351
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Champeaux-Depond C, Weller J, Resche-Rigon M. Neurofibromatosis type 2: A nationwide population-based study focused on survival after meningioma surgery. Clin Neurol Neurosurg 2020; 198:106236. [DOI: 10.1016/j.clineuro.2020.106236] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 08/25/2020] [Accepted: 09/12/2020] [Indexed: 11/30/2022]
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352
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Raffray M, Vigneau C, Couchoud C, Bayat S. Predialysis Care Trajectories of Patients With ESKD Starting Dialysis in Emergency in France. Kidney Int Rep 2020; 6:156-167. [PMID: 33426395 PMCID: PMC7785414 DOI: 10.1016/j.ekir.2020.10.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Emergency dialysis start (EDS) is frequent for patients with chronic kidney disease (CKD). To improve CKD management, new trajectory-based care policies are currently being introduced both in France and in the United States. This study describes the different types of predialysis care trajectories and factors associated with EDS. Methods Adults patients who started dialysis in France in 2015 were included. Individual clinical and health care consumption data were retrieved from the French national end-stage kidney disease (ESKD) registry (Renal Epidemiology and Information Network [REIN]) and the French National Health Data system (SNDS), respectively. Hierarchical Clustering on Principal Component was used to identify groups of patients with the same health care consumption profile during the 2 years before dialysis start. Logistic regression analysis was used to identify factors associated with EDS. Results Among the 8856 patients included in the analysis, 2681 (30.3%) had EDS. The Hierarchical Clustering on Principal Component identified six types of predialysis care trajectories in which EDS rate ranged from 13.8% to 61.8%. After adjustment for the patients’ characteristics, less frequent or lack of follow-up with a nephrologist was associated with higher risk of EDS (odds ratio [OR]: 1.32; 95% confidence interval [CI]: 1.17–1.50 and OR: 1.83; 95% CI: 1.58–2.12), but not follow-up with a general practitioner. Conclusions The care trajectories during the 2 years before dialysis start were heterogeneous and patients with a lesser or lack of follow-up with a nephrologist were more likely to start dialysis in emergency, regardless of the frequency of follow-up by a general practitioner (GP). New CKD policies should include actions to strengthen CKD screening and referral to nephrologists.
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Affiliation(s)
- Maxime Raffray
- University of Rennes, French School of Public Health (EHESP), Pharmaco-epidemiology and health Services Research, Rennes, France
- Correspondence: Maxime Raffray, French School of Public Health, 15 Avenue du Professeur Léon Bernard, 35043 Rennes, France.
| | - Cécile Vigneau
- University of Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), Rennes, France
| | - Cécile Couchoud
- REIN Registry, Biomedecine Agency, Saint-Denis-La-Plaine, France
| | - Sahar Bayat
- University of Rennes, French School of Public Health (EHESP), Pharmaco-epidemiology and health Services Research, Rennes, France
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353
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Assié JB, Corre R, Levra MG, Calvet CY, Gaudin AF, Grumberg V, Jouaneton B, Cotté FE, Chouaïd C. Nivolumab treatment in advanced non-small cell lung cancer: real-world long-term outcomes within overall and special populations (the UNIVOC study). Ther Adv Med Oncol 2020; 12:1758835920967237. [PMID: 33403011 PMCID: PMC7745546 DOI: 10.1177/1758835920967237] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 09/23/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To describe long-term outcomes of patients treated with nivolumab for advanced non-small cell lung cancer (aNSCLC) in everyday clinical practice in France, with a focus on patients aged ⩾80 years, patients with renal impairment and patients with brain metastases. METHODS The study included all patients with aNSCLC recorded in the French national hospital database, starting nivolumab in 2015-2016 and followed until December 2018. Patients were stratified by age, the presence of renal impairment and brain metastasis, as documented in the hospital discharge summaries. Information was retrieved on demographics, comorbidities and treatment history at baseline. Time to discontinuation of nivolumab treatment and overall survival were estimated using Kaplan-Meier survival analysis. RESULTS Overall, 10,452 patients were included, of whom 514 were octogenarians, 479 had renal impairment and 1800 had brain metastases at baseline. Median duration of nivolumab treatment was 2.8 months in the overall population and in both the octogenarian and renally impaired subgroups, and 2.3 months in patients with brain metastases. Median overall survival in these patient groups was 11.7 months (95% confidence interval: 11.3-12.2), 11.7 months (11.3-12.1), 11.7 months (11.3-12.2) and 9.9 months (9.0-10.9) respectively. Three-year overall survival rates were 19.1% (18.1-20.2) in the overall population, 16.5% (11.6-23.4) in octogenarians, 15.9% (11.8-21.4) in patients with renal impairment and 21.7% (19.4-24.2) in those with brain metastases. CONCLUSION This large nationwide retrospective real-life cohort provided narrow estimates of long-term overall survival, which reached 19% at 3 years, consistent with data from phase III trials of nivolumab. Survival rates were comparable in the three special populations of interest and the overall population.
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Affiliation(s)
- Jean-Baptiste Assié
- Service de Pneumologie, CHI Créteil, UPEC, Créteil, France
- Centre de Recherche des Cordeliers, Inserm, Sorbonne Université, Université de Paris, Functional Genomics of Solid Tumours Laboratory, Paris, France
| | - Romain Corre
- Service de Pneumologie, Centre Hospitalier Intercommunal de Quimper, Quimper, France
| | - Matteo Giaj Levra
- Thoracic Oncology Unit, Centre Hospitalier Universitaire Grenoble Alpes (CHUGA), Grenoble, France
- Institute for Advanced Biosciences INSERM U1209 CNRS UMR5309 Université Grenoble Alpes, Grenoble, France
| | | | | | | | | | | | - Christos Chouaïd
- Service de Pneumologie, CHI Créteil, UPEC, Créteil, France
- Inserm U955, UPEC, IMRB, équipe CEpiA, Créteil, France
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354
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Risk of early neurodevelopmental disorders associated with in utero exposure to valproate and other antiepileptic drugs: a nationwide cohort study in France. Sci Rep 2020; 10:17362. [PMID: 33093466 PMCID: PMC7581762 DOI: 10.1038/s41598-020-74409-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 08/25/2020] [Indexed: 12/21/2022] Open
Abstract
Information available on the risks of neurodevelopmental disorders (NDs) associated with in utero exposure to valproate (VPA) and to other antiepileptic drugs (AEDs) is limited. A nationwide population-based cohort study was conducted based on comprehensive data of the French National Health Data System (SNDS). Liveborn infants without brain malformation, born between January 2011 and December 2014, were followed from birth up to December 2016. NDs were identified based on diagnoses of mental or behavioural disorders and utilization of speech therapy, orthoptic or psychiatric services. The risk of NDs was compared between children exposed in utero to AED monotherapy and unexposed children, using Cox proportional hazard models adjusted for maternal and neonatal characteristics. The cohort included 1,721,990 children, 8848 of whom were exposed in utero to AED monotherapy. During a mean follow-up of 3.6 years, 15,458 children had a diagnosis of mental or behavioural disorder. In utero exposure to VPA was associated with an increased risk of NDs overall (aHR: 3.7; 95% CI 2.8–4.9) and among children born to a mother without mental illness (aHR 5.1; 95% CI 3.6–7.3). A dose–response relationship was demonstrated and the risk of NDs was more particularly increased for an exposure to VPA during the second or third trimesters of pregnancy. Among the other AEDs, only pregabalin was consistently associated with an increased risk of NDs (aHR: 1.5; 95% CI 1.0–2.1). This study confirms a four to fivefold increased risk of early NDs associated with exposure to VPA during pregnancy. The risk associated with other AEDs appears much lower.
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355
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Champeaux-Depond C, Constantinou P, Weller J. Cause-Specific Survival After Meningioma Surgery: A Nationwide Population-Based Competing Risk Study. World Neurosurg 2020; 146:e67-e75. [PMID: 33096279 DOI: 10.1016/j.wneu.2020.10.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/01/2020] [Accepted: 10/03/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Survival after meningioma surgery often is reported with inadequate allowance for competing causes of death. METHODS We processed the French Système National des Données de Santé database using an algorithm combining the type of surgical procedure and the International Classification of Diseases to retrieve appropriate cases of meningiomas. The cumulative incidence of meningioma-related death was the primary end point. A competing risk analysis was performed to identify factors associated with meningioma-specific death of patients who underwent meningioma surgery. RESULTS The risk of meningioma-related death at 1, 2, and 3 years respectively was 2.4%, 95% confidence interval [CI] 2-2.7; 3%, 95% CI 2.6-3.4; and 3.1%, 95% CI 2.7-3.6. In the adjusted Fine-Gray competing risk regression for meningioma cause-specific survival, age at surgery (subdistribution hazard ratio [SHR] 1.07, 95% CI 1.05-1.09, P < 0.001), mortality-related morbidity index (SHR 1.68, 95% CI 1.07-2.63, P = 0.025), expenditure-related morbidity index (SHR 1.06, 95% CI 1.03-1.09, P < 0.001), spinal location (SHR 0.2, 95% CI 0.08-0.47, P < 0.001), cerebrospinal fluid shunt (SHR 3.13, 95% CI 1.9-5.16, P < 0.001), grade (SHR 1.88, 95% CI 1.13-3.14, P = 0.015) redo surgery for recurrence (SHR 1.6, 95% CI 1.01-2.51, P = 0.043), and progressing meningioma (SHR 2.87, 95% CI 1.23-6.68, P = 0.015) were established as independent prognostic factors of meningioma-related death. CONCLUSIONS Cause-specific survival after meningioma surgery is greater in younger, low-comorbidity adults with spinal and benign meningioma. Those with an intracranial, progressing malignant tumor requiring cerebrospinal fluid shunting and having a severe global health-state have a significant increased risk of meningioma-related death. Redo surgery failed to improve the outcome. We recommend the use of competing risk model in meningioma studies in which unrelated mortality may be substantial, as this approach results in more accurate estimates of disease risk and associated predictors.
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Affiliation(s)
- Charles Champeaux-Depond
- Department of Neurosurgery, Lariboisière Hospital, Paris, France; INSERM U1153, Statistic and Epidemiologic Research Center Sorbonne Paris Cité (CRESS), ECSTRRA team, Université de Paris, Paris, France.
| | - Panayotis Constantinou
- Center for Research in Epidemiology and Population Health, French National Institute of Health and Medical Research (INSERM U1018), Université Paris-Saclay, Université Paris-Sud; French National Health Insurance (Cnam), Paris, France
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356
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French hepatitis C care cascade: substantial impact of direct-acting antivirals, but the road to elimination is still long. BMC Infect Dis 2020; 20:759. [PMID: 33059617 PMCID: PMC7559725 DOI: 10.1186/s12879-020-05478-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/05/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) elimination by 2030, as targeted by the World Health Organization (WHO), requires that 90% of people with chronic infection be diagnosed and 80% treated. We estimated the cascade of care (CoC) for chronic HCV infection in mainland France in 2011 and 2016, before and after the introduction of direct-acting antivirals (DAAs). METHODS The numbers of people (1) with chronic HCV infection, (2) aware of their infection, (3) receiving care for HCV and (4) on antiviral treatment, were estimated for 2011 and 2016. Estimates for 1) and 2) were based on modelling studies for 2011 and on a virological sub-study nested in a national cross-sectional survey among the general population for 2016. Estimates for 3) and 4) were made using the National Health Data System. RESULTS Between 2011 and 2016, the number of people with chronic HCV infection decreased by 31%, from 192,700 (95% Credibility interval: 150,900-246,100) to 133,500 (95% Confidence interval: 56,900-312,600). The proportion of people aware of their infection rose from 57.7 to 80.6%. The number of people receiving care for HCV increased by 22.5% (representing 25.7% of those infected in 2016), while the number of people on treatment increased by 24.6% (representing 12.1% of those infected in 2016). CONCLUSIONS This study suggests that DAAs substantially impact CoC. However, access to care and treatment for infected people remained insufficient in 2016. Updating CoC estimates will help to assess the impact of new measures implemented since 2016 as part of the goal to eliminate HCV.
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357
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Bénard-Laribière A, Pambrun E, Sutter-Dallay AL, Gautier S, Hurault-Delarue C, Damase-Michel C, Lacroix I, Pariente A. Impact of pregnancy on antidepressant treatment course: a population-based comparative cohort study in France. Arch Womens Ment Health 2020; 23:699-707. [PMID: 32394399 DOI: 10.1007/s00737-020-01033-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 04/07/2020] [Indexed: 11/28/2022]
Abstract
The prevention of relapses and the treatment of depression during pregnancy are difficult challenges. The maintenance of antidepressants in pregnancy with its concomitant risks to mother and child needs to be weighed against those associated with not treating the disease. This study aimed at quantifying the impact of the occurrence of pregnancy on the course of antidepressant treatment among newly treated women (< 6 months). We performed a comparative observational cohort study using the nationwide French reimbursement healthcare system database. Women who conceived in 2014 and initiated an antidepressant at any time in the 6 months before pregnancy were compared with nonpregnant women newly exposed to antidepressants with matching on age, antidepressant exposure, history of psychiatric disorders, and area of residence. The primary outcome was a composite of antidepressant discontinuation, switch to another antidepressant, and concomitant use of antidepressants. The secondary outcome was the resumption of antidepressant during follow-up. We used Cox marginal proportional hazards models to compare time to outcomes between pregnant and nonpregnant women. The pregnant cohort included 6593 women, and the comparison cohort 29,347 nonpregnant women. In the period following the first month of treatment, pregnant women were more likely to experience treatment modification, and especially to stop receiving it, compared with nonpregnant women (adjusted hazard ratio (aHR) 1.58; 95%CI, 1.51-1.62). Pregnant women who discontinued treatment had a 41% decreased incidence of antidepressant resumption compared with nonpregnant women (aHR 0.59; 95%CI, 0.56-0.62). Pregnancy was a determinant of antidepressant treatment modification, and especially of discontinuation.
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Affiliation(s)
- Anne Bénard-Laribière
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team PHARMACOEPIDEMIOLOGY, UMR 1219, F-33000, Bordeaux, France.
| | - Elodie Pambrun
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team PHARMACOEPIDEMIOLOGY, UMR 1219, F-33000, Bordeaux, France
| | - Anne-Laure Sutter-Dallay
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team PHARMACOEPIDEMIOLOGY, UMR 1219, F-33000, Bordeaux, France
- Charles Perrens Hospital, F-33000, Bordeaux, France
| | - Sophie Gautier
- Clinical Pharmacology Department, U 1171 University Hospital of Lille, University of Lille, F-59000, Lille, France
| | - Caroline Hurault-Delarue
- Clinical Pharmacology Department, INSERM UMR 1027, CIC INSERM 1436, Faculty of Medicine, University Hospital of Toulouse, F-31000, Toulouse, France
| | - Christine Damase-Michel
- Clinical Pharmacology Department, INSERM UMR 1027, CIC INSERM 1436, Faculty of Medicine, University Hospital of Toulouse, F-31000, Toulouse, France
| | - Isabelle Lacroix
- Clinical Pharmacology Department, INSERM UMR 1027, CIC INSERM 1436, Faculty of Medicine, University Hospital of Toulouse, F-31000, Toulouse, France
| | - Antoine Pariente
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team PHARMACOEPIDEMIOLOGY, UMR 1219, F-33000, Bordeaux, France
- Clinical Pharmacology, University Hospital of Bordeaux, F-33000, Bordeaux, France
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358
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Barataud-Reilhac A, Kerbrat S, Roux J, Guilleux A, Polard E, Leray E. Teriflunomide-exposed pregnancies in a French cohort of patients with multiple sclerosis. Neurol Clin Pract 2020; 10:287-297. [PMID: 32983608 DOI: 10.1212/cpj.0000000000000717] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 07/19/2019] [Indexed: 11/15/2022]
Abstract
Objective To describe pregnancies exposed to teriflunomide (TERIF) in women with multiple sclerosis (MS) in France over the period 2014-2016. Methods All 15- to 49-year-old women with MS in the national health insurance database were included. Pregnancies that had started between August 2014 and March 2016 were identified from their outcomes. Three groups according to treatment exposure were compared: TERIF, interferons (IFNs) or glatiramer acetate, and no medication. Results Among the 44,008 women with MS followed 24.5 months on average, 2,639 pregnancies were identified. There were 1,538 pregnancies (58.3%) that were not exposed to any MS treatment in accordance with the guidelines. A total of 673 pregnancies (25.5%) were exposed to IFN and/or glatiramer acetate, and possible or probable exposure to contra-indicated treatments was observed in 428 pregnancies (16.2%), of whom 47 pregnancies were exposed to TERIF. The annual incidence rate of pregnancies exposed to TERIF was 1.4 per 100 patient-years; i.e., 3 times less than the 2 control groups (5.6 and 4.7, respectively). The median exposure duration to TERIF was 45 days after conception. The outcomes comprised 23 live births, 22 abortions (3 times more than the 2 other groups), and 2 miscarriages. All newborns were healthy at birth. Conclusions Despite specific TERIF guidelines for pregnancy-related issues and the availability of alternative therapies, some pregnancies exposed to TERIF were identified. Most of the cases were because of the absence of the recommended accelerated elimination procedure and appeared to be mostly unplanned pregnancies that probably reflect a lack of effective contraception.
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Affiliation(s)
- Astrid Barataud-Reilhac
- Ecole des Hautes Etudes en Santé Publique (EHESP) (AB-R, JR, AG, EL), Département METIS, F-35043 Rennes, France; Univ Rennes (SK, JR, AG, EP, EL), EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins)-EA 7449, F-35000 Rennes, France; and Service de Pharmacovigilance (EP), CHU Rennes, F-35000 Rennes, France
| | - Sandrine Kerbrat
- Ecole des Hautes Etudes en Santé Publique (EHESP) (AB-R, JR, AG, EL), Département METIS, F-35043 Rennes, France; Univ Rennes (SK, JR, AG, EP, EL), EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins)-EA 7449, F-35000 Rennes, France; and Service de Pharmacovigilance (EP), CHU Rennes, F-35000 Rennes, France
| | - Jonathan Roux
- Ecole des Hautes Etudes en Santé Publique (EHESP) (AB-R, JR, AG, EL), Département METIS, F-35043 Rennes, France; Univ Rennes (SK, JR, AG, EP, EL), EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins)-EA 7449, F-35000 Rennes, France; and Service de Pharmacovigilance (EP), CHU Rennes, F-35000 Rennes, France
| | - Alice Guilleux
- Ecole des Hautes Etudes en Santé Publique (EHESP) (AB-R, JR, AG, EL), Département METIS, F-35043 Rennes, France; Univ Rennes (SK, JR, AG, EP, EL), EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins)-EA 7449, F-35000 Rennes, France; and Service de Pharmacovigilance (EP), CHU Rennes, F-35000 Rennes, France
| | - Elisabeth Polard
- Ecole des Hautes Etudes en Santé Publique (EHESP) (AB-R, JR, AG, EL), Département METIS, F-35043 Rennes, France; Univ Rennes (SK, JR, AG, EP, EL), EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins)-EA 7449, F-35000 Rennes, France; and Service de Pharmacovigilance (EP), CHU Rennes, F-35000 Rennes, France
| | - Emmanuelle Leray
- Ecole des Hautes Etudes en Santé Publique (EHESP) (AB-R, JR, AG, EL), Département METIS, F-35043 Rennes, France; Univ Rennes (SK, JR, AG, EP, EL), EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins)-EA 7449, F-35000 Rennes, France; and Service de Pharmacovigilance (EP), CHU Rennes, F-35000 Rennes, France
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Vallée A, Gabet A, Grave C, Lelong H, Blacher J, Olié V. Home blood pressure monitoring in France: Device possession rate and associated determinants, the Esteban study. J Clin Hypertens (Greenwich) 2020; 22:2204-2213. [PMID: 32966691 DOI: 10.1111/jch.14055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/24/2020] [Accepted: 09/04/2020] [Indexed: 11/28/2022]
Abstract
Home blood pressure monitoring (HBPM) is increasingly being promoted in hypertension guidelines to improve hypertension management. Possessing a HBPM device could improve blood pressure (BP) control and prognostic impact. The aims of this study were to estimate the possession rate of HBPM devices in the French population and in hypertensive adults, and to investigate the determinants of possessing such devices at home. Cross-sectional analyses were performed using data from the Esteban survey, which comprised a representative sample of the French population. Among the 2,054 study participants, 673 had hypertension. Of these, 385 were aware they had it. Weighted logistic regressions were performed to investigate the factors (socioeconomic, clinical, drug treatment, and healthcare visits) associated with possessing a HBPM device. 20.9% of the study sample, 42.1% of those with hypertension, and 54% of those aware of their hypertension, possessed a HBPM device. Female gender (OR = 2.03, 95%CI [1.46; 2.60]), smoking (OR = 2.33, 95%CI [1.51; 3.15]), antihypertensive drugs (OR = 1.75, 95%CI [1.06; 2.44]), general practitioner (GP) visits (OR = 3.28, 95%CI [1.84; 4.68]), and diabetes (OR = 0.41 95% CI [0.14; 0.68]) were associated with possessing a HBPM device among those aware of their hypertension. Over 20% of the study population possessed a HBPM device at home. This proportion rose to one in two in those aware or their hypertension. Among the latter, possessing a device was positively associated with female gender, GP visits, and antihypertensive drug use. Increasing possession of HBPM devices in the hypertensive population could foster better management of the condition.
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Affiliation(s)
- Alexandre Vallée
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, AP-HP, University of Paris, Paris, France
| | - Amélie Gabet
- Santé Publique France, The French Public Health Agency, Saint-Maurice, France
| | - Clémence Grave
- Santé Publique France, The French Public Health Agency, Saint-Maurice, France
| | - Hélène Lelong
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, AP-HP, University of Paris, Paris, France
| | - Jacques Blacher
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, AP-HP, University of Paris, Paris, France
| | - Valérie Olié
- Santé Publique France, The French Public Health Agency, Saint-Maurice, France
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360
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Mari K, Rannou F, Guillemin F, Elegbede M, Gueyffier F, Badot G, Mistretta F. Impact of terminating reimbursement of symptomatic slow-acting drugs in osteoarthritis in France on volume and cost of drug deliveries, assessed with administrative databases. Semin Arthritis Rheum 2020; 50:1307-1313. [PMID: 33130458 DOI: 10.1016/j.semarthrit.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 09/07/2020] [Accepted: 09/09/2020] [Indexed: 11/27/2022]
Abstract
WITH OSTEOARTHRITIS (OA) As one of the leading causes of disability in adults worldwide, its toll on patients and its economic burden for payers are substantial. The issue of change in OA management with the evolution of reimbursement schemes needs to be addressed. OBJECTIVE To assess the impact of terminating the reimbursement of symptomatic slow-acting drugs in OA (SYSADOAs) in France in terms of volume and cost, from a healthcare payer perspective. PRINCIPAL RESULTS We obtained costs and volumes from French public national databases. We considered three exposure periods around cutoff dates according to decisions of decreased then terminated SYSADOA reimbursement. The periods included 19 345 (control), 20 066 (secondary), and 16 200 (primary) patients, respectively. Mean ages were 66.2 (±11.8), 65.3 (±11.6) and 64.6 (±11.5) years and about 70% were women. The volume of nonsteroidal anti-inflammatory drug (NSAID) deliveries estimated by defined daily doses (DDDs) decreased during the periods from 40.5 (±76.3) DDDs per patient in 2008 to 29.6 (±66.4) in 2015. The volume of analgesic deliveries increased slowly over the three periods, from 70.2 (±108.9) DDDs in 2008 to 76.9 (±123.1) in 2015 for all patients. MAJOR CONCLUSIONS Our results did not show a measurable impact of terminating SYSADOA reimbursement on the delivery of NSAIDs and analgesics or on hospitalizations. However, neither do they allow for concluding that terminating SYSADOA reimbursement did not generate an increase in deliveries of non-reimbursed drugs, with their associated potential risks for public health.
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Affiliation(s)
| | - F Rannou
- INSERM UMR 1124, Laboratoire de Pharmacologie, Toxicologie et Signalisation Cellulaire, Faculté des Sciences Fondamentales et Biomédicales, UFR Biomédicale des Saints-Pères, Paris, France
| | - F Guillemin
- INSERM CIC 1433 Clinical Epidemiology, CHRU de Nancy, Université de Lorraine, Nancy, France
| | - M Elegbede
- University of Lyon, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, CNRS, Claude Bernard University Lyon, Université de Lyon, F-69003, France
| | - F Gueyffier
- University of Lyon, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, CNRS, Claude Bernard University Lyon, Université de Lyon, F-69003, France.
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De Oliveira H, Augusto V, Jouaneton B, Lamarsalle L, Prodel M, Xie X. Automatic and Explainable Labeling of Medical Event Logs With Autoencoding. IEEE J Biomed Health Inform 2020; 24:3076-3084. [PMID: 32886615 DOI: 10.1109/jbhi.2020.3021790] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Process mining is a suitable method for knowledge extraction from patient pathways. Structured in event logs, medical events are complex, often described using various medical codes. An efficient labeling of these events before applying process mining analysis is challenging. This paper presents an innovative methodology to handle the complexity of events in medical event logs. Based on autoencoding, accurate labels are created by clustering similar events in latent space. Moreover, the explanation of created labels is provided by the decoding of its corresponding events. Tested on synthetic events, the method is able to find hidden clusters on sparse binary data, as well as accurately explain created labels. A case study on real healthcare data is performed. Results confirm the suitability of the method to extract knowledge from complex event logs representing patient pathways.
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362
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Laanani M, Imbaud C, Tuppin P, Poulalhon C, Jollant F, Coste J, Rey G. Contacts with Health Services During the Year Prior to Suicide Death and Prevalent Conditions A Nationwide Study. J Affect Disord 2020; 274:174-182. [PMID: 32469801 DOI: 10.1016/j.jad.2020.05.071] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND This study was designed to describe contacts with health services during the year before suicide death in France, and prevalent mental and physical conditions. METHODS Data were extracted from the French National Health Data System (SNDS), which comprises comprehensive claims data for inpatient and outpatient care linked to the national causes-of-death registry. Individuals aged ≥15 years who died from suicide in France in 2013-2015 were included. Medical consultations, emergency room visits, and hospitalisations during the year preceding death were collected. Conditions were identified, and standardised prevalence ratios (SPRs) were estimated to compare prevalence rates in suicide decedents with those of the general population. RESULTS The study included 19,144 individuals. Overall, 8.5% of suicide decedents consulted a physician or attended an emergency room on the day of death, 34.1% during the week before death, 60.9% during the month before death. Most contacts involved a general practitioner or an emergency room. During the month preceding suicide, 24.4% of individuals were hospitalised at least once. Mental conditions (36.8% of cases) were 7.9-fold more prevalent in suicide decedents than in the general population. The highest SPRs among physical conditions were for liver/pancreatic diseases (SPR=3.3) and epilepsy (SPR=2.7). LIMITATIONS The study population was restricted to national health insurance general scheme beneficiaries (76% of the population living in France). CONCLUSIONS Suicide decedents have frequent contacts with general practitioners and emergency departments during the last weeks before death. Improving suicide risk identification and prevention in these somatic healthcare settings is needed.
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Affiliation(s)
- Moussa Laanani
- Centre for Epidemiology on Medical Causes of Death (CépiDc-Inserm), Le Kremlin-Bicêtre, France; Strategy and Research Department, French National Health Insurance, Paris, France.
| | - Claire Imbaud
- Centre for Epidemiology on Medical Causes of Death (CépiDc-Inserm), Le Kremlin-Bicêtre, France
| | - Philippe Tuppin
- Strategy and Research Department, French National Health Insurance, Paris, France
| | - Claire Poulalhon
- Centre of Research in Epidemiology and Statistics, Inserm, Villejuif, France
| | - Fabrice Jollant
- Université de Paris, Paris, France; GHU Paris Psychiatrie et Neurosciences, Sainte-Anne hospital, Paris, France; McGill Group for suicide studies, McGill University, Montréal, Canada; Nîmes university hospital (CHU), Nîmes, France
| | - Joël Coste
- Université de Paris, Paris, France; Assistance Publique-Hôpitaux de Paris, Biostatistics and Epidemiology unit, Cochin Hospital, Paris, France; French National Public Health Agency, Saint-Maurice, France
| | - Grégoire Rey
- Centre for Epidemiology on Medical Causes of Death (CépiDc-Inserm), Le Kremlin-Bicêtre, France
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363
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Benzodiazepine exposure in subjects with incident Alzheimer's disease and related syndromes in France: a longitudinal study 2011-2017. Int Clin Psychopharmacol 2020; 35:270-278. [PMID: 32324610 DOI: 10.1097/yic.0000000000000312] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Benzodiazepines are commonly used for behavioral and psychiatric symptoms of dementia, despite their numerous adverse effects and the lack of evidence regarding their efficacy in this context. We studied longitudinal benzodiazepines exposure in incident cases of Alzheimer's disease and related syndromes (ADRS) in France. We used a cohort of incident ADRS patients identified in 2012 within the national health data system. Benzodiazepines exposure was measured 1 year before, to 5 years after ADRS identification. Quarterly benzodiazepines prevalence and incidence were computed. We identified factors associated with long half-life benzodiazepines initiation. A total of 106 508 subjects were included. Quarterly benzodiazepines prevalence was stable (around 25%) but we saw an important decrease in long half-life benzodiazepines compensated by an increase in short half-life benzodiazepines. In most benzodiazepine initiations, the first episode lasted less than 3 months. Factors associated with initiating a long half-life benzodiazepine were young age, male gender, no registration with ADRS as a long-term disease, having consulted an ADRS specialist, antipsychotic reimbursement before the index date, no admission in nursing home. Prevalence of benzodiazepines use remains high in subjects with ADRS despite guidelines for their avoidance. However, indicators regarding benzodiazepine initiations (duration, benzodiazepine type) suggest some caution in their use.
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364
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Kabeshova A, Yu Y, Lukacs B, Bacry E, Gaïffas S. ZiMM: A deep learning model for long term and blurry relapses with non-clinical claims data. J Biomed Inform 2020; 110:103531. [PMID: 32818667 DOI: 10.1016/j.jbi.2020.103531] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 07/25/2020] [Accepted: 08/09/2020] [Indexed: 11/28/2022]
Abstract
This paper considers the problems of modeling and predicting a long-term and "blurry" relapse that occurs after a medical act, such as a surgery. We do not consider a short-term complication related to the act itself, but a long-term relapse that clinicians cannot explain easily, since it depends on unknown sets or sequences of past events that occurred before the act. The relapse is observed only indirectly, in a "blurry" fashion, through longitudinal prescriptions of drugs over a long period of time after the medical act. We introduce a new model, called ZiMM (Zero-inflated Mixture of Multinomial distributions) in order to capture long-term and blurry relapses. On top of it, we build an end-to-end deep-learning architecture called ZiMM Encoder-Decoder (ZiMM ED) that can learn from the complex, irregular, highly heterogeneous and sparse patterns of health events that are observed through a claims-only database. ZiMM ED is applied on a "non-clinical" claims database, that contains only timestamped reimbursement codes for drug purchases, medical procedures and hospital diagnoses, the only available clinical feature being the age of the patient. This setting is more challenging than a setting where bedside clinical signals are available. Our motivation for using such a non-clinical claims database is its exhaustivity population-wise, compared to clinical electronic health records coming from a single or a small set of hospitals. Indeed, we consider a dataset containing the claims of almost all French citizens who had surgery for prostatic problems, with a history between 1.5 and 5 years. We consider a long-term (18 months) relapse (urination problems still occur despite surgery), which is blurry since it is observed only through the reimbursement of a specific set of drugs for urination problems. Our experiments show that ZiMM ED improves several baselines, including non-deep learning and deep-learning approaches, and that it allows working on such a dataset with minimal preprocessing work.
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Affiliation(s)
| | | | | | | | - Stéphane Gaïffas
- LPSM, Université de Paris, France; DMA, Ecole normale supérieure, Paris, France.
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365
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Constantinou P, Pelletier-Fleury N, Olié V, Gastaldi-Ménager C, JuillÈre Y, Tuppin P. Patient stratification for risk of readmission due to heart failure by using nationwide administrative data. J Card Fail 2020; 27:266-276. [PMID: 32801005 DOI: 10.1016/j.cardfail.2020.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 06/27/2020] [Accepted: 07/31/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Identifying patients with heart failure (HF) who are most at risk of readmission permits targeting adapted interventions. The use of administrative data enables regulators to support the implementation of such interventions. METHODS AND RESULTS In a French nationwide cohort of patients aged 65 years or older, surviving an index hospitalization for HF in 2015 (N = 70,657), we studied HF readmission predictors available in administrative data, distinguishing HF severity from overall morbidity and taking into account the competing mortality risk, over a 1-year follow-up period. We also computed cumulative incidences and daily rates of HF readmission for patient groups defined according to HF severity and overall morbidity. Of the patients, 31.8% (n = 22,475) were readmitted at least once for HF, and 17.6% (n = 12,416) died without any readmission for HF. HF severity and overall morbidity were the strongest readmission predictors were the strongest readmission predictors (subdistribution hazard ratios 2.66 [95% CI: 2.52-2.81] and 1.37 [1.30-1.45], respectively, when comparing extreme categories). Overall morbidity and age were more strongly associated with the rate of death without HF readmission (cause-specific hazard ratios). The difference in observed HF readmission between patient risk groups was approximately 40% (21.9%, n = 2144/9,786 vs 60.4%, n = 618/1023). CONCLUSIONS Segmentation of HF patients into readmission risk groups is possible by using administrative data, and it enables the targeting of preventive interventions.
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Affiliation(s)
- Panayotis Constantinou
- Center for Research in Epidemiology and Population Health, French National Institute of Health and Medical Research (INSERM U1018), Université Paris-Saclay, Université Paris-Sud; French National Health Insurance (Cnam), Paris, France.
| | - Nathalie Pelletier-Fleury
- Center for Research in Epidemiology and Population Health, French National Institute of Health and Medical Research (INSERM U1018), Université Paris-Saclay, Université Paris-Sud
| | - Valérie Olié
- French Public Health Agency (Santé Publique France), Saint-Maurice, France
| | | | - Yves JuillÈre
- Department of Cardiology, Nancy University Hospital, Vandoeuvre-les-Nancy, France
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366
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Didier R, Gouysse M, Eltchaninoff H, Le Breton H, Commeau P, Cayla G, Glatt N, Glatt B, Gabbas M, Tuppin P, Liepchitz L, Boussac M, Iung B, Gilard M. Successful linkage of French large-scale national registry populations to national reimbursement data: Improved data completeness and minimized loss to follow-up. Arch Cardiovasc Dis 2020; 113:534-541. [DOI: 10.1016/j.acvd.2020.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/11/2020] [Accepted: 04/08/2020] [Indexed: 10/23/2022]
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367
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Bouée-Benhamiche E, Bousquet PJ, Ghabri S. Economic Evaluations of Anticancer Drugs Based on Medico-Administrative Databases: A Systematic Literature Review. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2020; 18:491-508. [PMID: 32056121 DOI: 10.1007/s40258-020-00562-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Oncology is among the most active therapeutic fields in terms of new drug development projects, with increasingly expensive drugs. The expected clinical benefit and cost effectiveness of these treatments in clinical practice have yet to be fully confirmed. Health medico-administrative databases may be useful for assessing the value of anticancer drugs with real-world data. OBJECTIVE The objectives of our systematic literature review (SLR) were to analyse economic evaluations of anticancer drugs based on health medico-administrative databases, to assess the quality of these evaluations, and to identify the inputs from such databases that can be used in economic evaluations of anticancer drugs. METHODS We performed an SLR by using PubMed and Web of Science articles published from January 2008 to January 2019. The search strategy focused on anticancer drug cost-effectiveness analyses (CEAs)/cost-utility analyses (CUAs) that were entirely based on medico-administrative databases. The review reported the main choices of economic evaluation methods in the analyses. The quality of the articles was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) and risk of bias assessment checklists. RESULTS Of the 306 records identified in PubMed, 12 articles were selected, and one additional article was identified through Web of Science. Ten of the 13 articles were CEAs and three were CUAs. Most of the analyses were carried out in North America (n = 11). The economic metric used was the cost per life-year gained (n = 10) or cost per quality-adjusted life-year (n = 3). Reporting of the target analysis population and strategies in the articles was in agreement with the CHEERS guidelines. The structural assumptions underpinning the economic models displayed the poorest reporting quality among the items analysed. Representativeness bias (n = 11) and the issue of censored medical costs (n = 8) were the most frequently analysed risks. CONCLUSION A comparison of the economic results was not relevant due to the high heterogeneity of the selected studies. Our SLR highlighted the benefits and pitfalls related to the use of medico-administrative databases in the economic evaluations of anticancer drugs.
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Affiliation(s)
- Elsa Bouée-Benhamiche
- Department of Health Data and Assessment, Survey Data Science and Assessment Division, French National Cancer Institute (Institut National du Cancer INCa), 52 Avenue André Morizet, 92100, Boulogne-Billancourt, France
| | - Philippe Jean Bousquet
- Department of Health Data and Assessment, Survey Data Science and Assessment Division, French National Cancer Institute (Institut National du Cancer INCa), 52 Avenue André Morizet, 92100, Boulogne-Billancourt, France
| | - Salah Ghabri
- Department of Economic and Public Health Evaluation, French National Authority for Health (Haute Autorité de Santé, HAS), 5 Avenue du Stade de France, 93218, Saint-Denis La Plaine CEDEX, France.
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368
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Boursier J, Shreay S, Fabron C, Torreton E, Fraysse J. Hospitalization costs and risk of mortality in adults with nonalcoholic steatohepatitis: Analysis of a French national hospital database. EClinicalMedicine 2020; 25:100445. [PMID: 32775971 PMCID: PMC7403878 DOI: 10.1016/j.eclinm.2020.100445] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 06/13/2020] [Accepted: 06/15/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) has reached high prevalence, paralleling the obesity pandemic. The aggressive form of the disease, nonalcoholic steatohepatitis (NASH), is characterized by fatty infiltration and inflammation of the liver, can progress to compensated cirrhosis (CC) and end-stage liver disease (ESLD: decompensated cirrhosis [DCC] and hepatocellular carcinoma [HCC]), and may ultimately require liver transplantation (LT). Real-world data on the burden of NAFLD/NASH are limited. This study aimed to evaluate the clinical and economic burden of NAFLD/NASH to the French hospital system. METHODS This retrospective cohort study used data from the French PMSI-MCO database. Adults with NAFLD/NASH diagnosis identified between 2009 and 2015 were categorized into disease severity cohorts (NAFLD/NASH, CC, DCC, HCC, and LT). Demographic and clinical data were assessed at the index (diagnosis) date. Hospitalization resource utilization and costs were assessed in the pre- and post-index periods. Rates of liver disease progression and death were evaluated for each cohort. FINDINGS During the median follow-up of 34.8 months, of the 131,656 patients included, 1491 patients developed CC (1.1%), 7846 developed DCC (5.9%), 1144 developed HCC (0.9%), and 52 required LT (0.04%). The diagnosis of NAFLD/NASH was associated with increasing annual costs: €7736 vs €5076 before the diagnosis. Rates of comorbidities, hospitalization resource utilization, and costs increased with disease progression. The rate of death at seven-year follow-up was 7.9% in NAFLD/NASH, CC: 18.0%, DCC: 34.9%, and HCC: 48.8%. INTERPRETATION NAFLD/NASH is associated with high economic burden and imparts substantial risk of negative clinical outcomes and mortality at all stages of disease.
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Affiliation(s)
- Jérôme Boursier
- Laboratoire HIFIH UPRES EA3859, SFR 4208, Université d'Angers, Angers, France
- Service d'Hépato-Gastroentérologie et Oncologie Digestive, Centre Hospitalier Universitaire d'Angers, Angers, France
- Corresponding author at: Service d'Hépato-Gastroentérologie et Oncologie Digestive, Centre Hospitalier Universitaire d'Angers, 4 rue Larrey, 49933 Angers cedex 09, France.
| | - Sanatan Shreay
- Gilead Sciences, Health Economics Outcomes Research, Foster City, United States
| | | | | | - Jeremy Fraysse
- Gilead Sciences, Health Economics Outcomes Research, Foster City, United States
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369
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Ben Messaoud K, Bouyer J, de La Rochebrochard E. Infertility Treatment in France, 2008-2017: A Challenge of Growing Treatment Needs at Older Ages. Am J Public Health 2020; 110:1418-1420. [PMID: 32673116 DOI: 10.2105/ajph.2020.305781] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To measure trends in infertility treatment use between 2008 and 2017 in France using data from the national health insurance system.Methods. Between 2008 and 2017, we observed a representative national sample of nearly 1% of all women aged 20 to 49 years who were affiliated with the main health insurance scheme in France (more than 100 000 women observed each year). We exhaustively recorded all health care reimbursed to these women.Results. Among women aged 20 to 49 years, 1.25% were treated for infertility each year. Logistic regression analysis showed a significant interaction between age and year of treatment use (P < .001). Over the decade, infertility treatment use increased by 23.9% among women aged 34 years or older, whereas among women younger than 34 years there was a nonsignificant variation.Conclusions. Women aged 34 years or older were increasingly treated for infertility between 2008 and 2017.Public Health Implications. Treatment efficiency decreases strongly with a woman's age, presenting a challenge for medical infertility care.
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Affiliation(s)
- Khaoula Ben Messaoud
- Khaoula Ben Messaoud is a PhD candidate with and Jean Bouyer and Elise de La Rochebrochard are with the Sexual and Reproductive Health and Rights Unit, Institut national d'etudes démographiques, Aubervilliers, France, and Institut national de la santé et de la recherche médicale, Université Paris-Saclay, Kremlin-Bicêtre, France
| | - Jean Bouyer
- Khaoula Ben Messaoud is a PhD candidate with and Jean Bouyer and Elise de La Rochebrochard are with the Sexual and Reproductive Health and Rights Unit, Institut national d'etudes démographiques, Aubervilliers, France, and Institut national de la santé et de la recherche médicale, Université Paris-Saclay, Kremlin-Bicêtre, France
| | - Elise de La Rochebrochard
- Khaoula Ben Messaoud is a PhD candidate with and Jean Bouyer and Elise de La Rochebrochard are with the Sexual and Reproductive Health and Rights Unit, Institut national d'etudes démographiques, Aubervilliers, France, and Institut national de la santé et de la recherche médicale, Université Paris-Saclay, Kremlin-Bicêtre, France
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370
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Oberlin P, de Peretti C. Bariatric Surgery in France from 1997 to 2018. Surg Obes Relat Dis 2020; 16:1069-1077. [PMID: 32660800 DOI: 10.1016/j.soard.2020.04.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 04/16/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Bariatric surgery is 1 of the major treatments of obesity. OBJECTIVES This study describes the development of the bariatric surgery in France and look at some factors of this evolution. SETTING It concerns the activity of all the French hospitals over a 22-year period. METHODS Hospitalization databases from 1997 to 2018 have been used to study the evolution of the number of bariatric operations, their types, the characteristics of both patients and hospitals performing this surgery. RESULTS The number of operations grew from 2800 in 1997 to 52,500 in 2018, with 2 interruptions in this growth, in 2002 and from 2017 to date. The rate of operations is 4 times higher for women than for men, with a peak in the 35-44 age group. The adjustable gastric banding was the most popular operation until 2010, then replaced by sleeve gastrectomy since 2010. Private for-profit hospitals carried out the majority of these operations, even if the public hospitals activity progressed regularly during the past 2 decades. CONCLUSIONS Compared to other countries, the rate of bariatric operations in France is rather high whereas the obesity rate is medium to low. Easy accessibility to bariatric surgery should play a role in the high rate, but specific studies are necessary to evaluate if the operations are delivered adequately to the obese population.
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Affiliation(s)
- Philippe Oberlin
- Bureau État de Santé de la Population, Direction de la Recherche, de l'Evaluation, des Études et des Statistiques, Ministère Chargé des Solidarités et de la Santé, Paris, France.
| | - Christine de Peretti
- Bureau État de Santé de la Population, Direction de la Recherche, de l'Evaluation, des Études et des Statistiques, Ministère Chargé des Solidarités et de la Santé, Paris, France
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371
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Maura G, Bardou M, Billionnet C, Weill A, Drouin J, Neumann A. Oral anticoagulants and risk of acute liver injury in patients with nonvalvular atrial fibrillation: a propensity-weighted nationwide cohort study. Sci Rep 2020; 10:11624. [PMID: 32669591 PMCID: PMC7363898 DOI: 10.1038/s41598-020-68304-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 06/15/2020] [Indexed: 11/28/2022] Open
Abstract
Insufficient real-world data on acute liver injury (ALI) risk associated with oral anticoagulants (OACs) exist in patients with nonvalvular atrial fibrillation (NVAF). Using the French national healthcare databases, a propensity-weighted nationwide cohort study was performed in NVAF patients initiating OACs from 2011 to 2016, considering separately those (1) with no prior liver disease (PLD) as main population, (2) with PLD, (3) with a history of chronic alcoholism. A Cox proportional hazards model was used to estimate the hazard ratio with 95% confidence interval (HR [95% CI]) of serious ALI (hospitalised ALI or liver transplantation) during the first year of treatment, for each non-vitamin K antagonist (VKA) oral anticoagulant (NOAC: dabigatran, rivaroxaban, apixaban) versus VKA. In patients with no PLD (N = 434,015), only rivaroxaban new users were at increased risk of serious ALI compared to VKA initiation (adjusted HR: 1.41 [1.05–1.91]). In patients with chronic alcoholism history (N = 13,173), only those initiating dabigatran were at increased risk of serious ALI compared to VKA (2.88 [1.74–4.76]) but an ancillary outcome suggested that differential clinical follow-up between groups might partly explain this association. In conclusion, this study does not suggest an increase of the 1-year risk of ALI in NOAC versus VKA patients with AF.
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Affiliation(s)
- Géric Maura
- French National Health Insurance (Caisse Nationale de L'Assurance Maladie, Cnam), 50 Avenue du Pr. André Lemierre, 75 986, Paris Cedex 20, France.
| | - Marc Bardou
- Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, Dijon-Bourgogne University Hospital, 21 000, Dijon, France.,Division of Gastroenterology, Dijon-Bourgogne University Hospital, 21 000, Dijon, France
| | - Cécile Billionnet
- French National Health Insurance (Caisse Nationale de L'Assurance Maladie, Cnam), 50 Avenue du Pr. André Lemierre, 75 986, Paris Cedex 20, France
| | - Alain Weill
- EPI-PHARE Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety (ANSM) and French National Health Insurance (CNAM), 93 200, Saint-Denis, France
| | - Jérôme Drouin
- EPI-PHARE Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety (ANSM) and French National Health Insurance (CNAM), 93 200, Saint-Denis, France
| | - Anke Neumann
- EPI-PHARE Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety (ANSM) and French National Health Insurance (CNAM), 93 200, Saint-Denis, France
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372
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Souty C, Launay T, Steichen O, Conte C, Turbelin C, Sarazin M, Vilcu AM, Rossignol L, Blanchon T, Lapeyre-Mestre M, Hanslik T. Use of the French healthcare insurance database to estimate the prevalence of exposure to potential drug-drug interactions. Eur J Clin Pharmacol 2020; 76:1675-1682. [PMID: 32632714 DOI: 10.1007/s00228-020-02952-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 06/30/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Drug-drug interactions (DDIs) require monitoring in an aging population with increasing polypharmacy exposure. We aimed to estimate the prevalence of exposure to potential DDIs using the French healthcare insurance system database, for six DDIs with various clinical relevance: angiotensin II receptor blockers or angiotensin-converting enzyme inhibitors and nonsteroidal anti-inflammatory drugs (ARBs-ACEIs + NSAIDs), antiplatelet agents and NSAIDs (AAP + NSAIDs), serotonergic drugs and tramadol (SD + T), statins and macrolides (S + M), oral anticoagulant and NSAIDs (OAC + NSAIDs), and colchicine and macrolides (C + M). METHODS We used exhaustive healthcare data from a 1/97th random sample of the population covered by the French health insurance system (EGB) between 2006 and 2016. Exposure to a DDI was defined as overlapping exposure to two interacting drugs. The prevalence of exposure was estimated by year. RESULTS Prevalence of exposure in 2016 was estimated at 3.7% for ARBs-ACEIs + NSAIDs, 1.5% for AAP + NSAIDs, 0.76% for SD + T, 0.36% for S + M, 0.24% for AOC + NSAIDs, and 0.02% for C + M. In 26% to 58% of episodes of exposure, the two interacting drugs were prescribed by the same physician and dispensed by the same pharmacy the same day. Between 2006 and 2016, the yearly prevalence was increasing for SD + T and for DDIs involving NSAIDs, and it was decreasing for those involving macrolides. CONCLUSION Exposures to potential DDIs in France are not uncommon with a high proportion resulting from a co-prescription by the same physician. Monitoring the prevalence of exposure to DDIs is needed to implement prevention measures. Administrative data enable this surveillance in large and representative cohorts.
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Affiliation(s)
- Cécile Souty
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé publique, Paris, France.
| | - Titouan Launay
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé publique, Paris, France
| | - Olivier Steichen
- Sorbonne Université, INSERM, Université Paris 13, Laboratoire d'informatique médicale et d'ingénierie des connaissances en e-santé, LIMICS, Paris, France.,Assistance Publique - Hôpitaux de Paris (APHP), hôpital Tenon, Service de Médecine Interne, Paris, France
| | - Cécile Conte
- INSERM, Université de Toulouse (LEASP UMR 1027), Service de Pharmacologie médicale et clinique, CIC 1436, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), Toulouse, France
| | - Clément Turbelin
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé publique, Paris, France
| | - Marianne Sarazin
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé publique, Paris, France
| | - Ana-Maria Vilcu
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé publique, Paris, France
| | - Louise Rossignol
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé publique, Paris, France.,Département de Médecine Générale, Université Paris Diderot, Paris, France
| | - Thierry Blanchon
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé publique, Paris, France
| | - Maryse Lapeyre-Mestre
- INSERM, Université de Toulouse (LEASP UMR 1027), Service de Pharmacologie médicale et clinique, CIC 1436, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), Toulouse, France
| | - Thomas Hanslik
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé publique, Paris, France.,Université de Versailles Saint-Quentin-en-Yvelines, UVSQ, UFR de Médecine, Versailles, France.,Assistance Publique - Hôpitaux de Paris (APHP), hôpital Ambroise Paré, Service de Médecine Interne, Boulogne Billancourt, France
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373
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Daveluy A, Micallef J, Sanchez-Pena P, Miremont-Salamé G, Lassalle R, Lacueille C, Grelaud A, Corand V, Victorri-Vigneau C, Batisse A, Le Boisselier R, Peyrière H, Frauger E, Lapeyre-Mestre M, Haramburu F. Ten-year trend of opioid and nonopioid analgesic use in the French adult population. Br J Clin Pharmacol 2020; 87:555-564. [PMID: 32496599 DOI: 10.1111/bcp.14415] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 05/15/2020] [Accepted: 05/24/2020] [Indexed: 02/06/2023] Open
Abstract
AIMS Analgesics are the most widely used medicines worldwide. In parallel, opioid abuse has increased and is of major concern. The accessibility of pharmacologically powerful medicines and the addictovigilance signals in France about the risk of opiates addiction call for an overview of analgesic use. The objective of this study was to investigate the use of analgesics reimbursed in France over a 10-year period through its prevalence. METHODS A cross-sectional study repeated yearly was conducted by using data from the French reimbursement database from 2006 to 2015. Analgesics were classified according to their pharmacological potency: prevalence of use for each category and sociodemographic characteristics of patients treated were analysed. RESULTS The annual prevalence of analgesic use was high and increased during the study period (59.8%, 253 976 users in 2015). In 2015, prevalence was always higher in women and increased with age, except for those older than 84 years. Peripheral analgesics were the most used (55.3%, 234 739 users). The prevalence of weak analgesic use decreased (21.3%, 90 257 users), mainly due to the definitive withdrawal of dextropropoxyphene in France in 2011, which was not offset by an increase in the consumption of other weak analgesics. For strong analgesics (1.2%, 5129 users), morphine was the most widely used, with a dramatic increase in oxycodone use, especially in the elderly. CONCLUSION The prevalence of analgesic use is high: approximately 31 million adults had at least 1 analgesic reimbursed in 2015. The most widely used analgesics were peripheral analgesics, far ahead of opioid analgesics.
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Affiliation(s)
- Amélie Daveluy
- Centre d'addictovigilance, Service de pharmacologie médicale, CHU Bordeaux, Bordeaux, France.,Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Team, Pharmacoepidemiology, Bordeaux, France
| | - Joëlle Micallef
- Aix Marseille Univ, AP-HM, INSERM, Inst Neurosci Syst, Service de Pharmacologie Clinique et Pharmacovigilance, Marseille, France
| | - Paola Sanchez-Pena
- Centre d'addictovigilance, Service de pharmacologie médicale, CHU Bordeaux, Bordeaux, France
| | - Ghada Miremont-Salamé
- Centre d'addictovigilance, Service de pharmacologie médicale, CHU Bordeaux, Bordeaux, France.,Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Team, Pharmacoepidemiology, Bordeaux, France
| | - Régis Lassalle
- Bordeaux PharmacoEpi, INSERM CIC1401, Bordeaux, France; ADERA, Pessac, France
| | | | - Angela Grelaud
- Bordeaux PharmacoEpi, INSERM CIC1401, Bordeaux, France; ADERA, Pessac, France
| | - Virginie Corand
- Centre d'Etude et de Traitement de la Douleur, CHU Bordeaux, Bordeaux, France
| | | | - Anne Batisse
- Centre d'addictovigilance de Paris, AP-HP, France
| | | | - Hélène Peyrière
- Centre d'addictovigilance de Montpellier, CHU, Montpellier, France
| | - Elisabeth Frauger
- Aix Marseille Univ, AP-HM, INSERM, Inst Neurosci Syst, Service de Pharmacologie Clinique et Pharmacovigilance, Marseille, France
| | | | - Françoise Haramburu
- Centre d'addictovigilance, Service de pharmacologie médicale, CHU Bordeaux, Bordeaux, France.,Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Team, Pharmacoepidemiology, Bordeaux, France
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374
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Justeau G, Gervès-Pinquié C, Le Vaillant M, Trzepizur W, Meslier N, Goupil F, Pigeanne T, Launois S, Leclair-Visonneau L, Masson P, Bizieux-Thaminy A, Humeau MP, Gosselin C, Blanchard M, Urban T, Gagnadoux F. Association Between Nocturnal Hypoxemia and Cancer Incidence in Patients Investigated for OSA: Data From a Large Multicenter French Cohort. Chest 2020; 158:2610-2620. [PMID: 32629036 DOI: 10.1016/j.chest.2020.06.055] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 05/20/2020] [Accepted: 06/08/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Previous studies have yielded inconsistent findings regarding the association between OSA and cancer in humans. RESEARCH QUESTION Is there an association between indexes of sleep-disordered breathing severity and cancer incidence in patients investigated for suspected OSA? STUDY DESIGN AND METHODS Data from a large multicenter cohort of cancer-free patients investigated for OSA were linked to health administrative data to identify new-onset cancer. Kaplan-Meier survival analysis and Cox proportional hazards models were used to evaluate the association of cancer incidence with OSA severity and nocturnal hypoxemia. RESULTS After a median follow-up period of 5.8 years (interquartile range, 3.8-7.8), 718 of 8,748 patients (8.2%) had received a diagnosis of cancer. On unadjusted Kaplan-Meier survival analyses, cancer incidence was associated with increasing severity of OSA (log-rank test, P < .0005) and nocturnal hypoxemia (log-rank test, P < .0001 for both oxygen desaturation index and percent night time with oxygen saturation < 90% [T90]). After adjustment for anthropomorphic data, smoking and alcohol consumption, comorbid cardiac, metabolic, and respiratory diseases, marital status, type of sleep study, and study site, only T90 was associated with cancer incidence (adjusted hazard ratio, 1.33; 95% CI, 1.05-1.68 for T90 ≥ 13% vs < 0.01%; P = .02). On stratified analyses, the association between T90 and cancer appeared stronger in older patients with obesity and no adequate OSA therapy. Among the most frequent cancer sites, nocturnal hypoxemia was associated with lung and breast malignancies. INTERPRETATION Nocturnal hypoxemia was associated with all-cancer incidence in patients investigated for OSA. Whether OSA therapy might reduce the risk of cancer needs further evaluation.
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Affiliation(s)
- Grégoire Justeau
- Department of Respiratory and Sleep Medicine, Angers University Hospital, Angers
| | | | - Marc Le Vaillant
- Pays de la Loire Respiratory Health Research Institute, Beaucouzé
| | - Wojciech Trzepizur
- Department of Respiratory and Sleep Medicine, Angers University Hospital, Angers; INSERM Unit 1063, Angers
| | - Nicole Meslier
- Department of Respiratory and Sleep Medicine, Angers University Hospital, Angers; INSERM Unit 1063, Angers
| | - François Goupil
- Department of Respiratory Diseases, Le Mans General Hospital, Le Mans
| | | | | | | | - Philippe Masson
- Department of Respiratory Diseases, Cholet General Hospital, Cholet
| | - Acya Bizieux-Thaminy
- Department of Respiratory Diseases, La Roche sur Yon General Hospital, La Roche sur Yon
| | | | | | | | - Thierry Urban
- Department of Respiratory and Sleep Medicine, Angers University Hospital, Angers
| | - Frédéric Gagnadoux
- Department of Respiratory and Sleep Medicine, Angers University Hospital, Angers; INSERM Unit 1063, Angers.
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375
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Lailler G, Piffaretti C, Fuentes S, Nabe HD, Oleko A, Cosson E, Fosse-Edorh S. Prevalence of prediabetes and undiagnosed type 2 diabetes in France: Results from the national survey ESTEBAN, 2014-2016. Diabetes Res Clin Pract 2020; 165:108252. [PMID: 32526264 DOI: 10.1016/j.diabres.2020.108252] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/27/2020] [Accepted: 06/04/2020] [Indexed: 01/03/2023]
Abstract
AIM To assess the prevalence of prediabetes, undiagnosed diabetes and diagnosed diabetes in France, among adults between 2014 and 2016 using data from the nationwide Esteban survey. METHODS National cross-sectional study conducted between 2014 and 2016 in metropolitan France. Individuals aged 18 to 74 were recruited with a 3-stage geographic sampling. They completed two face-to-face interviews, filled in a self-administered questionnaire and underwent a medical examination with the collection of biological samples. Their data were linked to the National Health Data System to identify anti-diabetic drugs reimbursement. Prediabetes and undiagnosed diabetes were defined as no diagnosis of diabetes and 6.1 mmol/l ≤ Fasting Plasma Glucose (FPG) < 7.0 mmol/l for prediabetes and FPG ≥ 7.0 mmol/l for undiagnosed diabetes. Non-pharmacologically treated diabetes and pharmacologically treated diabetes were defined as self-reported diabetes without or with self-reported or reimbursed antidiabetic medication, respectively. Estimated prevalence were weighted to take into account survey design and non-response. RESULTS The ESTEBAN survey recruited 3476 adults, 2270 were included in this analysis. The weighted prevalence was 1.7% [1.1 - 2.4] for undiagnosed diabetes (men: 2.7%, women; 0.9%), 9.9% [8.3 - 11.5] for prediabetes (men: 13.2%, women: 7.0%), 5.7% [4.3 - 7.1] for diagnosed diabetes. Among the diagnosed cases, 79% were pharmacologically treated. Among all diabetes cases, 23% were undiagnosed. CONCLUSION The prevalence of undiagnosed diabetes and prediabetes is increasing in France. Our results highlight the need to increase primary prevention and reinforce secondary prevention of diabetes.
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Affiliation(s)
- Grégory Lailler
- Santé Publique France, Department of Non-Communicable Diseases and Trauma
| | - Clara Piffaretti
- Santé Publique France, Department of Non-Communicable Diseases and Trauma
| | - Sonsoles Fuentes
- Santé Publique France, Department of Non-Communicable Diseases and Trauma
| | | | - Amivi Oleko
- Santé Publique France, Department of Environmental and Occupational Health, Saint-Maurice, France
| | - Emmanuel Cosson
- Department of Diabetology, Endocrinology and Metabolism, CRNH-IdF, CINFO, Paris 13 University, Sorbonne Paris cité, Avicenne Hospital, AP-HP, 93000 Bobigny, France; UMR U1153 Inserm, U1125 Inra, Cnam, Paris 13 University, Sorbonne Paris cité, 93000 Bobigny, France
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376
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Guilleux A, Roux J, Travers D, Leray E. Prevalence of mental disorders is higher in patients with multiple sclerosis than in the general population or in patients with rheumatoid arthritis in France. Mult Scler J Exp Transl Clin 2020; 6:2055217320941540. [PMID: 32922830 PMCID: PMC7457671 DOI: 10.1177/2055217320941540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 05/29/2020] [Accepted: 06/13/2020] [Indexed: 11/17/2022] Open
Abstract
Background Mental disorders (MDs) in multiple sclerosis (MS) patients decreases
treatment adherence and quality of life, and increases the risk of
disability progression and care consumption. Objective This study was to assess the prevalence of MDs in MS patients compared with
healthy controls (HC) of the French general population and rheumatoid
arthritis (RA) patients. Methods The 2015 prevalence of MDs for MS patients, RA patients and general
population was estimated using a random population-based data sample from
‘National Inter-Scheme Information System on Health Insurance’ in the
2011–2015 period. Two control groups (1:5 ratio for the HC and 1:1 for the
RA group) were matched to the MS group for year of birth, gender, area of
residence and health insurance scheme. Results A total of 1145 MS patients were identified (sex ratio of 2.5 (F/M); median
age 50 years). The prevalence of MDs was higher in the population of
patients with MS (37.3%) than in the French general population (13.6%), and
to a lesser extent in the RA group (21.1%) leading to the prevalence ratios
of 2.8 (95% confidence intervals (CIs) 2.5–3.0) and 1.9 (95% CI 1.7–2.3),
respectively. Conclusions This study confirmed that MS patients are at a higher risk of MDs than the
French general population or RA patients.
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Affiliation(s)
- Alice Guilleux
- EHESP, REPERES, University of Rennes, France
- Centre d’Investigation Clinique de Rennes, University of Rennes, France
| | - Jonathan Roux
- EHESP, REPERES, University of Rennes, France
- EHESP, REPERES, University of Rennes, France
- Centre d’Investigation Clinique de Rennes, University of Rennes, France
| | - David Travers
- Department of Psychiatry, University Hospital CHU Pontchaillou, France
- EHESP, REPERES, University of Rennes, France
- Centre d’Investigation Clinique de Rennes, University of Rennes, France
| | - Emmanuelle Leray
- EHESP, REPERES, University of Rennes, France
- Centre d’Investigation Clinique de Rennes, University of Rennes, France
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377
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de Germay S, Conte C, Rascol O, Montastruc JL, Lapeyre-Mestre M. β-Adrenoceptor Drugs and Parkinson's Disease: A Nationwide Nested Case-Control Study. CNS Drugs 2020; 34:763-772. [PMID: 32500347 DOI: 10.1007/s40263-020-00736-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Potential relationships between β-adrenergic drugs and α-synuclein synthesis in Parkinson's disease (PD) have been recently suggested. OBJECTIVE This study investigated the putative association between β-adrenoceptor drug exposure and PD occurrence. METHODS A nested case-control study was performed in the Echantillon Généraliste des Bénéficiaires (EGB) (a 1/97th random sample of affiliates to the French Insurance System). Incident PD patients diagnosed between 01/01/2008 and 31/12/2017 (index date) were matched 1:1 to controls by gender, birth year, and insurance scheme. Exposure to any β-agonist and to any β-antagonist was compared between cases and controls within 1-2 years before the index date, and exposure to salbutamol and to propranolol was individualized. The association between PD and β-adrenoceptor drugs was investigated through conditional logistic regression models adjusted for potential confounding factors. Because of a statistical interaction between β-agonists and diabetes, results were stratified according to the presence of diabetes. RESULTS Among the 2225 incident PD patients identified in the EGB (mean age 75.6 ± 10.2 years, sex ratio 1.04), no significant association was found between PD and β-antagonists (adjusted odds ratio [aOR] 1.05 [95% confidence interval 0.91-1.20]), except for propranolol (aOR 2.11 [1.38-3.23]). For β-agonists, a protective association in non-diabetic patients (aOR 0.75 [0.60-0.93]) and an opposite and significant association in diabetic patients (aOR 1.61 [1.02-2.55]) were observed. Similar results were found with salbutamol. CONCLUSION This study did not identify an increased risk of PD occurrence after β-antagonist exposure, except for propranolol (potential protopathic bias). The discordant results observed with β-agonists in patients with or without diabetes deserve further exploration of the influence of diabetic comorbidity on PD occurrence and evolution.
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Affiliation(s)
- Sibylle de Germay
- Service de Pharmacologie Médicale Et Clinique, Faculté de Médecine, Centre Hospitalier Universitaire, 37 allées Jules-Guesde, Toulouse, France.
- UMR 1027 INSERM Pharmacoépidémiologie, Université Paul Sabatier Toulouse III, Toulouse, France.
| | - Cécile Conte
- Service de Pharmacologie Médicale Et Clinique, Faculté de Médecine, Centre Hospitalier Universitaire, 37 allées Jules-Guesde, Toulouse, France
- UMR 1027 INSERM Pharmacoépidémiologie, Université Paul Sabatier Toulouse III, Toulouse, France
- CIC INSERM 1436, Paris, France
| | - Olivier Rascol
- Service de Pharmacologie Médicale Et Clinique, Faculté de Médecine, Centre Hospitalier Universitaire, 37 allées Jules-Guesde, Toulouse, France
- CIC INSERM 1436, Paris, France
- Réseau NS-PARK/FCRIN Et Centre COEN NeuroToul, Toulouse, France
| | - Jean-Louis Montastruc
- Service de Pharmacologie Médicale Et Clinique, Faculté de Médecine, Centre Hospitalier Universitaire, 37 allées Jules-Guesde, Toulouse, France
- UMR 1027 INSERM Pharmacoépidémiologie, Université Paul Sabatier Toulouse III, Toulouse, France
- Faculté de Médecine, Centre de PharmacoVigilance, Pharmacoépidémiologie Et D'Informations Sur Le Médicament, Centre Hospitalier Universitaire, Toulouse, France
- CIC INSERM 1436, Paris, France
- Réseau NS-PARK/FCRIN Et Centre COEN NeuroToul, Toulouse, France
| | - Maryse Lapeyre-Mestre
- Service de Pharmacologie Médicale Et Clinique, Faculté de Médecine, Centre Hospitalier Universitaire, 37 allées Jules-Guesde, Toulouse, France
- UMR 1027 INSERM Pharmacoépidémiologie, Université Paul Sabatier Toulouse III, Toulouse, France
- CIC INSERM 1436, Paris, France
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378
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Gandré C, Beauguitte L, Lolivier A, Coldefy M. Care coordination for severe mental health disorders: an analysis of healthcare provider patient-sharing networks and their association with quality of care in a French region. BMC Health Serv Res 2020; 20:548. [PMID: 32552821 PMCID: PMC7298939 DOI: 10.1186/s12913-020-05173-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 03/31/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For patients with multiple and complex health needs, such as those suffering from mental health disorders, outcomes are determined by the combined actions of the care providers they visit and their interactions. Care coordination is therefore essential. However, little is known on links between hospitals providing psychiatric care and community-based care providers which could serve as a basis for the creation of formal mental care networks supported by recent policies. In this context, we first aimed to identify and characterize existing types of healthcare provider patient-sharing networks for severe mental health disorders in one French region. Second, we aimed to analyse the association between their characteristics and the quality of the care they provide. METHODS Patient flows among healthcare providers involved in treating severe mental health disorders in the Provence-Alpes-Côte-d'Azur region were extracted from the French national health data system, which contains all billing records from the social health insurance. Healthcare provider networks that have developed around public and private non-profit hospitals were identified based on shared patients with other providers (hospitals, community-based psychiatrists, general practitioners and nurses). Hierarchical clustering was conducted to create a typology of the networks. Indicators of quality of care, encompassing multiple complementary dimensions, were calculated across these networks and linked to their characteristics using multivariable methods. RESULTS Three main types of existing healthcare provider networks were identified. They were either networks strongly organized around the main hospital providing psychiatric care; scattered networks involving numerous and diverse healthcare providers; or medically-oriented networks involving mainly physician providers. Few significant associations between the structure and composition of healthcare provider networks and indicators of quality of care were found. CONCLUSIONS Our findings provide a basis to develop explicit structuring of mental care based on pre-existing working relationships but suggest that healthcare providers' patient-sharing patterns were not the main driver of optimal care provision in the context explored. The shift towards a stronger integration of health and social care in the mental health field might impact these results but is currently not observable in the administrative data available for research purpose which should evolve to include social care.
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Affiliation(s)
- Coralie Gandré
- Institut de recherche et documentation en économie de la santé (IRDES), 117 bis rue Manin, 75019, Paris, France.
| | - Laurent Beauguitte
- UMR Géographie-cités, Centre National de la Recherche Scientifique, Paris, France
| | - Alexandre Lolivier
- Institut de recherche et documentation en économie de la santé (IRDES), 117 bis rue Manin, 75019, Paris, France
| | - Magali Coldefy
- Institut de recherche et documentation en économie de la santé (IRDES), 117 bis rue Manin, 75019, Paris, France
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379
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Van Ganse E, Danchin N, Mahé I, Hanon O, Jacoud F, Nolin M, Dalon F, Lefevre C, Cotté FE, Gollety S, Falissard B, Belhassen M, Steg PG. Comparative Safety and Effectiveness of Oral Anticoagulants in Nonvalvular Atrial Fibrillation: The NAXOS Study. Stroke 2020; 51:2066-2075. [PMID: 32539675 PMCID: PMC7306262 DOI: 10.1161/strokeaha.120.028825] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose: The effects of direct oral anticoagulants in nonvalvular atrial fibrillation should be assessed in actual conditions of use. France has near-universal healthcare coverage with a unified healthcare information system, allowing large population-based analyses. NAXOS (Evaluation of Apixaban in Stroke and Systemic Embolism Prevention in Patients With Nonvalvular Atrial Fibrillation) aimed to compare the safety, effectiveness, and mortality of apixaban with vitamin K antagonists (VKAs), rivaroxaban, and dabigatran, in oral anticoagulant-naive patients with nonvalvular atrial fibrillation. Methods: This was an observational study using French National Health System claims data and including all adults with nonvalvular atrial fibrillation who initiated oral anticoagulant between 2014 and 2016. Outcomes of interest were major bleeding events leading to hospitalization (safety), stroke and systemic thromboembolic events (effectiveness), and all-cause mortality. Four approaches were used for comparative analyses: matching on propensity score (PS; 1:n); as a sensitivity analysis, matching on high-dimensional PS; adjustment on PS; and adjustment on known confounders. For each outcome, cumulative incidence rates accounting for competing risks of death were estimated. Results: Overall, 321 501 patients were analyzed, of whom 35.0%, 27.2%, 31.1%, and 6.6% initiated VKAs, apixaban, rivaroxaban, and dabigatran, respectively. Apixaban was associated with a lower PS–matched risk of major bleeding compared with VKAs (hazard ratio [HR], 0.43 [95% CI, 0.40–0.46]) and rivaroxaban (HR, 0.67 [95% CI, 0.63–0.72]), but not dabigatran (HR, 0.93 [95% CI, 0.81–1.08]). Apixaban was associated with a lower risk of stroke and systemic thromboembolic event compared with VKAs (HR, 0.60 [95% CI, 0.56–0.65]), but not rivaroxaban (HR, 1.05 [95% CI, 0.97–1.15]) or dabigatran (HR, 0.93 [95% CI, 0.78–1.11]). All-cause mortality was lower with apixaban than with VKAs, but not lower than with rivaroxaban or dabigatran. Conclusions: Apixaban was associated with superior safety, effectiveness, and lower mortality than VKAs; with superior safety than rivaroxaban and similar safety to dabigatran; and with similar effectiveness when compared with rivaroxaban or dabigatran. These observational data suggest potentially important differences in outcomes between direct oral anticoagulants, which should be explored in randomized trials.
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Affiliation(s)
- Eric Van Ganse
- PELyon (Pharmaco Epidemiology Lyon), Lyon, France (E.V.G., F.J., M.N., F.D., M.B.).,Department of Respiratory Medicine, Croix Rousse University Hospital, Lyon, France (E.V.G.).,HESPER (Health Services and Performance Research) 7425, University Claude Bernard Lyon 1, Lyon, France (E.V.G.)
| | - Nicolas Danchin
- Hôpital Européen Georges Pompidou, Department of Cardiology, Paris, France (N.D.)
| | - Isabelle Mahé
- Hôpital Louis Mourier, AP-HP, Department of Internal Medicine, Colombes, France (I.M.).,Université de Paris, Department of Innovative Therapies in Haemostasis, INSERM, Paris, France (I.M.)
| | - Olivier Hanon
- Université Paris Descartes, Sorbonne Paris Cité, Equipe d'accueil, 4468, Paris, France (O.H.).,Hôpital Broca, Department of Geriatrics, AP-HP, Paris, France (O.H.)
| | - Flore Jacoud
- PELyon (Pharmaco Epidemiology Lyon), Lyon, France (E.V.G., F.J., M.N., F.D., M.B.)
| | - Maëva Nolin
- PELyon (Pharmaco Epidemiology Lyon), Lyon, France (E.V.G., F.J., M.N., F.D., M.B.)
| | - Faustine Dalon
- PELyon (Pharmaco Epidemiology Lyon), Lyon, France (E.V.G., F.J., M.N., F.D., M.B.)
| | - Cinira Lefevre
- Bristol-Myers Squibb, Rueil-Malmaison, France (C.L., F.-E.C., S.G.)
| | | | - Sabrina Gollety
- Bristol-Myers Squibb, Rueil-Malmaison, France (C.L., F.-E.C., S.G.)
| | | | - Manon Belhassen
- PELyon (Pharmaco Epidemiology Lyon), Lyon, France (E.V.G., F.J., M.N., F.D., M.B.)
| | - Ph Gabriel Steg
- Department of Cardiology, Hôpital Bichat, AP-HP, Paris, France (P.G.S.).,Université de Paris, Paris, France (P.G.S.).,INSERM U-1148, Paris, France (P.G.S.)
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380
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Bounoure F, Mouly D, Beaudeau P, Bentayeb M, Chesneau J, Jones G, Skiba M, Lahiani-Skiba M, Galey C. Syndromic Surveillance of Acute Gastroenteritis Using the French Health Insurance Database: Discriminatory Algorithm and Drug Prescription Practices Evaluations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124301. [PMID: 32560168 PMCID: PMC7345322 DOI: 10.3390/ijerph17124301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/12/2020] [Accepted: 06/14/2020] [Indexed: 01/26/2023]
Abstract
The French national public health agency (Santé publique France) has used data from the national health insurance reimbursement system (SNDS) to identify medicalised acute gastroenteritis (mAGE) for more than 10 years. This paper presents the method developed to evaluate this system: performance and characteristics of the discriminatory algorithm, portability in mainland and overseas French departments, and verification of the mAGE database updating process. Pharmacy surveys with certified mAGE from 2012 to 2015 were used to characterise mAGE and to estimate the sensitivity and predictive positive value (PPV) of the algorithm. Prescription characteristics from these pharmacy surveys and from 2014 SNDS prescriptions in six mainland and overseas departments were compared. The sensitivity (0.90) and PPV (0.82) did not vary according to the age of the population or year. Prescription characteristics were similar within all studied departments. This confirms that the algorithm can be used in all French departments, for both paediatric and adult populations, with stability and durability over time. The algorithm can identify mAGE cases at a municipal level. The validated system has been implemented in a national waterborne disease outbreaks surveillance system since 2019 with the aim of improving the prevention of infectious disease risk attributable to localised tap water systems.
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Affiliation(s)
- Frederic Bounoure
- Laboratory of Pharmaceutical & Biopharmaceutical Technology, UFR of Health, Normandy University, Unirouen, 22 Bd Gambetta, 76183 Rouen Cedex, France; (M.S.); (M.L.-S.)
- DC2N, INSERM U1239, Unirouen, Normandy University, 76128 Mont Saint Aignan, France
- Correspondence:
| | - Damien Mouly
- Santé Publique France, French National Public Health Agency, F-94415 Saint-Maurice, France; (D.M.); (P.B.); (M.B.); (J.C.); (G.J.); (C.G.)
| | - Pascal Beaudeau
- Santé Publique France, French National Public Health Agency, F-94415 Saint-Maurice, France; (D.M.); (P.B.); (M.B.); (J.C.); (G.J.); (C.G.)
| | - Malek Bentayeb
- Santé Publique France, French National Public Health Agency, F-94415 Saint-Maurice, France; (D.M.); (P.B.); (M.B.); (J.C.); (G.J.); (C.G.)
| | - Julie Chesneau
- Santé Publique France, French National Public Health Agency, F-94415 Saint-Maurice, France; (D.M.); (P.B.); (M.B.); (J.C.); (G.J.); (C.G.)
| | - Gabrielle Jones
- Santé Publique France, French National Public Health Agency, F-94415 Saint-Maurice, France; (D.M.); (P.B.); (M.B.); (J.C.); (G.J.); (C.G.)
| | - Mohamed Skiba
- Laboratory of Pharmaceutical & Biopharmaceutical Technology, UFR of Health, Normandy University, Unirouen, 22 Bd Gambetta, 76183 Rouen Cedex, France; (M.S.); (M.L.-S.)
- DC2N, INSERM U1239, Unirouen, Normandy University, 76128 Mont Saint Aignan, France
| | - Malika Lahiani-Skiba
- Laboratory of Pharmaceutical & Biopharmaceutical Technology, UFR of Health, Normandy University, Unirouen, 22 Bd Gambetta, 76183 Rouen Cedex, France; (M.S.); (M.L.-S.)
- DC2N, INSERM U1239, Unirouen, Normandy University, 76128 Mont Saint Aignan, France
| | - Catherine Galey
- Santé Publique France, French National Public Health Agency, F-94415 Saint-Maurice, France; (D.M.); (P.B.); (M.B.); (J.C.); (G.J.); (C.G.)
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Haneef R, Delnord M, Vernay M, Bauchet E, Gaidelyte R, Van Oyen H, Or Z, Pérez-Gómez B, Palmieri L, Achterberg P, Tijhuis M, Zaletel M, Mathis-Edenhofer S, Májek O, Haaheim H, Tolonen H, Gallay A. Innovative use of data sources: a cross-sectional study of data linkage and artificial intelligence practices across European countries. ACTA ACUST UNITED AC 2020; 78:55. [PMID: 32537143 PMCID: PMC7288525 DOI: 10.1186/s13690-020-00436-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 06/02/2020] [Indexed: 11/10/2022]
Abstract
Background The availability of data generated from different sources is increasing with the possibility to link these data sources with each other. However, linked administrative data can be complex to use and may require advanced expertise and skills in statistical analysis. The main objectives of this study were to describe the current use of data linkage at the individual level and artificial intelligence (AI) in routine public health activities, to identify the related estimated health indicators (i.e., outcome and intervention indicators) and health determinants of non-communicable diseases and the obstacles to linking different data sources. Method We performed a survey across European countries to explore the current practices applied by national institutes of public health, health information and statistics for innovative use of data sources (i.e., the use of data linkage and/or AI). Results The use of data linkage and AI at national institutes of public health, health information and statistics in Europe varies. The majority of European countries use data linkage in routine by applying a deterministic method or a combination of two types of linkages (i.e., deterministic & probabilistic) for public health surveillance and research purposes. The use of AI to estimate health indicators is not frequent at national institutes of public health, health information and statistics. Using linked data, 46 health outcome indicators, 34 health determinants and 23 health intervention indicators were estimated in routine. The complex data regulation laws, lack of human resources, skills and problems with data governance, were reported by European countries as obstacles to routine data linkage for public health surveillance and research. Conclusions Our results highlight that the majority of European countries have integrated data linkage in their routine public health activities but only a few use AI. A sustainable national health information system and a robust data governance framework allowing to link different data sources are essential to support evidence-informed health policy development. Building analytical capacity and raising awareness of the added value of data linkage in national institutes is necessary for improving the use of linked data in order to improve the quality of public health surveillance and monitoring activities.
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Affiliation(s)
- Romana Haneef
- Department of Non-Communicable Diseases and Injuries, Santé Publique France, 12 rue du Val d'Osne, 94415 Saint-Maurice, France
| | - Marie Delnord
- Epidemiology and public health, Sciensano, Brussels, Belgium
| | - Michel Vernay
- Department of Non-Communicable Diseases and Injuries, Santé Publique France, 12 rue du Val d'Osne, 94415 Saint-Maurice, France
| | - Emmanuelle Bauchet
- Department of Non-Communicable Diseases and Injuries, Santé Publique France, 12 rue du Val d'Osne, 94415 Saint-Maurice, France
| | - Rita Gaidelyte
- Health information centre, Institute of hygiene, Vilnius, Lithuania
| | - Herman Van Oyen
- Epidemiology and public health, Sciensano, Brussels, Belgium.,Department of public health, Ghent University, Ghent, Belgium
| | - Zeynep Or
- Institute of research and information for health economics, Paris, France
| | - Beatriz Pérez-Gómez
- National Centre for Epidemiology & CIBERESP, Carlos III Institute of Health, Madrid, Spain
| | - Luigi Palmieri
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, National Institute of Health, Rome, Italy
| | - Peter Achterberg
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Mariken Tijhuis
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Metka Zaletel
- National Institute of Public Health (NIJZ), Ljubljana, Slovenia
| | - Stefan Mathis-Edenhofer
- The Austrian National Public Health Institute (Gesundheit Österreich GmbH, GÖG), Vienna, Austria
| | - Ondřej Májek
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic.,Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | | | - Hanna Tolonen
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Anne Gallay
- Department of Non-Communicable Diseases and Injuries, Santé Publique France, 12 rue du Val d'Osne, 94415 Saint-Maurice, France
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382
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Grodner C, Sbidian E, Weill A, Mezzarobba M. Epidemiologic study in a real‐world analysis of patients with treatment for psoriasis in the French national health insurance database. J Eur Acad Dermatol Venereol 2020; 35:411-416. [DOI: 10.1111/jdv.16566] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 04/03/2020] [Indexed: 12/22/2022]
Affiliation(s)
- C. Grodner
- Département de Dermatologie AP‐HP Hôpitaux Universitaires Henri Mondor UPEC Créteil France
| | - E. Sbidian
- GIS‐EPIPHARE, Groupement d’intérêt scientifique Epidémiologie des produits de santé ANSM‐CNAM Paris France
- Centre d’Investigation Clinique 1430 INSERM Créteil France
- EA 7379 EpidermE Université Paris‐Est Créteil UPEC Créteil France
| | - A. Weill
- GIS‐EPIPHARE, Groupement d’intérêt scientifique Epidémiologie des produits de santé ANSM‐CNAM Paris France
- Caisse Nationale d’Assurance Maladie des Travailleurs Salariés (CNAM) Paris France
| | - M. Mezzarobba
- Caisse Nationale d’Assurance Maladie des Travailleurs Salariés (CNAM) Paris France
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383
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EU-Wide Access to High-quality, Affordable Precision Diagnostics: An EHA Position Paper. Hemasphere 2020; 4:e412. [PMID: 32647808 PMCID: PMC7306313 DOI: 10.1097/hs9.0000000000000412] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/06/2020] [Indexed: 11/26/2022] Open
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384
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Blotière PO, Miranda S, Weill A, Mikaeloff Y, Peyre H, Ramus F, Mahmoud Z, Coste J, Dray-Spira R. Risk of early neurodevelopmental outcomes associated with prenatal exposure to the antiepileptic drugs most commonly used during pregnancy: a French nationwide population-based cohort study. BMJ Open 2020; 10:e034829. [PMID: 32513880 PMCID: PMC7282331 DOI: 10.1136/bmjopen-2019-034829] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To assess the association between prenatal exposure to monotherapy with the antiepileptic drugs (AEDs) most commonly used during pregnancy and the risk of various neurodevelopmental outcomes compared with lamotrigine. DESIGN Nationwide population-based cohort study. SETTING French national healthcare databases. PARTICIPANTS Children born alive between 2011 and 2014 and prenatally exposed to AED monotherapy. PRIMARY AND SECONDARY OUTCOME MEASURES Outcomes included neurodevelopmental disorders (NDD), defined by International Classification of Diseases, 10th Revision codes F70-F98-pervasive developmental disorders (PDD, F84) and mental retardation (MR, F70-F79) were studied separately-and visits to speech therapists. The reference group comprised children prenatally exposed to lamotrigine. Children were followed until outcome, loss to follow-up, death or 31 December 2016. We performed inverse probability of treatment weighting analyses using the propensity score, which included maternal and infant characteristics. Hazard ratios (HRs) were calculated using Cox models. RESULTS The cohort comprised 9034 children, 2916 of which were exposed to lamotrigine, 1627 to pregabalin, 1246 to clonazepam, 991 to valproic acid (VPA), 621 to levetiracetam, 502 to carbamazepine, 477 to topiramate, 378 to gabapentin and 143 to oxcarbazepine. None of these AEDs, except VPA, was associated with an increased risk of any of the four neurodevelopmental outcomes investigated. Exposure to VPA was associated with increased risks of NDDs (HR=2.7, 95% CI (1.8 to 4.0)), PDD (HR=4.4 (2.1 to 9.3)), MR (HR=3.1 (1.5 to 6.2)) and visits to speech therapists (HR=1.5 (1.1 to 1.9)), with a dose-response relationship. CONCLUSIONS No increased risk of any of the neurodevelopmental outcomes investigated in this study was observed with prenatal exposure to levetiracetam, pregabalin, oxcarbazepine, topiramate, gabapentin, clonazepam or carbamazepine, compared with lamotrigine. However, this study corroborates the well-known association between maternal use of VPA during pregnancy and the risk of neurodevelopmental disorders in the offspring. Longer follow-up is necessary to confirm these findings.
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Affiliation(s)
- Pierre-Olivier Blotière
- Department of Public Health Studies, French National Health Insurance (CNAM), Paris, France
- Apemac, EA 4360, Université de Lorraine, Université Paris-Descartes, Nancy, France
| | - Sara Miranda
- Department of Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety, Saint-Denis, France
| | - Alain Weill
- Department of Public Health Studies, French National Health Insurance (CNAM), Paris, France
| | - Yann Mikaeloff
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Unité de Rééducation Neurologique Infantile, Bicêtre, France
- CESP, Faculté de médecine-Université Paris-Sud, Faculté de médecine-UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
| | - Hugo Peyre
- Laboratoire de Sciences Cognitives et Psycholinguistique, Ecole Normale Supérieure, EHESS, CNRS, PSL University, Paris, France
- Department of Child and Adolescent Psychiatry, Robert Debré Hospital, APHP, Paris, France
- INSERM UMR 1141, Paris Diderot University, Paris, France
| | - Franck Ramus
- Laboratoire de Sciences Cognitives et Psycholinguistique, Ecole Normale Supérieure, EHESS, CNRS, PSL University, Paris, France
| | - Zureik Mahmoud
- Department of Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety, Saint-Denis, France
- Versailles Saint-Quentin-en-Yvelines University, Versailles, France
| | - Joël Coste
- Department of Public Health Studies, French National Health Insurance (CNAM), Paris, France
- Biostatistics and Epidemiology Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, and Paris Descartes University, Paris, France
| | - Rosemary Dray-Spira
- Department of Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety, Saint-Denis, France
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Belhassen M, Tubach F, Hudry C, Woronoff-Lemsi M, Levy-Bachelot L, Van Ganse E, Fautrel B. Impact of persistence with tumour necrosis factor inhibitors on healthcare resource utilization and costs in chronic inflammatory joint diseases. Br J Clin Pharmacol 2020; 87:163-177. [PMID: 32441383 DOI: 10.1111/bcp.14387] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 05/05/2020] [Accepted: 05/12/2020] [Indexed: 01/08/2023] Open
Abstract
AIM To assess persistence with subcutaneous (SC) tumour necrosis factor (TNF) inhibitors as well as the impact of persistence on healthcare resource utilization (HCRU) and costs in patients with chronic inflammatory joint diseases. METHODS In this cohort study using population-based French claims data (from 2011 to 2014), we measured persistence with SC TNF inhibitors within 12 months (M0-12) following treatment initiation in treatment-naïve and treatment-experienced users (divided into three cohorts: rheumatoid arthritis [RA], ankylosing spondylitis [AS] and psoriatic arthritis [PsA]). Persistent patients were propensity score matched to nonpersistent patients at M12. The impact of persistence status on HCRU and costs was assessed during M12-24. RESULTS Of treatment-naïve (n = 3,804) and treatment-experienced (n = 2,279) users, only 56.1% and 46.8% were persistent at M12, respectively. Nonpersistent patients had more outpatient visits, computerized tomography scans, spine or joint magnetic resonance imaging procedures and disease-related hospitalizations, while persistent patients had more rheumatologist visits. Nonpersistent patients had lower drug costs but higher nondrug-related healthcare and hospitalization costs than persistent patients. In AS and PsA, overall healthcare costs were similar in persistent and nonpersistent patients. In RA, overall healthcare costs were lower in persistent patients (15,753€ vs 17,590€ in treatment-naïve and 17,622€ vs 21,177€ in treatment-experienced). CONCLUSION Persistence with SC TNF inhibitors within first 12 months following treatment initiation was low in both treatment-naïve and treatment-experienced patients. Differences were observed in distribution of costs between persistent and nonpersistent patients, showing that nonpersistence with SC TNF inhibitors can lead to increased HCRU and higher costs.
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Affiliation(s)
- Manon Belhassen
- Pharmacoepidemiologie Lyon (PELyon), Lyon, France; HESPER 7425, Health Services and Performance Research, University Claude Bernard Lyon 1, Lyon, France
| | - Florence Tubach
- Faculté de Médecine Sorbonne Université, AP-HP, Hôpital Pitié-Salpêtrière, Département Biostatistique Santé Publique et Information Médicale, Centre de Pharmacoépidémiologie (Céphépi), Unité de Recherche Clinique, INSERM, UMR 1123, Sorbonne Université, Paris, CIC-P 1421, France
| | | | - Macha Woronoff-Lemsi
- CHU Besançon, Université Franche-Comté, COMUE UBFC, UMR INSERM, Besançon, 1098, France
| | | | - Eric Van Ganse
- Pharmacoepidemiologie Lyon (PELyon), Lyon, France; HESPER 7425, Health Services and Performance Research, University Claude Bernard Lyon 1, Lyon, France
| | - Bruno Fautrel
- GRC 08, Institut Pierre Louis d'Epidémiologie et Santé Publique, AP-HP, Service de Rhumatologie, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
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386
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Bacry E, Gaïffas S, Leroy F, Morel M, Nguyen DP, Sebiat Y, Sun D. SCALPEL3: A scalable open-source library for healthcare claims databases. Int J Med Inform 2020; 141:104203. [PMID: 32485553 DOI: 10.1016/j.ijmedinf.2020.104203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 05/07/2020] [Accepted: 05/25/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This article introduces SCALPEL3 (Scalable Pipeline for Health Data), a scalable open-source framework for studies involving Large Observational Databases (LODs). It focuses on scalable medical concept extraction, easy interactive analysis, and helpers for data flow analysis to accelerate studies performed on LODs. MATERIALS AND METHODS Inspired from web analytics, SCALPEL3 relies on distributed computing, data denormalization and columnar storage. It was compared to the existing SAS-Oracle SNDS infrastructure by performing several queries on a dataset containing a three years-long history of healthcare claims of 13.7 million patients. RESULTS AND DISCUSSION SCALPEL3 horizontal scalability allows handling large tasks quicker than the existing infrastructure while it has comparable performance when using only a few executors. SCALPEL3 provides a sharp interactive control of data processing through legible code, which helps to build studies with full reproducibility, leading to improved maintainability and audit of studies performed on LODs. CONCLUSION SCALPEL3 makes studies based on SNDS much easier and more scalable than the existing framework [1]. It is now used at the agency collecting SNDS data, at the French Ministry of Health and soon at the National Health Data Hub in France [2].
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Affiliation(s)
- Emmanuel Bacry
- CEREMADE, Université Paris-Dauphine, PSL, Paris, France; CMAP, Ecole Polytechnique, 91128 Palaiseau, France
| | - Stéphane Gaïffas
- LPSM, Université Paris-Diderot, Paris, France; Ecole Normale Supérieure, Paris, France
| | - Fanny Leroy
- Caisse Nationale de l'Assurance Maladie, France
| | - Maryan Morel
- CMAP, Ecole Polytechnique, 91128 Palaiseau, France.
| | - Dinh-Phong Nguyen
- CMAP, Ecole Polytechnique, 91128 Palaiseau, France; Caisse Nationale de l'Assurance Maladie, France
| | | | - Dian Sun
- CMAP, Ecole Polytechnique, 91128 Palaiseau, France
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387
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Benzodiazepine Dispensing to Persons With Dementia in France, 2011-2016: A Nationwide Study. J Am Med Dir Assoc 2020; 21:830-836. [DOI: 10.1016/j.jamda.2020.02.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/19/2020] [Accepted: 02/24/2020] [Indexed: 12/12/2022]
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388
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Piccard M, Roussot A, Cottenet J, Cottin Y, Zeller M, Quantin C. Spatial distribution of in- and out-of-hospital mortality one year after acute myocardial infarction in France. Am J Prev Cardiol 2020; 2:100037. [PMID: 34327460 PMCID: PMC8315588 DOI: 10.1016/j.ajpc.2020.100037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To describe the spatial distribution of acute myocardial infarction (AMI) mortality in France in association with the socio-economic characteristics of the patient's place of residence. METHODS In this population-based study, we included patients hospitalized for AMI identified according to ICD-10 codes, using data from the national health insurance database from January 1, 2013 to December 31, 2014. In- and out-of-hospital deaths were identified over a period of 1 year following the first hospital stay for AMI.An exploratory analysis was performed to classify area profiles. The spatial analysis of AMI mortality was performed using a principal component analysis followed by an ascending hierarchical classification taking into account socio-economic data, access-time by road to coronary angiography, standardized in-hospital prevalence, and 1 year mortality. RESULTS Over the 2 years, 115,418 patients were hospitalized with a diagnosis of AMI. Patients were a mean of 68 ± 15 years and most were men (68.5%). The overall mortality rate was 12.2% after 1 year. More than half of patients (65.5%) underwent an early revascularization procedure. The map of standardized 1 year mortality showed a geographic area of high mortality extending diagonally from north-east to south-west France. We identified 6 different area profiles with standardized mortality varying from 15.9 to 54.4 per 100,000 inhabitants. The spatial distribution of higher mortality was associated with lower socioeconomic levels. These findings were not associated with a lower access to coronary angiography. CONCLUSION There are considerable geographical differences in the prevalence of AMI and 1 year mortality. The spatial distribution of lower healthcare indicators follows the distribution of social inequalities. This study highlights the importance of focusing national policies on universally accessible prevention programs such as the promotion cardiac rehabilitation and healthy lifestyles.
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Affiliation(s)
- Mickael Piccard
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France
- Bourgogne Franche-Comté University, Dijon, France
| | - Adrien Roussot
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France
- Bourgogne Franche-Comté University, Dijon, France
| | - Jonathan Cottenet
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France
- Bourgogne Franche-Comté University, Dijon, France
| | - Yves Cottin
- Department of Cardiology, University Hospital, Dijon, France
- Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases Research Team (PEC2, EA 7460), University of Bourgogne - Franche-Comté, Faculty of Health Sciences, 7 Boulevard Jeanne D’Arc, 21079, Dijon, France
| | - Marianne Zeller
- Department of Cardiology, University Hospital, Dijon, France
- Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases Research Team (PEC2, EA 7460), University of Bourgogne - Franche-Comté, Faculty of Health Sciences, 7 Boulevard Jeanne D’Arc, 21079, Dijon, France
| | - Catherine Quantin
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France
- Bourgogne Franche-Comté University, Dijon, France
- Inserm, CIC 1432, Dijon University Hospital, Clinical Investigation Center, Clinical Epidemiology/ Clinical Trials Unit, Dijon, France
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, High-Dimensional Biostatistics for Drug Safety and Genomics, CESP, Villejuif, France
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389
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Feldman SF, Lesuffleur T, Olié V, Gastaldi-Ménager C, Juillière Y, Tuppin P. Outpatient healthcare utilization 30 days before and after hospitalization for heart failure in France: Contribution of the national healthcare database (Systèmenationaldesdonnéesdesanté). Arch Cardiovasc Dis 2020; 113:401-419. [PMID: 32473996 DOI: 10.1016/j.acvd.2019.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/22/2019] [Accepted: 11/22/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Guidelines have been published concerning patient management after hospitalization for heart failure. The French national healthcare database (Systèmenationaldesdonnéesdesanté; SNDS) can be used to compare these guidelines with real-life practice. AIMS To study healthcare utilization 30 days before and after hospitalization for heart failure, and the variations induced by the exclusion of institutionalized patients, who are less exposed to outpatient healthcare utilization. METHODS We identified the first hospitalization for heart failure in 2015 of adult beneficiaries of the health insurance schemes covering 88% of the French population, who were alive 30 days after hospitalization. Outpatient healthcare utilization rates during the 30 days after hospitalization and the median times to outpatient care, together with their interquartile ranges, were described for all patients, and for a subgroup excluding institutionalized patients. RESULTS Among the 104,984 patients included (mean age 79 years; 52% women), 74% were non-institutionalized (mean age 78 years; 47% women). The frequencies of at least one consultation after hospitalization and the median times to consultation were 69% (total sample) vs. 78% (subgroup excluding institutionalized patients) and 8 days (interquartile range 3; 16) vs. 7 days (3; 15) for general practitioners, 20% vs. 21% and 14 days (7; 23) vs. 16 days (9; 24) for cardiologists and 58% vs. 69% and 3 days (1; 9) vs. 2 days (1; 7) for nurses, with reimbursement of diuretics in 77% vs. 86%, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers in 48% vs. 55% and beta-blockers in 55% vs. 63%. Departmental variations, excluding institutionalized patients, were large: general practice consultations (interquartile range 74%; 83%), cardiology consultations (11%; 23%) and nursing care (68%; 77%). CONCLUSIONS Low outpatient healthcare utilization rates, long intervals to first healthcare utilization and departmental variations indicate a mismatch between guidelines and real-life practice, which is accentuated when including institutionalized patients.
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Affiliation(s)
- Sarah F Feldman
- Caisse nationale de l'assurance maladie (CNAM), 75986 Paris, France
| | | | - Valérie Olié
- Santé publique France, 94410 Saint-Maurice, France
| | | | - Yves Juillière
- Cardiologie, Institut Lorrain du cœur et des vaisseaux Louis-Mathieu, 54500 Vandœuvre-lès-Nancy, France
| | - Philippe Tuppin
- Caisse nationale de l'assurance maladie (CNAM), 75986 Paris, France.
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390
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Gombault‐Datzenko E, Gallini A, Carcaillon‐Bentata L, Fabre D, Nourhashemi F, Andrieu S, Rachas A, Gardette V. Alzheimer’s disease and related syndromes and hospitalization: a nationwide 5‐year longitudinal study. Eur J Neurol 2020; 27:1436-1447. [DOI: 10.1111/ene.14256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 11/01/2019] [Accepted: 04/02/2020] [Indexed: 12/25/2022]
Affiliation(s)
| | - A. Gallini
- Department of Epidemiology University Hospital of Toulouse Toulouse France
- UMR1027 Epidemiology and Analyses in Public Health INSERM Toulouse France
- Faculty of Medicine Department of Epidemiology and Public Health Université de Toulouse III Toulouse France
| | | | - D. Fabre
- Department of Medical Information University Hospital of Toulouse Toulouse France
| | - F. Nourhashemi
- Faculty of Medicine Department of Epidemiology and Public Health Université de Toulouse III Toulouse France
- Gérontopole Cité de la Santé University Hospital of Toulouse Toulouse France
| | - S. Andrieu
- Department of Epidemiology University Hospital of Toulouse Toulouse France
- UMR1027 Epidemiology and Analyses in Public Health INSERM Toulouse France
- Faculty of Medicine Department of Epidemiology and Public Health Université de Toulouse III Toulouse France
| | | | - V. Gardette
- Department of Epidemiology University Hospital of Toulouse Toulouse France
- UMR1027 Epidemiology and Analyses in Public Health INSERM Toulouse France
- Faculty of Medicine Department of Epidemiology and Public Health Université de Toulouse III Toulouse France
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391
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Gandré C, Coldefy M. Disparities in the Use of General Somatic Care among Individuals Treated for Severe Mental Disorders and the General Population in France. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103367. [PMID: 32408658 PMCID: PMC7277621 DOI: 10.3390/ijerph17103367] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 04/30/2020] [Accepted: 05/10/2020] [Indexed: 01/13/2023]
Abstract
Individuals with severe mental illnesses (SMI) face a striking excess and premature mortality which has been demonstrated in several national contexts. This phenomenon, which constitutes a red-flag indicator of public health inequities, can be hypothesized to result from healthcare access issues which have been insufficiently documented so far. In this context, our objective was to explore patterns of general somatic healthcare use of individuals treated for SMI in comparison to those of the general population in France using national health administrative data and a matched case-control study. Differences in the use of general and specific somatic preventive care services, primary care, routine specialized somatic care and admissions to non-psychiatric hospital departments for somatic causes were described between cases and controls after adjustment on differing clinical needs, socio-economic status, and living environment. Our results show a lower use of general preventive care services and of routine specialized somatic care in the SMI population, despite more frequent comorbidities, and a higher occurrence of avoidable hospitalizations, despite higher contacts with primary care physicians. These findings suggest that the health system fails to address the specific needs of this vulnerable population and support the development of measures aimed at reducing this gap.
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392
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Emery C, Torreton E, Briere JB, Evers T, Fagnani F. Economic burden of coronary artery disease or peripheral artery disease in patients at high risk of ischemic events in the French setting: a claims database analysis. J Med Econ 2020; 23:513-520. [PMID: 31928390 DOI: 10.1080/13696998.2020.1715415] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Aims: Estimate the direct costs of high-risk patients presenting with coronary artery disease (CAD) or peripheral artery disease (PAD) in France.Materials and methods: This retrospective cohort study used a representative claims database, the "Echantillon Généraliste de Bénéficiaires" (EGB), to identify patients presenting with CAD or PAD between 2011 and 2016. Among those, patients meeting the COMPASS trial selection criteria were selected, as well as controls matched on age and sex. Direct costs (Euros 2016) were estimated in a societal perspective by comparing case and controls.Results: The adult population presenting with CAD or PAD in the EGB in 2016 was estimated at 29,888 individuals, representing a crude prevalence rate of 5.44%. After using the documented selection criteria of the COMPASS study, this population (COMPASS-like) was estimated at 17,369 individuals (58.1% of the CAD and/or PAD total population). Among them, a proportion of 11.5% presented with CAD + PAD. Compared with the original COMPASS population, patients were older (76.5 vs 68.2 years) and with a lower male predominance (60.0% vs 78.2% males). Compared with controls, the COMPASS-like population was characterized by a higher annual mortality (5.9% vs 3.5%) and the presence of more comorbidities on top of CAD and/or PAD. The annual per capita extra direct cost of the COMPASS-like population was estimated at €4,284, with a main contribution from inpatient care (58.9%). This extra cost was higher in the PAD ± CAD sub-group (€5,552) and the CAD + PAD sub-group (€8,067).Limitations: The EGB had limitations about several clinical features defining high-risk patients that may lead to bias in our estimates.Conclusions: Due to the high prevalence of CAD and/or PAD and the associated high unit costs, this population generates a significant economic burden, which is higher among patients with PAD and in those presenting simultaneously with both conditions.
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393
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Ousseine YM, Bouhnik AD, Peretti-Watel P, Sarradon-Eck A, Memoli V, Bendiane MK, Durand MA, Mancini J. The impact of health literacy on medico-social follow-up visits among French cancer survivors 5 years after diagnosis: The national VICAN survey. Cancer Med 2020; 9:4185-4196. [PMID: 32329183 PMCID: PMC7300405 DOI: 10.1002/cam4.3074] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 04/03/2020] [Accepted: 04/04/2020] [Indexed: 12/18/2022] Open
Abstract
Background Long‐term medico‐social follow‐up of cancer survivors is a challenge because of frequent subsequent troubles. In particular survivors with lower health literacy (HL) have poorer health and might more often use primary care services. However, the impact of HL on cancer survivors’ medico‐social follow‐up visits is not known. Our aim was to study medico‐social follow‐up and its associated determinants with a focus on HL 5 years after diagnosis. Methods VICAN is a national survey of French adult cancer survivors 5 years after a primary cancer. The Single‐Item Literacy Screener was used to define functional HL in this sample. We also asked patients to report the frequency of follow‐up visits with a general practitioner (GP) and/or social worker (SW) regarding their cancer disease. Results The 4045 participants were 57.4 ± 12.9 years old at diagnosis (range 20‐82) and 1495 (37%) were classified as having inadequate HL. Most cancer survivors (66.7%) were followed up by a GP regarding their cancer while only 14.5% had contact with a SW. After adjustment for sociodemographic, medical, and psychosocial characteristics, medico‐social follow‐ups (GP and SW visits) were more frequent among survivors with low HL. Furthermore, low income, unemployment, impaired mental health, treatment by chemotherapy, and perception of sequelae and fatigue were also associated with more frequent medico‐social follow‐up. Cancer localization association with medico‐social follow‐up was heterogeneous. Conclusion French cancer survivors with limited HL, lower socioeconomic status, and more severe cancer were more likely to use GP care and social services. Raising awareness and training GPs and SWs on medico‐social follow‐up for patients with limited HL seem necessary to support these vulnerable survivors.
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Affiliation(s)
- Youssoufa M Ousseine
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| | - Anne-Déborah Bouhnik
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| | | | - Aline Sarradon-Eck
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,Institut Paoli-Calmettes, UMR1252 SESSTIM CANBIOS, Marseille, France
| | - Victoria Memoli
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| | - Marc-Karim Bendiane
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA
| | - Julien Mancini
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,APHM, Hop Timone, BIOSTIC, Marseille, France
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394
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Bonnet F, Bénard A, Poulizac P, Afonso M, Maillard A, Salvo F, Berdaï D, Salles N, Rousselot N, Marchi S, Hayes N, Joseph JP. Discontinuing statins or not in the elderly? Study protocol for a randomized controlled trial. Trials 2020; 21:342. [PMID: 32307005 PMCID: PMC7169009 DOI: 10.1186/s13063-020-04259-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 03/15/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The risk/benefit ratio of using statins for primary prevention of cardiovascular (CV) events in elderly people has not been established. The main objectives of the present study are to assess the cost-effectiveness of statin cessation and to examine the non-inferiority of statin cessation in terms of mortality in patients aged 75 years and over, treated with statins for primary prevention of CV events. METHODS The "Statins in the elderly" (SITE) study is an ongoing 3-year follow-up, open-label comparative multi-centre, randomized clinical trial that is being conducted in two parallel groups in outpatient primary care offices. Participants meeting the following criteria are included: people aged 75 years and older being treated with statins as primary prevention for CV events, who provide informed consent. After randomization, patients in the statin-cessation strategy are instructed to withdraw their treatment. In the comparison strategy, patients continue their statin treatment at the usual dosage. The cost-effectiveness of the statin-cessation strategy compared to continuing statins will be estimated through the incremental cost per quality-adjusted life years (QALYs) gained at 36 months, from the perspective of the French healthcare system. Overall mortality will be the primary clinical endpoint. We assumed that the mortality rate at 3 years will be 15%. The sample size was computed to achieve 90% power in showing the non-inferiority of statin cessation, assuming a non-inferiority margin of 5% of the between-group difference in overall mortality. In total, the SITE study will include 2430 individuals. DISCUSSION There is some debate on the value of statins in people over 75 years old, especially for primary prevention of CV events, due to a lack of evidence of their efficacy in this population, potential compliance-related events, drug-drug interactions and side effects that could impair quality of life. Data from clinical trials guide the initiation of medication therapy for primary or secondary prevention of CV disease but do not define the timing, safety, or risks of discontinuing the agents. The SITE study is one of the first to examine whether treatment cessation is a cost-effective and a safe strategy in people of 75 years and over, formerly treated with statins. TRIAL REGISTRATION ClinicalTrials.gov: NCT02547883. Registered on 11 September 2015.
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Affiliation(s)
- Fabrice Bonnet
- CHU de Bordeaux, Service de Médecine Interne et Maladies Infectieuses, Saint-André Hospital, 1 rue Jean Burguet, F-33000, Bordeaux, France.
- ISPED, INSERM U1219, Bordeaux Population Health Research Center, University of Bordeaux, F-33000, Bordeaux, France.
| | - Antoine Bénard
- CHU de Bordeaux, Pôle de Santé Publique, Clinical Epidemiology Unit (USMR), F-33000, Bordeaux, France
- ISPED, INSERM U1219, Bordeaux Population Health Research Center, Team EMOS, UMR 1219, University of Bordeaux, F-33000, Bordeaux, France
| | - Pierre Poulizac
- CHU de Bordeaux, Direction de la Recherche Clinique et de l'Innovation, F-33000, Bordeaux, France
| | - Mélanie Afonso
- Département de Médecine Générale, University of Bordeaux, F-33000, Bordeaux, France
| | - Aline Maillard
- CHU de Bordeaux, Pôle de Santé Publique, Clinical Epidemiology Unit (USMR), F-33000, Bordeaux, France
| | - Francesco Salvo
- ISPED, INSERM U1219, Bordeaux Population Health Research Center, Pharmaco-Epidemiology Team, UMR 1219, University of Bordeaux, F-33000, Bordeaux, France
- CHU de Bordeaux, Service de Pharmacologie Médicale, F-33000, Bordeaux, France
| | - Driss Berdaï
- CHU de Bordeaux, Service de Pharmacologie Médicale, F-33000, Bordeaux, France
| | - Nathalie Salles
- CHU de Bordeaux, Service de Gériatrie, Hôpital Haut-Lévêque, F-33000, Bordeaux, France
| | - Nicolas Rousselot
- Département de Médecine Générale, University of Bordeaux, F-33000, Bordeaux, France
| | - Sébastien Marchi
- CHU de Bordeaux, Direction de la Recherche Clinique et de l'Innovation, F-33000, Bordeaux, France
| | - Nathalie Hayes
- CHU de Bordeaux, Direction de la Recherche Clinique et de l'Innovation, F-33000, Bordeaux, France
| | - Jean-Philippe Joseph
- ISPED, INSERM U1219, Bordeaux Population Health Research Center, University of Bordeaux, F-33000, Bordeaux, France
- Département de Médecine Générale, University of Bordeaux, F-33000, Bordeaux, France
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395
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FitzGerald RE. Perspective on Health Effects of Endocrine Disruptors with a Focus on Data Gaps. Chem Res Toxicol 2020; 33:1284-1291. [DOI: 10.1021/acs.chemrestox.9b00529] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Rex E. FitzGerald
- Swiss Centre for Applied Human Toxicology SCAHT, University of Basel, Missionsstrasse 64, CH-4055 Basel, Switzerland
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396
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Incidence of and Risk Factors for Systemic Adverse Events After Screening or Primary Diagnostic Colonoscopy: A Nationwide Cohort Study. Am J Gastroenterol 2020; 115:537-547. [PMID: 32149780 DOI: 10.14309/ajg.0000000000000574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To estimate the systemic serious adverse event (SAE) rates after colonoscopy and to identify their risk factors. METHODS A nationwide cohort study was conducted using the comprehensive French claims databases SNDS (National Health Data System). Patients aged 30 years and over who underwent a first screening or diagnostic colonoscopy in 2010-2015 were included. The rates of cardiovascular and renal SAEs were estimated within 5 days after colonoscopy. The standardized incidence ratios were calculated to compare these incidence rates with those of the same events in the general population, and the associated risk factors were assessed by multilevel logistic regression. RESULTS Among the 4,088,799 included patients (median age, 59 years [interquartile range = 50-67]; 55.2% women; 30.1% with a Charlson index score ≤1), the 5-day SAE incidence rate was 2.8/10,000 procedures for shock, 0.87/10,000 for myocardial infarction, 1.9/10,000 for stroke, 2.9/10,000 for pulmonary embolism, 5.5/10,000 for acute renal failure, and 3.3/10,000 for urolithiasis. These SAEs occurred 3.3 to 15.8 times more often during the first 5 days after colonoscopy than expected in the general population. Thirty-day mortality rates ranged from 2.2/1,000 cases of urolithiasis to 268.1/1,000 cases of shock. Increasing age was associated with an increasing incidence of SAEs. Risks of shock and acute renal failure were associated with a greater number of comorbidities than the other SAEs. Colonoscopies in university hospitals were associated with higher risks, reflecting patient selection processes. DISCUSSION The systemic SAEs can be associated with a substantial mortality. They should be taken into account when deciding colonoscopy, in addition to perforation and bleeding, particularly in elderly patients with multiple comorbidities.
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397
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Lannou S, Mansencal N, Couchoud C, Lassalle M, Dubourg O, Stengel B, Jacquelinet C, Charron P. The Public Health Burden of Cardiomyopathies: Insights from a Nationwide Inpatient Study. J Clin Med 2020; 9:jcm9040920. [PMID: 32230881 PMCID: PMC7230913 DOI: 10.3390/jcm9040920] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 11/16/2022] Open
Abstract
Cardiomyopathies are responsible for heart failure and sudden cardiac death, but epidemiological data are scarce and the public health burden may be underestimated. We studied aggregating data from all public or private hospitals in France. Patients were categorized from relevant ICD-10 codes into dilated, hypertrophic, restrictive, or other cardiomyopathies (DCM, HCM, RCM, or OCM, respectively). Between 2008 and 2015, a total of 326,461 distinct patients had cardiomyopathy-related hospitalizations. The hospital-based prevalence of cardiomyopathy was 809 per million inhabitants (PMI) per year, including 428 PMI for DCM, 101 PMI for HCM, 26 PMI for RCM, and 253 PMI for OCM. Patients with cardiomyopathies accounted for 51% of all heart transplants, 33% of defibrillator implantations, 38% of mechanical circulatory supports, and 11.3% of hospitalizations for heart failure. In patients less than 40 years of age, these figures were 71%, 51%, 63%, and 23%, respectively. Over 2008–2015 and considering all cardiomyopathies, there was a significant increase for heart transplant (average annual percentage change, AAPC: +3.86%, p = 0.0015) and for defibrillator implantation (AAPC: +6.98%, p < 0.0001), and a significant decrease of in-hospital mortality (AAPC: −4.7%, p = 0.0002). This nationwide study shows that cardiomyopathies constitute an important cause of hospitalization, with increasing invasive therapeutic procedures and decreasing mortality.
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Affiliation(s)
- Simon Lannou
- APHP, Service de Cardiologie, Centre de référence des maladies cardiaques héréditaires ou rares, Hôpital Ambroise Paré, 92100 Boulogne Billancourt, France; (S.L.); (N.M.); (O.D.)
| | - Nicolas Mansencal
- APHP, Service de Cardiologie, Centre de référence des maladies cardiaques héréditaires ou rares, Hôpital Ambroise Paré, 92100 Boulogne Billancourt, France; (S.L.); (N.M.); (O.D.)
- Univ Paris-Saclay, Univ Versailles-Saint Quentin, Univ Paris-Sud, Inserm, Clinical Epidemiology Team, CESP Centre for Research in Epidemiology and Population Health, 94807 Villejuif, France; (B.S.); (C.J.)
| | - Cécile Couchoud
- Agence de la Biomédecine, 93212 Saint-Denis la Plaine, France; (C.C.); (M.L.)
| | - Mathilde Lassalle
- Agence de la Biomédecine, 93212 Saint-Denis la Plaine, France; (C.C.); (M.L.)
| | - Olivier Dubourg
- APHP, Service de Cardiologie, Centre de référence des maladies cardiaques héréditaires ou rares, Hôpital Ambroise Paré, 92100 Boulogne Billancourt, France; (S.L.); (N.M.); (O.D.)
- Univ Paris-Saclay, Univ Versailles-Saint Quentin, Univ Paris-Sud, Inserm, Clinical Epidemiology Team, CESP Centre for Research in Epidemiology and Population Health, 94807 Villejuif, France; (B.S.); (C.J.)
| | - Bénédicte Stengel
- Univ Paris-Saclay, Univ Versailles-Saint Quentin, Univ Paris-Sud, Inserm, Clinical Epidemiology Team, CESP Centre for Research in Epidemiology and Population Health, 94807 Villejuif, France; (B.S.); (C.J.)
| | - Christian Jacquelinet
- Univ Paris-Saclay, Univ Versailles-Saint Quentin, Univ Paris-Sud, Inserm, Clinical Epidemiology Team, CESP Centre for Research in Epidemiology and Population Health, 94807 Villejuif, France; (B.S.); (C.J.)
- Agence de la Biomédecine, 93212 Saint-Denis la Plaine, France; (C.C.); (M.L.)
| | - Philippe Charron
- APHP, Service de Cardiologie, Centre de référence des maladies cardiaques héréditaires ou rares, Hôpital Ambroise Paré, 92100 Boulogne Billancourt, France; (S.L.); (N.M.); (O.D.)
- APHP, Département de Génétique, Centre de référence des maladies cardiaques héréditaires ou rares, Hôpital Pitié-Salpêtrière, 75013 Paris, France
- Sorbonne Université, INSERM, UMR_S 1166 and ICAN Institute for Cardiometabolism and Nutrition, 75013 Paris, France
- Correspondence: ; Tel.: +33-1-42-16-13-47
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398
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Hospitalisations with infections related to antimicrobial-resistant bacteria from the French nationwide hospital discharge database, 2016. Epidemiol Infect 2020; 147:e144. [PMID: 30869047 PMCID: PMC6518510 DOI: 10.1017/s0950268819000402] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Massive use of antibiotics has led to increased bacterial resistance to these drugs, making infections more difficult to treat. Few studies have assessed the overall antimicrobial resistance (AMR) burden, and there is a paucity of comprehensive data to inform health policies. This study aims to assess the overall annual incident number of hospitalised patients with AMR infection in France, using the National Hospital Discharge database. All incident hospitalisations with acute infections in 2016 were extracted. Infections which could be linked with an infecting microorganism were first analysed. Then, an extrapolation of bacterial species and resistance status was performed, according to age class, gender and infection site to estimate the total number of AMR cases. Resistant bacteria caused 139 105 (95% CI 127 920-150 289) infections, resulting in a 12.3% (95% CI 11.3-13.2) resistance rate. ESBL-producing Enterobacteriaceae and methicillin-resistant Staphylococcus aureus were the most common resistant bacteria (>50%), causing respectively 49 692 (95% CI 47 223-52 142) and 19 493 (95% CI 15 237-23 747) infections. Although assumptions are needed to provide national estimates, information from PMSI is comprehensive, covering all acute bacterial infections and a wide variety of microorganisms.
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399
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Pladys A, Defossez G, Lemordant P, Lassalle M, Ingrand P, Jacquelinet C, Riou C, Bouzillé G, Van Hille P, Vigneau C, Cuggia M, Bayat S. Cancer risk in dialyzed patients with and without diabetes. Cancer Epidemiol 2020; 65:101689. [PMID: 32126508 DOI: 10.1016/j.canep.2020.101689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/14/2020] [Accepted: 02/17/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The risk of cancer is higher in patients with renal diseases and diabetes compared with the general population. The aim of this study was to assess in dialyzed patients, the association between diabetes and the risk to develop a cancer after dialysis start. METHODS All patients who started dialysis in the French region of Poitou-Charentes between 2008 and 2015 were included. Their baseline characteristics were extracted from the French Renal Epidemiology and Information Network and were linked to data relative to cancer occurrence from the Poitou-Charentes General Cancer Registry using a procedure developed by the INSHARE platform. The association between diabetes and the risk of cancer was assessed using the Fine & Gray model that takes into account the competing risk of death. RESULTS Among the 1634 patients included, 591 (36.2 %) had diabetes and 91 (5.6 %) patients developed a cancer (n = 24 before or at dialysis start, and n = 67 after dialysis start). The risk to develop a cancer after dialysis initiation was lower in dialyzed patients with diabetes than without diabetes (SHR = 0.54; 95 %CI: 0.32-0.91). Moreover, compared with the general population, the cancer risk was higher in dialyzed patients without diabetes, but not in those with diabetes. CONCLUSION The risk of developing a cancer in the region of Poitou-Charentes is higher in dialyzed patients without diabetes than with diabetes.
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Affiliation(s)
- Adélaïde Pladys
- Univ Rennes, EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins) - EA 7449, F-35000 Rennes, France
| | - Gautier Defossez
- Poitou-Charentes General Cancer Registry, Poitiers University Hospital, University of Poitiers, Poitiers, France; INSERM, CIC1402, Poitiers, France
| | - Pierre Lemordant
- Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, F-35000 Rennes, France
| | - Mathilde Lassalle
- Renal Epidemiology and Information Network (REIN), Biomedicine Agency, La Plaine Saint-Denis, France
| | - Pierre Ingrand
- Poitou-Charentes General Cancer Registry, Poitiers University Hospital, University of Poitiers, Poitiers, France; INSERM, CIC1402, Poitiers, France
| | - Christian Jacquelinet
- Renal Epidemiology and Information Network (REIN), Biomedicine Agency, La Plaine Saint-Denis, France; CESP Centre for Research in Epidemiology and Population Health, Inserm UMRS 1018, Univ Versailles-Saint Quentin, Univ Paris-Saclay, Univ Paris Sud, Villejuif, France.
| | - Christine Riou
- Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, F-35000 Rennes, France
| | - Guillaume Bouzillé
- Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, F-35000 Rennes, France
| | - Pascal Van Hille
- Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, F-35000 Rennes, France
| | - Cécile Vigneau
- University of Rennes 1, INSERM U1085-IRSET, Rennes, France; CHU Pontchaillou, Department of Nephrology, Rennes, France
| | - Marc Cuggia
- Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, F-35000 Rennes, France
| | - Sahar Bayat
- Univ Rennes, EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins) - EA 7449, F-35000 Rennes, France
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400
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Barré T, Marcellin F, Di Beo V, Delorme J, Rojas Rojas T, Mathurin P, Protopopescu C, Bailly F, Coste M, Authier N, Carrieri MP, Rolland B. Untreated alcohol use disorder in people who inject drugs (PWID) in France: a major barrier to HCV treatment uptake (the ANRS-FANTASIO study). Addiction 2020; 115:573-582. [PMID: 31595554 PMCID: PMC7027887 DOI: 10.1111/add.14820] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/11/2019] [Accepted: 09/06/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Although people who inject drugs (PWID) are the core at-risk population in the hepatitis C virus (HCV) epidemic in industrialized countries, few initiate treatment. Alcohol use disorder (AUD), common within this population, has been identified as a barrier to HCV treatment uptake in the general population. We investigated whether the arrival of new and well-tolerated HCV treatments (direct-acting antivirals: DAA) has improved HCV treatment uptake in French PWID compared with former treatments (pegylated interferon-based treatments: Peg-IFN). DESIGN Using discrete-time Cox proportional hazards models based on exhaustive care delivery data, we tested for associations between AUD (defined by AUD-related long-term illness status, diagnosis coding during hospitalization and/or AUD pharmacological treatment) and first HCV treatment delivery, after adjusting for gender, age, complementary universal health cover, liver disease severity and type of opioid agonist therapy (OAT) received. Separate analyses were performed for 2012-13 (Peg-IFN era) and 2014-16 (DAA era). SETTING France. PARTICIPANTS All French people chronically HCV-infected who received OAT at least once during 2012-16 and were covered by the national health insurance (n = 24 831). MEASUREMENTS Incidence rate of HCV treatment uptake, hazard ratios associated with AUD and other covariates. FINDINGS Incidence rate (IR) of HCV treatment uptake per 100 person-years was 6.56, confidence interval (CI) = 6.30-6.84; and IR = 5.70, 95% CI = 5.51-5.89 for Peg-IFN-based treatment (2012-13) and DAA (2014-16), respectively. After multiple adjustment, people with AUD not receiving related medication had 30 and 14% lower Peg-IFN-based treatment and DAA uptake, respectively, than those without AUD [hazard ratio (HR) = 0.70, 95% CI = 0.62-0.80 and HR = 0.86, 95% CI = 0.78-0.94]. No difference was observed between those treated for AUD and those without AUD. CONCLUSIONS Despite the benefits of direct-acting antiviral treatment, untreated alcohol use disorder appears to remain a major barrier to hepatitis C virus treatment access for people who inject drugs in France.
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Affiliation(s)
- Tangui Barré
- Aix Marseille Université, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information MédicaleMarseilleFrance,ORS PACA, Observatoire Régional de la Santé Provence‐Alpes‐Côte d'AzurMarseilleFrance
| | - Fabienne Marcellin
- Aix Marseille Université, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information MédicaleMarseilleFrance,ORS PACA, Observatoire Régional de la Santé Provence‐Alpes‐Côte d'AzurMarseilleFrance
| | - Vincent Di Beo
- Aix Marseille Université, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information MédicaleMarseilleFrance,ORS PACA, Observatoire Régional de la Santé Provence‐Alpes‐Côte d'AzurMarseilleFrance
| | - Jessica Delorme
- CHU Clermont‐Ferrand, Neuro‐Dol, Service de pharmacologie médicale, Centres addictovigilance et pharmacovigilanceUniversité Clermont AuvergneClermont‐FerrandFrance
| | - Teresa Rojas Rojas
- Aix Marseille Université, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information MédicaleMarseilleFrance,ORS PACA, Observatoire Régional de la Santé Provence‐Alpes‐Côte d'AzurMarseilleFrance
| | - Philippe Mathurin
- Service des maladies de l'appareil digestif, CHU LilleUniversité de LilleLilleFrance
| | - Camelia Protopopescu
- Aix Marseille Université, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information MédicaleMarseilleFrance,ORS PACA, Observatoire Régional de la Santé Provence‐Alpes‐Côte d'AzurMarseilleFrance
| | - François Bailly
- Service d'hépatologie et d'addictologie, Groupe hospitalier Nord, Hôpital de la Croix‐RousseLyonFrance
| | - Marion Coste
- Aix Marseille Université, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information MédicaleMarseilleFrance,ORS PACA, Observatoire Régional de la Santé Provence‐Alpes‐Côte d'AzurMarseilleFrance
| | - Nicolas Authier
- CHU Clermont‐Ferrand, Neuro‐Dol, Service de pharmacologie médicale, Centres addictovigilance et pharmacovigilanceUniversité Clermont AuvergneClermont‐FerrandFrance
| | - Maria Patrizia Carrieri
- Aix Marseille Université, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information MédicaleMarseilleFrance,ORS PACA, Observatoire Régional de la Santé Provence‐Alpes‐Côte d'AzurMarseilleFrance
| | - Benjamin Rolland
- Service Universitaire d'Addictologie de Lyon (SUAL), CH Le VinatierUniversité de LyonBronFrance
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