AMI in the contemporary era is lacking. In particular, the effect of stopping β-blockers in patients initially treated after AMI is unknown.
Methods and Results:
Using the French healthcare databases, 73 450 patients (<80 years of age), admitted for AMI in 2007 to 2012, without acute coronary syndrome (ACS) in the previous 2 years and no evidence of heart failure, having received optimal treatment with myocardial revascularization and all recommended medications in the 4 months after index admission, and not having discontinued β-blockers before 1 year, were followed for 3.8 years on average. β-Blocker discontinuation was defined as 4 consecutive months without exposure. If β-blocker treatment was resumed later on, follow-up was stopped. Both the risk of the composite outcome of death or admission for ACS and the risk of all-cause mortality were assessed in relation with β-blocker discontinuation during follow-up. Adjusted hazard ratios were estimated using marginal structural models accounting for time-varying confounders affected by previous exposure. A similar analysis was performed with statins. Of 204 592 patient-years, 12 002 (5.9%) corresponded to discontinued β-blocker treatment. For β-blocker discontinuation, the adjusted hazard ratio for death or ACS was 1.17 (95% confidence interval, 1.01–1.35); for all-cause death, the adjusted hazard ratio was 1.13 (95% confidence interval, 0.94–1.36). In contrast, for statin discontinuation, the adjusted hazard ratios for death or ACS and for all-cause death were 2.31 (95% confidence interval, 2.01–2.65) and 2.57 (95% confidence interval, 2.19–3.02), respectively.
Conclusions:
In routine care of patients without heart failure, revascularized and optimally treated after AMI, discontinuation of β-blockers beyond 1 year after AMI was associated with an increased risk of death or readmission for ACS, while statistical significance was not reached for the association with all-cause mortality. A contemporary randomized clinical trial is needed to precise the role of β-blockers in the long-term treatment after AMI.
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Affiliation(s)
- Anke Neumann
- Department of Studies in Public Health, French National Health Insurance (Caisse nationale de l’Assurance Maladie, Cnam), Paris, France (A.N., G.M., A.W., F.A.); and Department of Cardiology, Hôpital Européen Georges Pompidou, Assistance Publique–Hôpitaux de Paris, INSERM 970, Université Paris Descartes, France (N.D.)
| | - Géric Maura
- Department of Studies in Public Health, French National Health Insurance (Caisse nationale de l’Assurance Maladie, Cnam), Paris, France (A.N., G.M., A.W., F.A.); and Department of Cardiology, Hôpital Européen Georges Pompidou, Assistance Publique–Hôpitaux de Paris, INSERM 970, Université Paris Descartes, France (N.D.)
| | - Alain Weill
- Department of Studies in Public Health, French National Health Insurance (Caisse nationale de l’Assurance Maladie, Cnam), Paris, France (A.N., G.M., A.W., F.A.); and Department of Cardiology, Hôpital Européen Georges Pompidou, Assistance Publique–Hôpitaux de Paris, INSERM 970, Université Paris Descartes, France (N.D.)
| | - François Alla
- Department of Studies in Public Health, French National Health Insurance (Caisse nationale de l’Assurance Maladie, Cnam), Paris, France (A.N., G.M., A.W., F.A.); and Department of Cardiology, Hôpital Européen Georges Pompidou, Assistance Publique–Hôpitaux de Paris, INSERM 970, Université Paris Descartes, France (N.D.)
| | - Nicolas Danchin
- Department of Studies in Public Health, French National Health Insurance (Caisse nationale de l’Assurance Maladie, Cnam), Paris, France (A.N., G.M., A.W., F.A.); and Department of Cardiology, Hôpital Européen Georges Pompidou, Assistance Publique–Hôpitaux de Paris, INSERM 970, Université Paris Descartes, France (N.D.)
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480
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Huiart L, Ferdynus C, Renoux C, Beaugrand A, Lafarge S, Bruneau L, Suissa S, Maillard O, Ranouil X. Trends in initiation of direct oral anticoagulant therapies for atrial fibrillation in a national population-based cross-sectional study in the French health insurance databases. BMJ Open 2018; 8:e018180. [PMID: 29602837 PMCID: PMC5884337 DOI: 10.1136/bmjopen-2017-018180] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Unlike several other national health agencies, French health authorities recommended that the newer direct oral anticoagulant (DOAC) agents only be prescribed as second choice for the treatment of newly diagnosed non-valvular atrial fibrillation (NVAF), with vitamin K antagonists (VKA) remaining the first choice. We investigated the patterns of use of DOACs versus VKA in the treatment of NVAF in France over the first 5 years of DOAC availability. We also identified the changes in patient characteristics of those who initiated DOAC treatment over this time period. METHODS Based on the French National Health Administrative Database, we constituted a population-based cohort of all patients who were newly treated for NVAF between January 2011 and December 2015. Trends in drug use were described as the percentage of patients initiating each drug at the time of treatment initiation. A multivariate analysis using logistic regression model was performed to identify independent sociodemographic and clinical predictors of initial anticoagulant choice. RESULTS The cohort comprised 814 446 patients who had received a new anticoagulant treatment for NVAF. The proportion of patients using DOACs as initial anticoagulant therapy reached 54% 3 months after the Health Ministry approved the reimbursement of dabigatran for NVAF, and 61% by the end of 2015, versus VKA use. In the multivariate analysis, we found that DOAC initiators were younger and healthier overall than VKA initiators, and this tendency was reinforced over the 2011-2014 period. DOACs were more frequently prescribed by cardiologists in 2012 and after (adjusted OR in 2012: 2.47; 95% CI 2.40 to 2.54). CONCLUSION Despite recommendations from health authorities, DOACs have been rapidly and massively adopted as initial therapy for NVAF in France. Observational studies should account for the fact that patients selected to initiate DOAC treatment are healthier overall, as failure to do so may bias the risk-benefit assessment of DOACs.
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Affiliation(s)
- Laetitia Huiart
- Unité de Soutien Méthodologique, CHU de la Réunion, Saint-Denis, France
- CHU de la Réunion, INSERM, CIC1410, Saint-Pierre, France
- Université de La Réunion, UFR Santé, Saint-Denis, France
- INSERM, Université d’Aix-Marseille, IRD, UMR912 "Sciences Économiques et Sociales de la Santé et Traitement de l’Information Médicale" (SESSTIM), Marseille, France
| | - Cyril Ferdynus
- Unité de Soutien Méthodologique, CHU de la Réunion, Saint-Denis, France
- CHU de la Réunion, INSERM, CIC1410, Saint-Pierre, France
| | - Christel Renoux
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, Canada
- Department of Epidemiology and Biostatistics, McGill University, Montréal, Canada
| | - Amélie Beaugrand
- Unité de Soutien Méthodologique, CHU de la Réunion, Saint-Denis, France
- Centre Hospitalier National d’Ophtalmologie des Quinze-Vingts, Paris, France
| | - Sophie Lafarge
- CHU de la Réunion, INSERM, CIC1410, Saint-Pierre, France
| | - Léa Bruneau
- Unité de Soutien Méthodologique, CHU de la Réunion, Saint-Denis, France
- INSERM, Université d’Aix-Marseille, IRD, UMR912 "Sciences Économiques et Sociales de la Santé et Traitement de l’Information Médicale" (SESSTIM), Marseille, France
| | - Samy Suissa
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Canada
- Department of Epidemiology and Biostatistics, McGill University, Montréal, Canada
| | - Olivier Maillard
- CHU de la Réunion, INSERM, CIC1410, Saint-Pierre, France
- INSERM, Université d’Aix-Marseille, IRD, UMR912 "Sciences Économiques et Sociales de la Santé et Traitement de l’Information Médicale" (SESSTIM), Marseille, France
| | - Xavier Ranouil
- CHU de la Réunion, Service de cardiologie, Saint-Denis, France
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481
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Excess mortality and hospitalizations in transitional-age youths with a long-term disease: A national population-based cohort study. PLoS One 2018. [PMID: 29534076 PMCID: PMC5849314 DOI: 10.1371/journal.pone.0193729] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Introduction The number of adolescents with a severe chronic disease has increased in high-income countries due to improvements in the prognosis of childhood-onset chronic conditions. The transition from childhood to adulthood is a critical period that may be associated with increased mortality and morbidity. We aimed to estimate the prevalence of adolescents with a long-term disease (LTD) in France and assess their mortality and hospitalization risks relative to the general population. Materials and methods We extracted a population-based cohort from the French national health insurance database that included 61,119 subjects who reached 14 years of age between 2005 and 2014. LTDs are diagnosed by patients’ physicians and then confirmed and registered by a physician of the national health insurance system. We assessed mortality and hospitalizations using data of patients who were between 14 and 21 years-old. Results Among 14-year-old adolescents, 3.30% (95% confidence interval: 3.16–3.44) had a LTD. Their mortality rate between the ages of 14 and 21 years was 20.9/10,000 person-years (13.7–32.1) versus 1.9 (1.5–2.5) for adolescents without a LTD. Mortality was higher in males than females in youths without a LTD, but not in those with a LTD. We found a similar pattern for the risk of hospitalization for an external cause. The five-year probability of hospitalization was 61.8% among youths with a LTD versus 42.7% for those without. The rate of planned hospitalizations sharply fell at 19 years-of-age among youths with a LTD, whereas the rate of unplanned hospitalizations remained stable. Conclusion The 3% of youths with a LTD have ten-fold higher mortality than those without and a high risk of hospitalization. The decrease in the rate of planned hospitalizations at age 19 among youths with a LTD may indicate differences in medical practice after transfer to adult care or a break in medical care.
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482
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Two-year management after renal transplantation in 2013 in France: Input from the French national health system database. Nephrol Ther 2018; 14:207-216. [PMID: 29477277 DOI: 10.1016/j.nephro.2017.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 11/10/2017] [Accepted: 11/19/2017] [Indexed: 11/23/2022]
Abstract
The objective of this study was to describe the management of patients undergoing renal transplantation in 2013 and over the following two years on the basis of healthcare consumption data. The National Health Insurance Information System was used to identify 1876 general scheme beneficiaries undergoing a first isolated renal transplantation (median age: 53 years; men 63%). Overall, 1.2% of patients died during the transplantation hospital stay (>65 years 3.3%) and 87% of patients had a functional graft at 2 years. Thirty-three percent of patients were readmitted to hospital for 1 day or longer during the first month, 73% the first year and 55% the second year. At least 10% of patients were hospitalised for antirejection treatment during the first quarter after renal transplantation, 16% the first year and 9% the second year. The first year, 32% of patients were hospitalised for renal disease (12% the second year), 14% were hospitalised for cardiovascular disease (9% the second year), 13% for infectious disease (5% the second year) and 2% for a malignant tumour (2% the second year). Almost 80% of patients consulted their general practitioner each year (almost 50% consulted every quarter). During the second year, 83% of patients were taking antihypertensives, 45% lipid-lowering drugs, 26% antidiabetic drugs, 77% tacrolimus, 18% ciclosporin, 88% mycophenolic acid and 69% corticosteroids. This study highlights the important contribution of healthcare consumption data to a better understanding of the modalities of management of renal transplant recipients in France, allowing improvement of this management in line with guidelines.
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483
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Berdaï D, Thomas-Delecourt F, Szwarcensztein K, d’Andon A, Collignon C, Comet D, Déal C, Dervaux B, Gaudin AF, Lamarque-Garnier V, Lechat P, Marque S, Maugendre P, Méchin H, Moore N, Nachbaur G, Robain M, Roussel C, Tanti A, Thiessard F. Requests for post-registration studies (PRS), patients follow-up in actual practice: Changes in the role of databases. Therapie 2018. [DOI: 10.1016/j.therap.2017.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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484
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Oger E. Editorial. Fundam Clin Pharmacol 2018; 32:77. [PMID: 29341301 DOI: 10.1111/fcp.12341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Emmanuel Oger
- Clinical section Fundamental and Clinical Pharmacology, CHU Rennes, University of Rennes, Rennes, France
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485
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Brouard C, Boussac-Zarebska M, Silvain C, Durand J, de Lédinghen V, Pillonel J, Delarocque-Astagneau E. Rapid and large-scale implementation of HCV treatment advances in France, 2007-2015. BMC Infect Dis 2017; 17:784. [PMID: 29262788 PMCID: PMC5738822 DOI: 10.1186/s12879-017-2889-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 12/06/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The last decade was marked by major advances in HCV treatment with the introduction of first wave protease inhibitors (1st-wave PIs, telaprevir or boceprevir) in 2011 and second direct-acting antivirals (2nd-wave DAAs) in 2014, that followed low effective pegylated interferon α / ribavirin bitherapy. We estimated the number of patients initiating HCV treatment in France between 2007 and 2015 according to the type of therapy, described their demographical characteristics, and estimated how many were cured with 2nd-wave DAAs in 2014-2015. METHODS Individual data from the national health insurance information system were analysed. HCV treatment initiation was defined as a drug reimbursement in the absence of any reimbursement for the same drug in the previous six weeks. RESULTS Between 2007 and 2015, 72,277 patients initiated at least one HCV treatment. The annual number of patients initiating treatment decreased from 2007 (~13,300) to 2010 (~10,000). It then increased with the introduction of 1st-wave PIs (~12,500 in 2012), before decreasing again in 2013 (~8400). A marked increase followed upon the approval of 2nd-wave DAAs in 2014 (~11,600). Approximately, 8700 and 14,700 patients initiated 2nd-wave DAAs in 2014 and 2015, respectively, corresponding to an estimated 20,300 cured patients in 2014-2015. Patients initiating HCV treatment were mostly male (~65% throughout the 9-year period). Women were older than men (mean age: 55.0 vs. 48.9). Increasing age was associated with more advanced treatment. Among patients initiating 2nd-wave DAAs, the proportions of those under 40 and over 79 years old increased between 2014 and 2015, whereas the proportion of those previously treated for HCV 2007 onwards declined. CONCLUSIONS Successive advances in HCV treatment have been rapidly and widely implemented in France. With the announcement of universal access to DAAs in mid-2016 and price reductions, access to 2nd-wave DAAs is expected to expand even more.
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Affiliation(s)
- Cécile Brouard
- Santé publique France, the national public health agency, Saint-Maurice, France
| | | | | | - Julien Durand
- Santé publique France, the national public health agency, Saint-Maurice, France
| | - Victor de Lédinghen
- Investigation Centre of Liver Fibrosis, Haut-Lévêque Hospital, Bordeaux University Hospital, Pessac, France
| | - Josiane Pillonel
- Santé publique France, the national public health agency, Saint-Maurice, France
| | - Elisabeth Delarocque-Astagneau
- INSERM 1181, Biostatistics, Biomathematics, Pharmacoepidemiology, and Infectious Diseases (B2PHI), Paris, France
- Institut Pasteur, B2PHI, Paris, France
- Versailles Saint-Quentin University, UMR 1181, B2PHI, Montigny-le-Bretonneux, France
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486
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Chan Chee C, Chin F, Ha C, Beltzer N, Bonaldi C. Use of medical administrative data for the surveillance of psychotic disorders in France. BMC Psychiatry 2017; 17:386. [PMID: 29202735 PMCID: PMC5715638 DOI: 10.1186/s12888-017-1555-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 11/22/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Psychotic disorders are among the most severe psychiatric disorders that have great effects on the individuals and the society. For surveillance of chronic low prevalence conditions such as psychotic disorders, medical administrative databases can be useful due to their large coverage of the population, their continuous availability and low costs with possibility of linkage between different databases. The aims of this study are to identify the population with psychotic disorders by different algorithms based on the French medical administrative data and examine the prevalence and characteristics of this population in 2014. METHODS The health insurance system covers the entire population living in France and all reimbursements of ambulatory care in private practice are included in a national health insurance claim database, which can be linked with the national hospital discharge databases. Three algorithms were used to select most appropriately persons with psychotic disorders through data from hospital discharge databases, reimbursements for psychotropic medication and full insurance coverage for chronic and costly conditions. RESULTS In France in 2014, estimates of the number of individuals with psychotic disorders were 469,587 (54.6% males) including 237,808 with schizophrenia (63.6% males). Of those, 77.0% with psychotic disorders and 70.8% with schizophrenia received exclusively ambulatory care. Prevalence rates of psychotic disorders were 7.4 per 1000 inhabitants (8.3 in males and 6.4 in females) and 3.8 per 1000 inhabitants (4.9 in males and 2.6 in females) for schizophrenia. Prevalence of psychotic disorders reached a maximum of 14 per 1000 in males between 35 and 49 years old then decreased with age while in females, the highest rate of 10 per 1000 was reached at age 50 without decrease with advancing age. No such plateau was observed in schizophrenia. DISCUSSION This study is the first in France using an exhaustive sample of medical administrative data to derive prevalence rates for psychotic disorders. Although only individuals in contact with healthcare services were included, the rates were congruent with reported estimates from systematic reviews. The feasibility of this study will allow the implementation of a national surveillance of psychotic disorders essential for healthcare management and policy planning.
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Affiliation(s)
- Christine Chan Chee
- Direction of Non Communicable Diseases and Trauma, French National Public Health Agency, 12, rue du Val d’Osne, 94415 Saint-Maurice cedex, France
| | - Francis Chin
- Direction of Non Communicable Diseases and Trauma, French National Public Health Agency, 12, rue du Val d’Osne, 94415 Saint-Maurice cedex, France
| | - Catherine Ha
- Direction of Non Communicable Diseases and Trauma, French National Public Health Agency, 12, rue du Val d’Osne, 94415 Saint-Maurice cedex, France
| | - Nathalie Beltzer
- Direction of Non Communicable Diseases and Trauma, French National Public Health Agency, 12, rue du Val d’Osne, 94415 Saint-Maurice cedex, France
| | - Christophe Bonaldi
- Direction of Non Communicable Diseases and Trauma, French National Public Health Agency, 12, rue du Val d’Osne, 94415 Saint-Maurice cedex, France
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487
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Goldberg M. Favoriser l’utilisation du Système national d’information interrégimes de l’assurance maladie (SNIIRAM). Rev Epidemiol Sante Publique 2017; 65 Suppl 4:S141-S143. [DOI: 10.1016/j.respe.2017.01.118] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 01/31/2017] [Indexed: 10/19/2022] Open
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488
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Lefeuvre D, Rudant J, Foulon S, Alla F, Weill A. Healthcare expenditure of multiple sclerosis patients in 2013: A nationwide study based on French health administrative databases. Mult Scler J Exp Transl Clin 2017; 3:2055217317730421. [PMID: 28932411 PMCID: PMC5600306 DOI: 10.1177/2055217317730421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 08/09/2017] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Little is known about expenditure items of multiple sclerosis (MS) patients over recent years in France. OBJECTIVE To describe healthcare expenditure among MS patients and identify the main expenditure drivers. METHODS All healthcare expenditure reimbursed by French National Health Insurance to MS patients in 2013 was described on the basis of nationwide health administrative databases (SNIIRAM/PMSI). Expenditure was described globally and according to age and sex. RESULTS The average expenditure among the 90,288 MS patients included was €11,900 per patient. Pharmacy and hospitalisation accounted for 47% and 23% of healthcare expenditure, respectively (38% and 22% of MS patients were treated with disease-modifying therapies and hospitalised overnight or longer, respectively). Average expenditure did not differ according to age. However, pharmacy expenditure decreased with age (from 71% between the ages of 20 and 29 years to 18% between the ages of 70 and 79 years), whereas hospitalisation expenditure increased with age (from 15% to 35%). Paramedical fees accounted for 2% of expenditure between the ages of 20 and 29 years and 24% between the ages of 70 and 79 years. CONCLUSION Overall, pharmacy expenditure was the main expenditure item, which decreased with increasing age, while hospitalisation and paramedical expenditure increased with increasing age.
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Affiliation(s)
- Delphine Lefeuvre
- Direction de la stratégie, des études et des statistiques, French National Health Insurance (Caisse Nationale de l'Assurance Maladie des Travailleurs Salariés), France
| | - Jérémie Rudant
- Direction de la stratégie, des études et des statistiques, French National Health Insurance (Caisse Nationale de l'Assurance Maladie des Travailleurs Salariés), France
| | - Stéphanie Foulon
- Direction de la stratégie, des études et des statistiques, French National Health Insurance (Caisse Nationale de l'Assurance Maladie des Travailleurs Salariés), France
| | - François Alla
- Caisse Nationale de l'Assurance Maladie des Travailleurs Salariés), France
| | - Alain Weill
- Direction de la stratégie, des études et des statistiques, French National Health Insurance (Caisse Nationale de l'Assurance Maladie des Travailleurs Salariés), France
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489
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Goldberg M, Carton M, Doussin A, Fagot-Campagna A, Heyndrickx E, Lemaitre M, Nicolau J, Quantin C. [The REDSIAM network]. Rev Epidemiol Sante Publique 2017; 65 Suppl 4:S144-S148. [PMID: 28844426 DOI: 10.1016/j.respe.2017.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 06/06/2017] [Indexed: 10/19/2022] Open
Abstract
The French national health database (SNIIRAM) proved to be very useful for epidemiology, health economics, evaluation, surveillance or public health. However, it is a complex database requiring important resources and expertise for being used. The REDSIAM network has been set up for promoting the collaboration of teams working on the Sniiram. The main aim of REDSIAM is to develop and validate methods for analyzing the Sniiram database for research, surveillance, evaluation and public health purposes by sharing the knowledge and experience of specialized teams in the fields of diseases identification from the Sniiram data. The work conducted within the network is devoted to the development and the validation of algorithms using Sniiram data for identifying specific diseases. The REDSIAM governance includes the Steering Committee composed of the main organizations in charge of producing and using the Sniiram data, the Bureau and the Technical Committee. The network is organized in thematic working groups focused on specific pathological domains, and a charter defines the rules for participation in the network, the functioning of the thematic working groups, the rules for publishing and making available algorithms. The articles in this special issue of the journal present the first results of some of the thematic working groups.
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Affiliation(s)
- M Goldberg
- Unité cohortes épidémiologiques en population, UMS 11 Inserm, université René-Descartes, 94800 Villejuif, France.
| | - M Carton
- Unité cohortes épidémiologiques en population, UMS 11 Inserm, université René-Descartes, 94800 Villejuif, France
| | - A Doussin
- Santé publique France, 94410 Saint-Maurice, France
| | - A Fagot-Campagna
- CnamTS, direction de la stratégie, des études et des statistiques, département d'études sur les pathologies et les patients, 75020 Paris, France
| | - E Heyndrickx
- Unité cohortes épidémiologiques en population, UMS 11 Inserm, université René-Descartes, 94800 Villejuif, France
| | - M Lemaitre
- Agence nationale de sécurité des médicaments et des produits de santé, 93200 Saint-Denis, France
| | - J Nicolau
- Santé publique France, 94410 Saint-Maurice, France
| | - C Quantin
- Service de biostatistiques et d'information médicale (DIM), université de Bourgogne Franche-Comté, CHRU de Dijon, 21000 Dijon, France; Inserm, CIC 1432, clinical investigation center, clinical epidemiology/clinical trials unit, Dijon university hospital, 21000 Dijon, France; Biostatistics, biomathematics, pharmacoepidemiology and infectious diseases (B2PHI), Inserm, institut Pasteur, UVSQ, université Paris-Saclay, 94800 Villejuif, France
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490
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Fosse-Edorh S, Rigou A, Morin S, Fezeu L, Mandereau-Bruno L, Fagot-Campagna A. [Algorithms based on medico-administrative data in the field of endocrine, nutritional and metabolic diseases, especially diabetes]. Rev Epidemiol Sante Publique 2017. [PMID: 28625707 DOI: 10.1016/j.respe.2017.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Medico-administrative databases represent a very interesting source of information in the field of endocrine, nutritional and metabolic diseases. The objective of this article is to describe the early works of the Redsiam working group in this field. METHODS Algorithms developed in France in the field of diabetes, the treatment of dyslipidemia, precocious puberty, and bariatric surgery based on the National Inter-schema Information System on Health Insurance (SNIIRAM) data were identified and described. RESULTS Three algorithms for identifying people with diabetes are available in France. These algorithms are based either on full insurance coverage for diabetes or on claims of diabetes treatments, or on the combination of these two methods associated with hospitalizations related to diabetes. Each of these algorithms has a different purpose, and the choice should depend on the goal of the study. Algorithms for identifying people treated for dyslipidemia or precocious puberty or who underwent bariatric surgery are also available. CONCLUSION Early work from the Redsiam working group in the field of endocrine, nutritional and metabolic diseases produced an inventory of existing algorithms in France, linked with their goals, together with a presentation of their limitations and advantages, providing useful information for the scientific community. This work will continue with discussions about algorithms on the incidence of diabetes in children, thyroidectomy for thyroid nodules, hypothyroidism, hypoparathyroidism, and amyloidosis.
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Affiliation(s)
- S Fosse-Edorh
- Santé publique France, 12, rue du Val-d'Osne, 94415 Saint-Maurice cedex, France.
| | - A Rigou
- Santé publique France, 12, rue du Val-d'Osne, 94415 Saint-Maurice cedex, France
| | - S Morin
- Haute Autorité de santé, 93210 Saint-Denis, France
| | - L Fezeu
- Inserm (U1153), Inra (U1125), université Paris 13, équipe de recherche en épidémiologie nutritionnelle (EREN), centre de recherche en épidémiologie et statistiques, Cnam, COMUE, Sorbonne Paris Cité, 93000 Bobigny, France
| | - L Mandereau-Bruno
- Santé publique France, 12, rue du Val-d'Osne, 94415 Saint-Maurice cedex, France
| | - A Fagot-Campagna
- Caisse nationale d'assurance maladie des travailleurs salariés, 75020 Paris, France
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