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Magyari M, Koechlin A, Duclos A, Kopp TI, Allaoui EM, Polazzi S, Seeldrayers P, Autier P. Long-Term Safety of Teriflunomide in Multiple Sclerosis Patients: Results of Prospective Comparative Studies in Three European Countries. Pharmacoepidemiol Drug Saf 2024; 33:e5866. [PMID: 39013832 DOI: 10.1002/pds.5866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 05/02/2024] [Accepted: 06/20/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND AND OBJECTIVES Teriflunomide is a disease-modifying therapy (DMT) for multiple sclerosis (MS). This post authorisation safety study assessed risks of adverse events of special interest (AESI) associated with teriflunomide use. METHODS Secondary use of individual data from the Danish MS Registry (DMSR), the French National Health Data System (SNDS), the Belgian national database of health care claims (AIM-IMA) and the Belgian Treatments in MS Registry (Beltrims). We included patients treated with a DMT at the date of teriflunomide reimbursement or initiating another DMT. Adjusted hazard rates (aHR) and 95% confidence intervals were derived from Cox models with time-dependent exposure comparing teriflunomide treatment with another DMT. RESULTS Of 81 620 patients (72% women) included in the cohort, 22 324 (27%) were treated with teriflunomide. After a median follow-up of 4 years, teriflunomide use compared to other DMT was not associated with a risk of all-cause mortality, severe infection, pneumoniae, herpes zoster reactivation, pancreatitis, cardiovascular condition and cancers. For opportunistic infections, aHR for teriflunomide versus other DMT was 2.4 (1.2-4.8) in SNDS, which was not bound to a particular opportunistic agent. The aHR was 2.0 (1.1-3.7) for renal failures in the SNDS, but no association was found in other data sources. A total of 187 SNDS patients had a history of renal failure prior to cohort entry. None of these patients (0%) had a renal failure recurrence when treated with teriflunomide for 19 (13%) recurrences reported for patients on another DMT. DISCUSSION We found no evidence that teriflunomide use would be associated with an increased risk of AESI. Trial Registration EUPAS register: EU PAS 19610.
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Affiliation(s)
- Melinda Magyari
- Danish Multiple Sclerosis Registry, Copenhagen University Hospital Rigshospitalet Denmark, Glostrup, Denmark
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark
- Institute for Clinical Medicine, University of Copenhagen, Denmark
| | - Alice Koechlin
- International Prevention Research Institute (iPRI), Lyon, France
| | - Antoine Duclos
- Health Data Department, Hospices Civils de Lyon, Lyon, France
| | - Tine Iskov Kopp
- Danish Multiple Sclerosis Registry, Copenhagen University Hospital Rigshospitalet Denmark, Glostrup, Denmark
| | - El Maâti Allaoui
- L'Agence Intermutualiste-Het InterMutualistisch Agentschap (AIM-IMA), Brussels, Belgium
| | | | | | - Philippe Autier
- International Prevention Research Institute (iPRI), Lyon, France
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Couderc AL, Bouhnik AD, Rey D, Bendiane MK, Greillier L, Nouguerède É, Pille A, Montegut C, Rousseau F, Villani P, Mancini J. Quality of life in older French long-term lung cancer survivors: VICAN5 national survey. Lung Cancer 2023; 180:107197. [PMID: 37116376 DOI: 10.1016/j.lungcan.2023.107197] [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: 01/29/2023] [Revised: 04/13/2023] [Accepted: 04/17/2023] [Indexed: 04/30/2023]
Abstract
OBJECTIVES This study aimed to describe quality of life (QoL) five years after diagnosis, in a representative sample of lung cancer (LC) survivors, to compare the QoL of survivors aged 70 years or older with that of younger ones, and to identify factors associated with poorer long-term QoL in both age groups. MATERIALS AND METHODS Our study sample consists of all individuals with a LC diagnosed between January 2010 and December 2011, who participated in the French national survey VICAN 5. RESULTS A total of 371 participants had LC. At the time of the survey, 21.3% of the participants were 70 years or older. In this older age group, feeling self-conscious about appearance and suspected neuropathic pain were independently associated with physical QoL impairment and lower Post-Traumatic Growth Inventory score, and suspected neuropathic pain was associated with impaired mental QoL. In younger patients, impaired physical QoL was independently associated with male gender, metastatic cancer, suspected neuropathic pain, report of severe after-effects of LC and difficulty breathing at rest in the past 7 days, and impaired mental QoL was independently associated with male gender, impaired ECOG-PS, and anxiety. CONCLUSION Factors associated with an impaired QoL in LC survivors, varied according to patient age. In both populations, psychological support and adapted physical activity can be offered to improve mental QoL and physical symptomatology. For older survivors with neuropathic pain, analgesic therapies can be discussed to improve long-term QoL.
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Affiliation(s)
- Anne-Laure Couderc
- Internal Medicine, Geriatrics and Therapeutic Unit, AP-HM, Marseille, France; Aix-Marseille Univ, CNRS, EFS, ADES, Marseille, France.
| | - Anne-Déborah Bouhnik
- Aix Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Economics & Social Sciences Applied to Health & Analysis of Medical Information, Marseille, France
| | - Dominique Rey
- Internal Medicine, Geriatrics and Therapeutic Unit, AP-HM, Marseille, France; Aix-Marseille Univ, CNRS, EFS, ADES, Marseille, France
| | - Marc-Karim Bendiane
- Aix Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Economics & Social Sciences Applied to Health & Analysis of Medical Information, Marseille, France
| | - Laurent Greillier
- Multidisciplinary Oncology and Therapeutic Innovations Department, AP-HM, Marseille, France; Aix-Marseille Univ, CNRS, INSERM, CRCM, Marseille, France
| | - Émilie Nouguerède
- Internal Medicine, Geriatrics and Therapeutic Unit, AP-HM, Marseille, France
| | - Ariane Pille
- Internal Medicine, Geriatrics and Therapeutic Unit, AP-HM, Marseille, France
| | - Coline Montegut
- Internal Medicine, Geriatrics and Therapeutic Unit, AP-HM, Marseille, France; Oncology Department, Institut Paoli Calmettes, Marseille, France
| | | | - Patrick Villani
- Internal Medicine, Geriatrics and Therapeutic Unit, AP-HM, Marseille, France; Aix-Marseille Univ, CNRS, EFS, ADES, Marseille, France
| | - Julien Mancini
- Aix Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Economics & Social Sciences Applied to Health & Analysis of Medical Information, Marseille, France; APHM, BIOSTIC, Hop Timone, Marseille, France
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Guo Ie H, Tang CH, Sheu ML, Liu HY, Lu N, Tsai TY, Chen BL, Huang KC. Evaluation of risk adjustment performance of diagnosis-based and medication-based comorbidity indices in patients with chronic obstructive pulmonary disease. PLoS One 2022; 17:e0270468. [PMID: 35802678 PMCID: PMC9269939 DOI: 10.1371/journal.pone.0270468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 06/12/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives
This study assessed risk adjustment performance of six comorbidity indices in two categories of comorbidity measures: diagnosis-based comorbidity indices and medication-based ones in patients with chronic obstructive pulmonary disease (COPD).
Methods
This was a population–based retrospective cohort study. Data used in this study were sourced from the Taiwan National Health Insurance Research Database. The study population comprised all patients who were hospitalized due to COPD for the first time in the target year of 2012. Each qualified patient was individually followed for one year starting from the index date to assess two outcomes of interest, medical expenditures within one year after discharge and in-hospital mortality of patients. To assess how well the added comorbidity measures would improve the fitted model, we calculated the log-likelihood ratio statistic G2. Subsequently, we compared risk adjustment performance of the comorbidity indices by using the Harrell c-statistic measure derived from multiple logistic regression models.
Results
Analytical results demonstrated that that comorbidity measures were significant predictors of medical expenditures and mortality of COPD patients. Specifically, in the category of diagnosis-based comorbidity indices the Elixhauser index was superior to other indices, while the RxRisk-V index was a stronger predictor in the framework of medication-based codes, for gauging both medical expenditures and in-hospital mortality by utilizing information from the index hospitalization only as well as the index and prior hospitalizations.
Conclusions
In conclusion, this work has ascertained that comorbidity indices are significant predictors of medical expenditures and mortality of COPD patients. Based on the study findings, we propose that when designing the payment schemes for patients with chronic diseases, the health authority should make adjustments in accordance with the burden of health care caused by comorbid conditions.
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Affiliation(s)
- Huei Guo Ie
- Teaching Resource Center, Office of Academic Affairs, Taipei Medical University, Taipei City, Taiwan
| | - Chao-Hsiun Tang
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei City, Taiwan
| | - Mei-Ling Sheu
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei City, Taiwan
| | - Hung-Yi Liu
- Health and Clinical Research Data Center, Taipei Medical University, Taipei City, Taiwan
| | - Ning Lu
- Department of Health Administration, College of Health and Human Services, Governors State University, University Park, Illinois, United States of America
| | - Tuan-Ya Tsai
- Department of Pharmacy, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
| | - Bi-Li Chen
- Department of Pharmacy, Taipei Medical University Hospital, Taipei City, Taiwan
| | - Kuo-Cherh Huang
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei City, Taiwan
- * E-mail:
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Victoria M, Marie B, Dominique R, Caroline A, Marc-Karim BD, Julien M, Sophie L, Anne-Déborah B. Breast reconstruction and quality of life five years after cancer diagnosis: VICAN French National cohort. Breast Cancer Res Treat 2022; 194:449-461. [PMID: 35608713 DOI: 10.1007/s10549-022-06626-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 05/03/2022] [Indexed: 12/26/2022]
Abstract
PURPOSE Women with breast cancer (BC) who have a mastectomy may subsequently undergo breast reconstruction (BR). This study aimed to identify (1) factors associated with having BR, (2) factors associated with immediate BR (IBR) and delayed BR (DBR), and (3) associations between no BR, IBR and DBR and physical and mental quality of life (QoL) 5 years after diagnosis. METHODS Analyses were based on data from the national French cancer cohort VICAN, which followed a representative sample of cancer survivors, including BC survivors, for 5 years after diagnosis. BR and BR type (IBR/DBR) were identified using medico-administrative databases. The SF12 scale was used to measure mental and physical QoL. Multivariate logistic regressions were used to identify factors associated with BR, and linear models to evaluate associations between BR and BR type with QoL. RESULTS Of the 1192 BC survivors in VICAN, 32.6% (n = 388) had a mastectomy. Among them, 60.1% (n = 233) had BR. Of these, 38.6% (n = 90) and 61.4% (n = 143) had IBR and DBR, respectively. Compared with women who had BR, women who did not were more likely to be older and to have a lower level of health literacy. Compared with women who did not have BR, those with IBR had better mental QoL, while those who had either IBR or DBR had better physical QoL. CONCLUSION Older women and those with inadequate health literacy were less likely to have BR. This may reflect women's preferences, inequalities in care options offered after a mastectomy, and socioeconomic barriers to accessing BR. These issues need further exploration. Furthermore, BR was associated with a better long-term physical QoL. IBR was associated with better mental QoL and should be promoted when possible.
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Affiliation(s)
- Memoli Victoria
- Aix Marseille Univ, INSERM, IRD, SESSTIM, ISSPAM, Cancer Biomedicine & Society Group, Equipe Labellisée Ligue 2019, 13009, Marseille, BDR, France
| | - Bannier Marie
- Department of Surgery, Institut Paoli-Calmettes, Marseille, France
| | - Rey Dominique
- Aix Marseille Univ, INSERM, IRD, SESSTIM, ISSPAM, Cancer Biomedicine & Society Group, Equipe Labellisée Ligue 2019, 13009, Marseille, BDR, France
| | | | - Ben Diane Marc-Karim
- Aix Marseille Univ, INSERM, IRD, SESSTIM, ISSPAM, Cancer Biomedicine & Society Group, Equipe Labellisée Ligue 2019, 13009, Marseille, BDR, France
| | - Mancini Julien
- Aix Marseille Univ, INSERM, IRD, SESSTIM, ISSPAM, Cancer Biomedicine & Society Group, Equipe Labellisée Ligue 2019, 13009, Marseille, BDR, France.
- APHM, BIOSTIC, Hop Timone, Marseille, France.
| | - Lauzier Sophie
- Université Laval, Québec, Canada
- CHU de Québec-Université Laval Research Center, Québec, Canada
| | - Bouhnik Anne-Déborah
- Aix Marseille Univ, INSERM, IRD, SESSTIM, ISSPAM, Cancer Biomedicine & Society Group, Equipe Labellisée Ligue 2019, 13009, Marseille, BDR, France
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Creff G, Jegoux F, Bendiane MK, Babin E, Licaj I. Returning to work by thyroid cancer survivors 5 years after diagnosis: the VICAN survey. J Cancer Surviv 2021; 16:801-811. [PMID: 34382180 DOI: 10.1007/s11764-021-01074-y] [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: 02/21/2021] [Accepted: 06/09/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Return to work (RTW) following cancer diagnosis is a challenge for both the patient and society. As thyroid cancer (TC) incidence is increasing, this study aims to assess difficulties in returning to work and income changes in TC survivors 5 years post-diagnosis. METHODS This study belongs to the national VICAN survey conducted in France among TC patients diagnosed between January and June 2010. Data were collected through phone interviews, medical surveys and from the national medico-administrative register in 2012 and 2015. We used multivariate logistic regressions to investigate TC impact on employment and income changes. RESULTS Of 146 patients, 121(82.9%) were women; the mean age was 42 years (SD = 8.34), 119 (81.3%) were diagnosed at an early stage, and 142(97.6%) underwent thyroidectomy. At 5 years post-diagnosis, 116 (79.7%) of the TC survivors were professionally active, 22 (15.4%) were unemployed and 8 (4.90%) were receiving disability. Among the patients employed at the time of diagnosis (n = 122), 15 (12.3%) had not returned to work 5 years post-diagnosis. Between 2 and 5 years post-diagnosis, there was no significant improvement in rates of RTW. At 5 years post-diagnosis, 90 (61.6%) reported an income decline. All TC survivors who have not returned to work were women and declared higher fatigue. Moreover, in multivariate analyses, not returning to work was associated with weight gain (OR = 8.41 (1.21; 58.23)) and working arrangements (6.90 (1.18-38.48)), while income decline was associated with comorbidities (OR = 2.28 (1.07; 4.86)) and to be engaged in manual work (OR = 2.28 (1.07; 4.88)). CONCLUSION This study highlights that, despite a good prognostic, up to 12.3% of TC survivors had not returned to work and 61.6% reported an income decline, 5 years post-diagnosis. Weight gain, fatigue, to be a woman and working-type arrangement were associated with higher probability of not returning to work. IMPLICATIONS FOR CANCER SURVIVORS TC affects a young working population. Our study identified potentially vulnerable TC survivors and important modifiable factors which may help TC survivors to be professionally active and, therefore, increase their overall quality of life.
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Affiliation(s)
- G Creff
- Department of Otolaryngology-Head and Neck Surgery, Rennes University Hospital, Rennes, France.
| | - F Jegoux
- Department of Otolaryngology-Head and Neck Surgery, Rennes University Hospital, Rennes, France
| | | | - E Babin
- Head and Neck Department, University Hospital Centre Caen, Caen, France.,Cancer & Cognition Platform, Ligue Contre le Cancer, Caen, France
| | - I Licaj
- Cancer & Cognition Platform, Ligue Contre le Cancer, Caen, France.,Clinical Research Department, Centre François Baclesse, Caen, France.,Department of Community Medicine, Faculty of Health Sciences, The UiT Arctic University of Norway, Tromsø, Norway
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Evolution of physical activity and body weight changes in breast cancer survivors five years after diagnosis - VICAN 2 & 5 French national surveys. Breast 2021; 59:248-255. [PMID: 34315007 PMCID: PMC8326424 DOI: 10.1016/j.breast.2021.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/22/2021] [Accepted: 07/16/2021] [Indexed: 01/07/2023] Open
Abstract
Background Regular physical activity (PA) and healthy body weight have proven benefits on survival in breast cancer (BC) survivors. We aimed to define predictors of long-term PA and weight gain in a representative sample of BC survivors. Methods Data were analysed from 723 women with BC who participated in both the 2012 and 2015 French National VICAN surveys. Results Five years after diagnosis, 26.0, 60.6, and 13.4 % of BC survivors reported regular, occasional and no PA, respectively. Moreover, 27.4 % had a weight gain ≥5 kg. In multinomial logistic regressions, regular and occasional PA were both associated with not having depressive disorders, with higher post-traumatic growth, and with a healthy and stable Body Mass Index. Occasional PA was associated with the use of non-conventional medicine, and regular PA with better mental quality of life and normal arm mobility. Weight gain ≥5 kg was associated with younger age, heavier body weight at diagnosis, and lymphedema 5 years after diagnosis. Conclusions Mental well-being is associated with successful long-term patient investment in PA. Psychological support and early management of disease sequelae are needed to help ensure BC survivors engage in and maintain healthy lifestyles. A quarter of breast cancer survivors at 5 years reported regular physical activity. Occasional physical activity was associated with use of non-conventional medicine. Mental well-being was associated with long-term investment in physical activity. Early sequelae managing may help survivors engage in and maintain healthy lifestyles.
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Delrieu L, Bouaoun L, Fatouhi DE, Dumas E, Bouhnik AD, Noelle H, Jacquet E, Hamy AS, Coussy F, Reyal F, Heudel PE, Bendiane MK, Fournier B, Michallet M, Fervers B, Fagherazzi G, Pérol O. Patterns of Sequelae in Women with a History of Localized Breast Cancer: Results from the French VICAN Survey. Cancers (Basel) 2021; 13:1161. [PMID: 33800346 PMCID: PMC7962808 DOI: 10.3390/cancers13051161] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/22/2021] [Accepted: 03/02/2021] [Indexed: 11/30/2022] Open
Abstract
Breast cancer (BC) remains complex for women both physically and psychologically. The objectives of this study were to (1) assess the evolution of the main sequelae and treatment two and five years after diagnosis in women with early-stage breast cancer, (2) explore patterns of sequelae associated with given sociodemographic, clinical, and lifestyle factors. The current analysis was based on 654 localized BC patients enrolled in the French nationwide longitudinal survey "vie après cancer" VICAN (January-June 2010). Information about study participants was collected at enrollment, two and five years after diagnosis. Changes over time of the main sequelae were analyzed and latent class analysis was performed to identify patterns of sequelae related to BC five years after diagnosis. The mean age (±SD) of study participants at inclusion was 49.7 (±10.5) years old. Six main classes of sequelae were identified two years and five years post-diagnosis (functional, pain, esthetic, fatigue, psychological, and gynecological). A significant decrease was observed for fatigue (p = 0.03) and an increase in cognitive sequelae was reported (p = 0.03). Two latent classes were identified-functional and esthetic patterns. Substantial sequelae remain up to five years after BC diagnosis. Changes in patient care pathways are needed to identify BC patients at a high risk.
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Affiliation(s)
- Lidia Delrieu
- Department Prevention, Cancer, Environment, Léon Bérard Cancer Center, 69008 Lyon, France; (L.D.); (H.N.); (B.F); (B.F.)
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Institut Curie, Paris University, 75005 Paris, France; (E.D.); (A.-S.H.); (F.C.); (F.R.)
| | - Liacine Bouaoun
- International Agency for Research on Cancer, 69372 Lyon, France;
| | - Douae El Fatouhi
- Center of Research in Epidemiology and Population Health, UMR 1018 Inserm, Institut Gustave Roussy, Paris-Sud Paris-Saclay University, 94807 Villejuif, France; (D.E.F.); (G.F.)
| | - Elise Dumas
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Institut Curie, Paris University, 75005 Paris, France; (E.D.); (A.-S.H.); (F.C.); (F.R.)
- MINES ParisTech, PSL Research University, CBIO-Centre for Computational Biology, 75006 Paris, France
| | - Anne-Deborah Bouhnik
- INSERM, IRD, SESSTIM, Economics & Social Sciences Applied to Health & Analysis of Medical Information, Aix Marseille University, 13007 Marseille, France; (A.-D.B.); (M.-K.B.)
| | - Hugo Noelle
- Department Prevention, Cancer, Environment, Léon Bérard Cancer Center, 69008 Lyon, France; (L.D.); (H.N.); (B.F); (B.F.)
| | - Emmanuelle Jacquet
- Oncology and Blood Diseases Department, University Hospital Center, Joseph Fourier University, CEDEX 9, 38043 Grenoble, France;
| | - Anne-Sophie Hamy
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Institut Curie, Paris University, 75005 Paris, France; (E.D.); (A.-S.H.); (F.C.); (F.R.)
- Department of Medical Oncology, Institut Curie, 75005 Paris, France
| | - Florence Coussy
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Institut Curie, Paris University, 75005 Paris, France; (E.D.); (A.-S.H.); (F.C.); (F.R.)
- Department of Medical Oncology, Institut Curie, 75005 Paris, France
| | - Fabien Reyal
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Institut Curie, Paris University, 75005 Paris, France; (E.D.); (A.-S.H.); (F.C.); (F.R.)
- Department of Surgical Oncology, Institut Curie, University Paris, 75005 Paris, France
| | - Pierre-Etienne Heudel
- Department of Medical Oncology, Léon Bérard Cancer Center, 69008 Lyon, France; (P.-E.H.); (M.M.)
| | - Marc-Karim Bendiane
- INSERM, IRD, SESSTIM, Economics & Social Sciences Applied to Health & Analysis of Medical Information, Aix Marseille University, 13007 Marseille, France; (A.-D.B.); (M.-K.B.)
| | - Baptiste Fournier
- Department Prevention, Cancer, Environment, Léon Bérard Cancer Center, 69008 Lyon, France; (L.D.); (H.N.); (B.F); (B.F.)
| | - Mauricette Michallet
- Department of Medical Oncology, Léon Bérard Cancer Center, 69008 Lyon, France; (P.-E.H.); (M.M.)
| | - Béatrice Fervers
- Department Prevention, Cancer, Environment, Léon Bérard Cancer Center, 69008 Lyon, France; (L.D.); (H.N.); (B.F); (B.F.)
- Cancer Research Center of Lyon, INSERM UA8, Léon Bérard Cancer Center, 69008 Lyon, France
| | - Guy Fagherazzi
- Center of Research in Epidemiology and Population Health, UMR 1018 Inserm, Institut Gustave Roussy, Paris-Sud Paris-Saclay University, 94807 Villejuif, France; (D.E.F.); (G.F.)
- Department of Population Health, Luxembourg Institute of Health (LIH), 1445 Strassen, Luxembourg
| | - Olivia Pérol
- Department Prevention, Cancer, Environment, Léon Bérard Cancer Center, 69008 Lyon, France; (L.D.); (H.N.); (B.F); (B.F.)
- Cancer Research Center of Lyon, INSERM UA8, Léon Bérard Cancer Center, 69008 Lyon, France
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Dugué J, Humbert M, Bendiane MK, Bouhnik AD, Babin E, Licaj I. Head and neck cancer survivors' pain in France: the VICAN study. J Cancer Surviv 2021; 16:119-131. [PMID: 33635450 DOI: 10.1007/s11764-021-01010-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 02/17/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE Pain is an increasing concern in the growing number of head and neck cancer survivors. This study aimed to analyze the 5-year prevalence of pain in French survivors of head and neck cancer and to identify associated factors. METHODS Analyses were performed among 296 5-year cancer survivors diagnosed in 2010. Using multivariable logistic regressions, we studied the associations between pain and factors collected in the French representative national "vie après le cancer" (VICAN) survey. Eligible participants were aged from 18 to 82 years; patients' living conditions, socioeconomic characteristics, and medical data were collected. RESULTS Pain was reported by 72.6% of the participants. In the multivariable analyses, decreasing level of physical activity was the only determinant of increased overall pain (OR= 2.77, CI= 1.48-5.17). The chronic pain prevalence was 62.3%. The main risk factors found were tumor localization in the oropharynx (OR= 2.49, CI= 1.27-4.88), education (at least a high school's degree) (OR= 0.33, CI= 0.13-0.9), and decreased physical activity (OR= 2.20, CI= 1.24-3.9). CONCLUSIONS Five years after diagnosis, pain is a very frequent sequelae that has a significant impact on quality of life in head and neck cancer survivors. Reduced physical activity, a low level of education, and tumor localization in the oropharynx are factors associated with pain. IMPLICATIONS FOR CANCER SURVIVORS Pain frequency and its impact on patients' lives imply that an adaptation must be made in terms of both pain diagnosis and management and the training of healthcare professionals. CLINICAL TRIAL REGISTRATION This is not a clinical trial. ISP number: INSERM C11-63.
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Affiliation(s)
- Justin Dugué
- Department of Otorhinolaryngology Head and Neck Surgery, Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000, Caen, France.
| | - Maxime Humbert
- Department of Otorhinolaryngology Head and Neck Surgery, Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000, Caen, France
| | - Marc-Karim Bendiane
- Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM) Marseille, INSERM, IRD, Aix Marseille University, Marseille, France
| | - Anne-Déborah Bouhnik
- Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM) Marseille, INSERM, IRD, Aix Marseille University, Marseille, France
| | - Emmanuel Babin
- Department of Otorhinolaryngology Head and Neck Surgery, Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000, Caen, France
| | - Idlir Licaj
- Clinipace Biostatistics, Morrisville, NC, 27560, USA.,Clinical Research Department, Centre François Baclesse, Caen, France.,Department of Community Medicine, Faculty of Health Sciences, The UiT Arctic University of Norway, Tromsø, Norway
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Li J, Zuo K, Zhang J, Hu C, Wang P, Jiao J, Liu Z, Yin X, Liu X, Li K, Yang X. Shifts in gut microbiome and metabolome are associated with risk of recurrent atrial fibrillation. J Cell Mol Med 2020; 24:13356-13369. [PMID: 33058365 PMCID: PMC7701499 DOI: 10.1111/jcmm.15959] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/15/2020] [Accepted: 09/21/2020] [Indexed: 12/13/2022] Open
Abstract
Alternations of gut microbiota (GM) in atrial fibrillation (AF) with elevated diversity, perturbed composition and function have been described previously. The current work aimed to assess the association of GM composition with AF recurrence (RAF) after ablation based on metagenomic sequencing and metabolomic analyses and to construct a GM-based predictive model for RAF. Compared with non-AF controls (50 individuals), GM composition and metabolomic profile were significantly altered between patients with recurrent AF (17 individuals) and non-RAF group (23 individuals). Notably, discriminative taxa between the non-RAF and RAF groups, including the families Nitrosomonadaceae and Lentisphaeraceae, the genera Marinitoga and Rufibacter and the species Faecalibacterium spCAG:82, Bacillus gobiensis and Desulfobacterales bacterium PC51MH44, were selected to construct a taxonomic scoring system based on LASSO analysis. After incorporating the clinical factors of RAF, taxonomic score retained a significant association with RAF incidence (HR = 2.647, P = .041). An elevated AUC (0.954) and positive NRI (1.5601) for predicting RAF compared with traditional clinical scoring (AUC = 0.6918) were obtained. The GM-based taxonomic scoring system theoretically improves the model performance, and the nomogram and decision curve analysis validated the clinical value of the predicting model. These data provide novel possibility that incorporating the GM factor into future recurrent risk stratification.
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Affiliation(s)
- Jing Li
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Kun Zuo
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jing Zhang
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Chaowei Hu
- Key Laboratory of Upper Airway Dysfunction-related Cardiovascular Diseases, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Pan Wang
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jie Jiao
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Zheng Liu
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiandong Yin
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiaoqing Liu
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | | | - Xinchun Yang
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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10
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Carrier H, Cortaredona S, Philipps V, Jacqmin-Gadda H, Tournier M, Verdoux H, Verger P. Long-term risk of hip or forearm fractures in older occasional users of benzodiazepines. Br J Clin Pharmacol 2020; 86:2155-2164. [PMID: 32285959 DOI: 10.1111/bcp.14307] [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: 08/01/2019] [Revised: 03/21/2020] [Accepted: 03/24/2020] [Indexed: 01/14/2023] Open
Abstract
AIMS This article sought to study the association between patterns of benzodiazepine (BZD) use and the risk of hip and forearm fractures in people aged 50 and 75 years or more. METHODS In a representative cohort of the French National Health Insurance Fund of individuals aged 50 years or older (n = 106 437), we followed up BZD dispensing (reflecting their patterns of use) and the most frequent fall-related fractures (hip and forearm) for 8 years. We used joint latent class models to simultaneously identify BZD dispensing trajectories and the risk of fractures in the entire cohort and in those 75 years or older). We used a survival model to estimate the adjusted hazard ratios (aHRs) between these trajectories and the risk of fractures. RESULTS In the entire cohort, we identified 5 BZD trajectories: non-users (76.7% of the cohort); occasional users (15.2%); decreasing users (2.6%); late increasing users (3.0%); and early increasing users (2.4%). Compared with non-users, fracture risk was not increased in either occasional users (aHR = 0.99, 95% confidence interval [CI] 0.99-1.00) or in decreasing users (aHR = 0.90, 95% CI 0.74-1.08). It was significantly higher in early increasing users (aHR = 1.86, 95% CI 1.62-2.14) and in late increasing users (aHR = 1.39, 95% CI 1.15-1.60). We observed similar trajectories and risk levels in the people older than 75 years. CONCLUSION Occasional BZD use, which is compatible with current recommendations, was not associated with an excess risk of the most frequent fall-related fractures in people older than 50 or 75 years.
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Affiliation(s)
- Hélène Carrier
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France.,IHU-Méditerranée Infection, Marseille, France.,Department of General Practice, Aix-Marseille University, Marseille, France.,ORS Paca, Regional Health Observatory, Provence-Alpes-Côte d'Azur, Marseille, France
| | - Sébastien Cortaredona
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France.,IHU-Méditerranée Infection, Marseille, France
| | - Viviane Philipps
- Univ. Bordeaux, Inserm, Bordeaux Population Health, UMR 1219, ISPED, Bordeaux, France
| | - Hélène Jacqmin-Gadda
- Univ. Bordeaux, Inserm, Bordeaux Population Health, UMR 1219, ISPED, Bordeaux, France
| | - Marie Tournier
- Univ. Bordeaux, Inserm, Bordeaux Population Health, UMR 1219, ISPED, Bordeaux, France.,Centre Hospitalier Charles Perrens, Bordeaux, France
| | - Hélène Verdoux
- Univ. Bordeaux, Inserm, Bordeaux Population Health, UMR 1219, ISPED, Bordeaux, France.,Centre Hospitalier Charles Perrens, Bordeaux, France
| | - Pierre Verger
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France.,IHU-Méditerranée Infection, Marseille, France.,ORS Paca, Regional Health Observatory, Provence-Alpes-Côte d'Azur, Marseille, France
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11
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Janah A, Bouhnik AD, Touzani R, Bendiane MK, Peretti-Watel P. Underprescription of Step III Opioids in French Cancer Survivors With Chronic Pain: A Call for Integrated Early Palliative Care in Oncology. J Pain Symptom Manage 2020; 59:836-847. [PMID: 31707070 DOI: 10.1016/j.jpainsymman.2019.10.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 10/23/2019] [Accepted: 10/23/2019] [Indexed: 11/18/2022]
Abstract
CONTEXT Chronic pain (CP) is a major concern in cancer survivors. Often under-reported by patients, it is both underassessed and undertreated by care providers. OBJECTIVES To assess CP prevalence and related treatment in cancer survivors five years after diagnosis and to identify factors associated with prescribing opioids among survivors with CP, focusing on access to palliative care (PC). METHODS In 2015-2016, we interviewed 4174 French patients diagnosed with cancer five years previously. Combining patient-reported and clinical-reported outcomes together with medicoadministrative data, we studied factors associated with Step II and Step III opioid prescriptions in cancer survivors with CP. We performed multinomial logistic regression adjusting for various covariates, including self-reported health status variables and inpatient PC. RESULTS Five years after cancer diagnosis, 63.5% of the respondents reported current CP (i.e., pain lasting three months or more). Of these, 64.6% and 14.4% were prescribed at least one Step II or Step III opioid, respectively. Only 1.9% had had inpatient PC since diagnosis. After adjustment for age, gender, clinical and self-reported variables, we found that the latter were more likely to receive Step III opioids (adjusted relative risk ratio 5.33; 95% CI 1.15, 24.58). CONCLUSION This study showed a high prevalence of CP five years after cancer diagnosis. Step III opioids were underprescribed but positively associated with inpatient PC. PC access in France remains limited, especially among cancer survivors. Integrating PC in oncology is essential to provide the best cancer-related symptoms management.
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Affiliation(s)
- Asmaa Janah
- INSERM, IRD, SESSTIM, Economics and Social Sciences Applied to Health & Analysis of Medical Information, Aix Marseille University, Marseille, France
| | - Anne-Déborah Bouhnik
- INSERM, IRD, SESSTIM, Economics and Social Sciences Applied to Health & Analysis of Medical Information, Aix Marseille University, Marseille, France
| | - Rajae Touzani
- INSERM, IRD, SESSTIM, Economics and Social Sciences Applied to Health & Analysis of Medical Information, Aix Marseille University, Marseille, France; Institut Paoli Calmettes, SESSTIM, Marseille, France
| | - Marc-Karim Bendiane
- INSERM, IRD, SESSTIM, Economics and Social Sciences Applied to Health & Analysis of Medical Information, Aix Marseille University, Marseille, France.
| | - Patrick Peretti-Watel
- IRD, AP-HM, SSA, VITROME, Aix Marseille University, Marseille, France; IHU-Méditerranée Infection, Marseille, France; ORS PACA, Southeastern Health Regional Observatory, Marseille, France
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12
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Bocquier A, Cortaredona S, Fressard L, Galtier F, Verger P. Seasonal influenza vaccination among people with diabetes: influence of patients' characteristics and healthcare use on behavioral changes. Hum Vaccin Immunother 2020; 16:2565-2572. [PMID: 32209014 PMCID: PMC7644174 DOI: 10.1080/21645515.2020.1729628] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Annual seasonal influenza vaccination (SIV) is recommended for people with diabetes, but vaccine coverage remains low. We estimated the probabilities of stopping or starting SIV, their correlates, and the expected time spent in the vaccinated state over 10 seasons for different patient profiles. We set up a retrospective cohort study of patients with diabetes in 2006 (n = 16,026), identified in a representative sample of beneficiaries of the French National Health Insurance Fund. We followed them up over 10 seasons (2005/06–2015/16). We used a Markov model to estimate transition probabilities and a proportional hazards model to study covariates. Between two consecutive seasons, the probabilities of starting (0.17) or stopping (0.09) SIV were lower than those of remaining vaccinated (0.91) or unvaccinated (0.83). Men, older patients, those with type 1 diabetes, treated diabetes or more comorbidities, frequent contacts with doctors, and with any hospital stay for diabetes or influenza during the last year were more likely to start and/or less likely to stop SIV. The mean expected number of seasons with SIV uptake over 10 seasons (range: 2.6–7.9) was lowest for women <65 years with untreated diabetes and highest for men ≥65 years with type 1 diabetes. Contacts with doctors and some clinical events may play a key role in SIV adoption. Healthcare workers have a crucial role in reducing missed opportunities for SIV. The existence of empirical patient profiles with different patterns of SIV uptake should encourage their use of tailored educational approaches about SIV to address patients’ vaccine hesitancy.
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Affiliation(s)
- A Bocquier
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME , Marseille, France.,IHU-Méditerranée Infection , Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur , Marseille, France
| | - S Cortaredona
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME , Marseille, France.,IHU-Méditerranée Infection , Marseille, France
| | - L Fressard
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME , Marseille, France.,IHU-Méditerranée Infection , Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur , Marseille, France
| | - F Galtier
- INSERM, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-Reivac), GH Cochin Broca Hôtel Dieu , Paris, France.,CIC 1411, CHU Montpellier, Hôpital Saint Eloi , Montpellier, France
| | - P Verger
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME , Marseille, France.,IHU-Méditerranée Infection , Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur , Marseille, France.,INSERM, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-Reivac), GH Cochin Broca Hôtel Dieu , Paris, France
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13
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Adherence trajectories of adjuvant endocrine therapy in the five years after its initiation among women with non-metastatic breast cancer: a cohort study using administrative databases. Breast Cancer Res Treat 2020; 180:777-790. [PMID: 32086655 DOI: 10.1007/s10549-020-05549-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 01/27/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE Despite the benefits of adjuvant endocrine therapy (AET) for reducing recurrence and mortality risks after hormone-sensitive breast cancer, AET adherence is sub-optimal for a high proportion of women. However, little is known about long-term patterns of AET adherence over the minimally recommended 5 years. Our objectives were to: (1) identify 5-year AET adherence trajectory groups; (2) describe trajectory groups according to adherence measures traditionally used (i.e., Proportion of Days Covered); and (3) explore factors associated with trajectories. METHODS We conducted a 5-year cohort study using data from a French national study that included AET dispensing data. Women diagnosed with first non-metastatic breast cancer and having at least 1 AET dispensing in the 12 months after diagnosis were included. Group-based trajectory modeling was used to identify adherence trajectory groups by clustering similar patterns of monthly AET dispensing. Multinomial logistic regressions were used to identify factors associated with trajectories. RESULTS Among 674 women, five AET adherence trajectory groups were identified: (1) quick decline and stop (5.2% of women); (2) moderate decline and stop (6.4%); (3) slow decline (17.2%); (4) high adherence (30.0%); and (5) maintenance of very high adherence (41.2%). Mean 5-year Proportion of Days Covered varied from 10 to 97% according to trajectories. Women who did not receive chemotherapy or a personalized care plan were more likely to belong to trajectories where AET adherence declined and stopped. CONCLUSION Our results provide information on the diversity of longitudinal AET adherence patterns, the timing of decline and discontinuation and associated factors that could inform healthcare professionals.
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14
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The positive effect of workplace accommodations on the continued employment of cancer survivors five years after diagnosis. Support Care Cancer 2020; 28:4435-4443. [PMID: 31919668 DOI: 10.1007/s00520-019-05189-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 11/08/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE To address the gap highlighted in the literature on the effect of professional interventions to facilitate continued employment, this study aims to evaluate the effect of workplace accommodations on the continued employment 5 years after a cancer diagnosis. METHODS This study is based on VICAN5, a French survey conducted in 2015-2016 to examine the living conditions of cancer survivors 5 years after diagnosis. Two subsamples, one with and one without workplace accommodations, were matched using a propensity score to control for the individual, professional, and medical characteristics potentially associated with receipt of workplace accommodations. RESULTS The study sample was composed of 1514 cancer survivors aged 18-54 and employed as salaried at diagnosis. Among them, 61.2% received workplace accommodations within 5 years after diagnosis: 35.5% received a modified workstation, 41.5% received a modified schedule, and 49.2% received reduced hours. After matching, receipt of workplace accommodations appeared to improve the continued employment rate 5 years after cancer diagnosis from 77.8% to 95.0%. CONCLUSIONS Receipt of workplace accommodations strongly increases the continued employment of cancer survivors 5 years after diagnosis. More research is needed to better understand the differences in receipt of workplace accommodations along with the related selection effect.
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15
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Verger P, Fressard L, Cortaredona S, Lévy-Bruhl D, Loulergue P, Galtier F, Bocquier A. Trends in seasonal influenza vaccine coverage of target groups in France, 2006/07 to 2015/16: Impact of recommendations and 2009 influenza A(H1N1) pandemic. ACTA ACUST UNITED AC 2019; 23. [PMID: 30514414 PMCID: PMC6280418 DOI: 10.2807/1560-7917.es.2018.23.48.1700801] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background and aimsSeasonal influenza vaccination (SIV) uptake (SIVU) rates in France are below target. We (i) describe trends in French SIVU over 10 consecutive seasons among different target groups and (ii) examine the effects of the 2009 influenza A(H1N1) pandemic and the publication of new SIV recommendations in 2011 and 2013.MethodsOur study was based on records of vaccines delivered in community pharmacies for a permanent, representative sample of 805,000 beneficiaries of the French National Health Insurance Fund. For the first objective, we analysed SIVU rate trends among ≥ 65 year olds as well as among < 65 year olds with each of the following conditions: diabetes, respiratory, cardiovascular, neuromuscular, or chronic liver disease. For the second goal, we computed segmented log-binomial regression analyses.ResultsAfter the 2009 pandemic, except for the target group with liver diseases, where the difference was not statistically significant, SIVU fell significantly in all groups during the 2010/11 season, remaining relatively stable until 2015/16 in groups not targeted by new recommendations. Crude SIVU rates in 2015/16 were 48% (43,950/91,794) for ≥ 65 year olds and between 16% (407/2,565) and 29% (873/3,056) for < 65 year olds depending on their condition. SIVU increased modestly after new recommendations were published, but only in patients newly eligible for a free vaccine voucher.ConclusionsOur results suggest: (i) a prolonged confidence crisis in SIV, initially impelled by the 2009 pandemic vaccination campaign; (ii) that new recommendations are ineffective without additional measures. Interventional research in this field is a priority.
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Affiliation(s)
- Pierre Verger
- INSERM, F-CRIN, Innovative Clinical research Network in vaccinology (I-Reivac), GH Cochin Broca Hôtel Dieu, Paris, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France.,Aix-Marseille Université, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
| | - Lisa Fressard
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Sébastien Cortaredona
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France.,Aix-Marseille Université, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
| | - Daniel Lévy-Bruhl
- Santé publique France, Direction des maladies infectieuses, Saint-Maurice, France
| | - Pierre Loulergue
- Assistance Publique Hôpitaux de Paris, CIC Cochin-Pasteur, Paris, France.,Inserm CIC 1417, Paris, France.,Université Paris Descartes, Sorbonne Paris cité, Paris, France.,INSERM, F-CRIN, Innovative Clinical research Network in vaccinology (I-Reivac), GH Cochin Broca Hôtel Dieu, Paris, France
| | - Florence Galtier
- CIC 1411, CHU Montpellier, Hôpital Saint Eloi, Montpellier, France.,INSERM, F-CRIN, Innovative Clinical research Network in vaccinology (I-Reivac), GH Cochin Broca Hôtel Dieu, Paris, France
| | - Aurélie Bocquier
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France.,Aix-Marseille Université, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
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16
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Bocquier A, Cortaredona S, Fressard L, Loulergue P, Raude J, Sultan A, Galtier F, Verger P. Trajectories of seasonal influenza vaccine uptake among French people with diabetes: a nationwide retrospective cohort study, 2006-2015. BMC Public Health 2019; 19:918. [PMID: 31288768 PMCID: PMC6617633 DOI: 10.1186/s12889-019-7209-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 06/20/2019] [Indexed: 01/20/2023] Open
Abstract
Background Annual seasonal influenza vaccination (SIV) is recommended for people with diabetes, but their SIV rates remain far below public health targets. We aimed to identify temporal trajectories of SIV uptake over a 10-year period among French people with diabetes and describe their clinical characteristics. Methods We identified patients with diabetes in 2006 among a permanent, representative sample of beneficiaries of the French National Health Insurance Fund. We followed them up over 10 seasons (2005/06–2015/16), using SIV reimbursement claims and group-based trajectory modelling to identify SIV trajectories and to study sociodemographic, clinical, and healthcare utilization characteristics associated with the trajectories. Results We identified six trajectories. Of the 15,766 patients included in the model, 4344 (28%) belonged to the “continuously vaccinated” trajectory and 4728 (30%) to the “never vaccinated” one. Two other trajectories showed a “progressive decrease” (2832, 18%) or sharp “postpandemic decrease” (1627, 10%) in uptake. The last two trajectories (totalling 2235 patients, 14%) showed an early or delayed “increase” in uptake. Compared to “continuously vaccinated” patients, those in the “progressively decreasing” trajectory were older and those in all other trajectories were younger with fewer comorbidities at inclusion. Worsening diabetes and comorbidities during follow-up were associated with the “increasing” trajectories. Conclusions Most patients with diabetes had been continuously vaccinated or never vaccinated and thus had stable SIV behaviours. Others adopted or abandoned SIV. These behaviour shifts might be due to increasing age, health events, or contextual factors (e.g., controversies about vaccine safety or efficacy). Healthcare professionals and stakeholders should develop tailored strategies that take each group’s specificities into account. Electronic supplementary material The online version of this article (10.1186/s12889-019-7209-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Aurélie Bocquier
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, 19-21 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France. .,IHU-Méditerranée Infection, Marseille, France. .,ORS PACA Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France.
| | - Sébastien Cortaredona
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, 19-21 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France.,IHU-Méditerranée Infection, Marseille, France
| | - Lisa Fressard
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, 19-21 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France.,IHU-Méditerranée Infection, Marseille, France.,ORS PACA Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Pierre Loulergue
- INSERM, F-CRIN Innovative Clinical research Network in vaccinology (I-Reivac), GH Cochin Broca Hôtel Dieu, 75014, Paris, France.,Université Paris Descartes, Sorbonne Paris cité, Paris, France.,Inserm CIC 1417, Paris, France.,Assistance Publique Hôpitaux de Paris, CIC Cochin-Pasteur, Paris, France
| | - Jocelyn Raude
- EHESP Rennes, Université Sorbonne Paris Cité, Paris, France.,Unité des Virus Emergents (UVE: Aix-Marseille Univ - IRD 190 - Inserm 1207 - IHU Méditerranée Infection), Marseille, France
| | - Ariane Sultan
- Endocrinology-Diabetology-Nutrition Department, University Hospital, Montpellier, France.,PhyMedExp, University of Montpellier CNRS INSERM, Montpellier, France
| | - Florence Galtier
- INSERM, F-CRIN Innovative Clinical research Network in vaccinology (I-Reivac), GH Cochin Broca Hôtel Dieu, 75014, Paris, France.,CIC 1411 CHU Montpellier Hôpital Saint Eloi, Montpellier, France
| | - Pierre Verger
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, 19-21 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France.,IHU-Méditerranée Infection, Marseille, France.,ORS PACA Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France.,INSERM, F-CRIN Innovative Clinical research Network in vaccinology (I-Reivac), GH Cochin Broca Hôtel Dieu, 75014, Paris, France
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17
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Lehn SF, Zwisler AD, Pedersen SGH, Gjørup T, Thygesen LC. Development of a prediction model for 30-day acute readmissions among older medical patients: the influence of social factors along with other patient-specific and organisational factors. BMJ Open Qual 2019; 8:e000544. [PMID: 31259284 PMCID: PMC6567955 DOI: 10.1136/bmjoq-2018-000544] [Citation(s) in RCA: 4] [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: 10/03/2018] [Revised: 01/21/2019] [Accepted: 05/16/2019] [Indexed: 12/23/2022] Open
Abstract
Background Readmission rate is one way to measure quality of care for older patients. Knowledge is sparse on how different social factors can contribute to predict readmission. We aimed to develop and internally validate a comprehensive model for prediction of acute 30-day readmission among older medical patients using various social factors along with demographic, organisational and health-related factors. Methods We performed an observational prospective study based on a group of 770 medical patients aged 65 years or older, who were consecutively screened for readmission risk factors at an acute care university hospital during the period from February to September 2012. Data on outcome and candidate predictors were obtained from clinical screening and administrative registers. We used multiple logistic regression analyses with backward selection of predictors. Measures of model performance and performed internal validation were calculated. Results Twenty percent of patients were readmitted within 30 days from index discharge. The final model showed that low educational level, along with male gender, contact with emergency doctor, specific diagnosis, higher Charlson Comorbidity Index score, longer hospital stay, cognitive problems, and medical treatment for thyroid disease, acid-related disorders, and glaucoma, predicted acute 30-day readmission. Area under the receiver operating characteristic curve (0.70) indicated acceptable discriminative ability of the model. Calibration slope was 0.98 and calibration intercept was 0.01. In internal validation analysis, both discrimination and calibration measures were stable. Conclusions We developed a model for prediction of readmission among older medical patients. The model showed that social factors in the form of educational level along with demographic, organisational and health-related factors contributed to prediction of acute 30-day readmissions among older medical patients.
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Affiliation(s)
- Sara Fokdal Lehn
- Department of Medicine, Holbæk University Hospital, Holbæk, Denmark
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Ann-Dorthe Zwisler
- Knowledge Center for Rehabilitation and Palliative Care, University of Southern Denmark, Nyborg, Denmark
| | | | - Thomas Gjørup
- Emergency Clinic, Gentofte Hospital, Hellerup, Denmark
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Verdoux H, Pambrun E, Tournier M, Cortaredona S, Verger P. Multi-trajectories of antidepressant and antipsychotic use: a 11-year naturalistic study in a community-based sample. Acta Psychiatr Scand 2019; 139:536-547. [PMID: 30844084 DOI: 10.1111/acps.13020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To explore the temporal dynamic of antidepressant and antipsychotic co-prescribing in real-life conditions. METHODS The study was performed using reimbursement data from the French Insurance Healthcare system in a cohort of 118 454 persons with at least one dispensing of antidepressants and/or antipsychotics over the period 2006-2016. Latent class analyses were used to identify homogeneous groups of persons following similar multi-trajectories of antidepressant and/or antipsychotic dispensing. Multivariate polynomial logistic regression models were used to explore the characteristics independently associated with distinct trajectories. RESULTS Five multi-trajectories of antidepressant and/or antipsychotic dispensing were identified: more than half of the sample (58%) had very low antidepressant and antipsychotic use; two groups had chronic (12%) or decreasing (11%) antidepressant use with very low antipsychotic use; two groups used both antidepressants and antipsychotics simultaneously either in an increasing (12%) or chronic (7%) way. Persons with chronic antidepressant-antipsychotic use presented with markers of poor social and mental health conditions. CONCLUSIONS Most persons using antipsychotics over the follow-up also used antidepressants over the same period. The benefit/risk ratio of these prescribing practices should be further explored as the long-term efficacy of antidepressant-antipsychotic polypharmacy is poorly documented, while this combination increases the risk of adverse effects.
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Affiliation(s)
- H Verdoux
- U1219, University of Bordeaux, Bordeaux, France.,INSERM, U1219, Bordeaux, France
| | - E Pambrun
- U1219, University of Bordeaux, Bordeaux, France.,INSERM, U1219, Bordeaux, France
| | - M Tournier
- U1219, University of Bordeaux, Bordeaux, France.,INSERM, U1219, Bordeaux, France
| | - S Cortaredona
- IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Aix-Marseille University, Marseille, France
| | - P Verger
- IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Aix-Marseille University, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
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Radomski TR, Zhao X, Hanlon JT, Thorpe JM, Thorpe CT, Naples JG, Sileanu FE, Cashy JP, Hale JA, Mor MK, Hausmann LRM, Donohue JM, Suda KJ, Stroupe KT, Good CB, Fine MJ, Gellad WF. Use of a medication-based risk adjustment index to predict mortality among veterans dually-enrolled in VA and medicare. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2019; 7:S2213-0764(18)30230-6. [PMID: 31031120 DOI: 10.1016/j.hjdsi.2019.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 04/09/2019] [Accepted: 04/13/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is systemic undercoding of medical comorbidities within administrative claims in the Department of Veterans Affairs (VA). This leads to bias when applying claims-based risk adjustment indices to compare outcomes between VA and non-VA settings. Our objective was to compare the accuracy of a medication-based risk adjustment index (RxRisk-VM) to diagnostic claims-based indices for predicting mortality. METHODS We modified the RxRisk-V index (RxRisk-VM) by incorporating VA and Medicare pharmacy and durable medical equipment claims in Veterans dually-enrolled in VA and Medicare in 2012. Using the concordance (C) statistic, we compared its accuracy in predicting 1 and 3-year all-cause mortality to the following models: demographics only, demographics plus prescription count, or demographics plus a diagnostic claims-based risk index (e.g., Charlson, Elixhauser, or Gagne). We also compared models containing demographics, RxRisk-VM, and a claims-based index. RESULTS In our cohort of 271,184 dually-enrolled Veterans (mean age = 70.5 years, 96.1% male, 81.7% non-Hispanic white), RxRisk-VM (C = 0.773) exhibited greater accuracy in predicting 1-year mortality than demographics only (C = 0.716) or prescription counts (C = 0.744), but was less accurate than the Charlson (C = 0.794), Elixhauser (C = 0.80), or Gagne (C = 0.810) indices (all P < 0.001). Combining RxRisk-VM with claims-based indices enhanced its accuracy over each index alone (all models C ≥ 0.81). Relative model performance was similar for 3-year mortality. CONCLUSIONS The RxRisk-VM index exhibited a high level of, but slightly less, accuracy in predicting mortality in comparison to claims-based risk indices. IMPLICATIONS Its application may enhance the accuracy of studies examining VA and non-VA care and enable risk adjustment when diagnostic claims are not available or biased. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Thomas R Radomski
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive, Pittsburgh, PA, 15240, USA; Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, 230 McKee Place Suite 600, Pittsburgh, PA, 15213, USA.
| | - Xinhua Zhao
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive, Pittsburgh, PA, 15240, USA
| | - Joseph T Hanlon
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive, Pittsburgh, PA, 15240, USA; Division of Geriatrics, Department of Medicine, University of Pittsburgh School of Medicine, 3471 5th Ave, Kaufmann Building Suite 500, Pittsburgh, PA, 15213, USA
| | - Joshua M Thorpe
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive, Pittsburgh, PA, 15240, USA; Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Carolyn T Thorpe
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive, Pittsburgh, PA, 15240, USA; Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Jennifer G Naples
- Division of Geriatrics, Department of Medicine, University of Pittsburgh School of Medicine, 3471 5th Ave, Kaufmann Building Suite 500, Pittsburgh, PA, 15213, USA
| | - Florentina E Sileanu
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive, Pittsburgh, PA, 15240, USA
| | - John P Cashy
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive, Pittsburgh, PA, 15240, USA
| | - Jennifer A Hale
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive, Pittsburgh, PA, 15240, USA
| | - Maria K Mor
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive, Pittsburgh, PA, 15240, USA
| | - Leslie R M Hausmann
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive, Pittsburgh, PA, 15240, USA; Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, 230 McKee Place Suite 600, Pittsburgh, PA, 15213, USA
| | - Julie M Donohue
- Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Katie J Suda
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, PO Box 1033, 5000 S. 5th Ave, Hines, IL, USA; Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois at Chicago College of Pharmacy, 833 S. Wood Street, Chicago, IL, 60612, USA
| | - Kevin T Stroupe
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois at Chicago College of Pharmacy, 833 S. Wood Street, Chicago, IL, 60612, USA
| | - Chester B Good
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive, Pittsburgh, PA, 15240, USA; Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, 230 McKee Place Suite 600, Pittsburgh, PA, 15213, USA; Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Michael J Fine
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive, Pittsburgh, PA, 15240, USA; Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, 230 McKee Place Suite 600, Pittsburgh, PA, 15213, USA
| | - Walid F Gellad
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive, Pittsburgh, PA, 15240, USA; Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, 230 McKee Place Suite 600, Pittsburgh, PA, 15213, USA; Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, 130 De Soto Street, Pittsburgh, PA, 15261, USA
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Verdoux H, Pambrun E, Tournier M, Cortaredona S, Verger P. Trajectories of Antipsychotic Drug Use Over 10 Years in a French Community-Based Sample of Persons Aged 50 and Older. Am J Geriatr Psychiatry 2019; 27:73-83. [PMID: 30442530 DOI: 10.1016/j.jagp.2018.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 09/10/2018] [Accepted: 09/10/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify the temporal prescribing patterns of antipsychotics among persons aged 50 and older and to explore the demographic and clinical characteristics associated with each trajectory of antipsychotic drug use. METHODS This was a historical fixed cohort study on a community-based sample of persons affiliated with the French Insurance Healthcare system. Data from community drug reimbursement claims were collected by the French Insurance Healthcare system over the period 2006-2015. The study included 160,853 persons aged 50 and older. Trajectories of antipsychotic drug use were identified by examining the distribution of antipsychotic use within consecutive 3-month periods over the entire follow-up period. Latent class analyses were used to identify distinct trajectories. Multivariate polynomial logistic regression models were used to explore the characteristics independently associated with trajectories. RESULTS Five trajectories of antipsychotic use were identified: null or very low use (93.8%), occasional use (2%), decreasing use (1.6%), chronic use (1.5%), and increasing use (1.1%). Occasional users were older and had a lower use of other psychotropic drugs and a high use of health resources. Chronic users had the highest frequency of chronic psychiatric diseases and were less likely to present with dementia or Parkinson disease. Persons with increasing use of antipsychotics were more frequently males and had a high frequency of dementia; half of them died over the follow-up period compared with 20% in the total sample. CONCLUSION Further studies should explore whether the benefit-risk ratio of antipsychotic drugs in older adults differs according to trajectories of use.
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Affiliation(s)
- Hélène Verdoux
- University of Bordeaux (HV, EP, MT), Bordeaux, France; the Institut National de la Santé et de la Recherche Médicale (HV, EP, MT), U1219, F-33000, Bordeaux, France
| | - Elodie Pambrun
- University of Bordeaux (HV, EP, MT), Bordeaux, France; the Institut National de la Santé et de la Recherche Médicale (HV, EP, MT), U1219, F-33000, Bordeaux, France
| | - Marie Tournier
- University of Bordeaux (HV, EP, MT), Bordeaux, France; the Institut National de la Santé et de la Recherche Médicale (HV, EP, MT), U1219, F-33000, Bordeaux, France
| | - Sébastien Cortaredona
- IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection (SC, PV), Aix-Marseille University, Marseille, France
| | - Pierre Verger
- IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection (SC, PV), Aix-Marseille University, Marseille, France; ORS PACA (PV), Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, F-13006, Marseille, France.
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Verger P, Mmadi Mrenda B, Cortaredona S, Tournier M, Verdoux H. Trajectory analysis of anxiolytic dispensing over 10 years among new users aged 50 and older. Acta Psychiatr Scand 2018; 137:328-341. [PMID: 29441519 DOI: 10.1111/acps.12858] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To identify temporal trajectories of anxiolytic benzodiazepine (A-BZD) use over 10 years among new A-BZD users aged 50 and older and describe treatment patterns and demographic and clinical characteristics associated with each trajectory. METHOD A representative cohort of the French national health insurance fund users was tracked from 2006 through 2015. We used latent class mixed models to identify the trajectories. RESULTS We observed four trajectories among new users (no A-BZD dispensing in 2005) plus one non-use trajectory. The proportion of occasional use among users was 60%; early increasing use, 10%; late increasing use, 17%; and increasing/decreasing use, 13%. Prevalence of occasional use decreased with age in women, but not men. Duration of treatment episodes and doses differed between trajectories. Multiple regression analyses with occasional use as the reference showed that the other three trajectories shared characteristics (age, coprescriptions of other psychotropic drugs, and more general practitioner consultations) but differed by the presence at inclusion or occurrence during follow-up of psychiatric, neurodegenerative, and somatic conditions. CONCLUSION We found four different long-term temporal trajectories in new A-BZD users (occasional, early increasing, late increasing, and increasing/decreasing use). Difficulties quitting or reducing consumption may be very different for each trajectory, requiring tailored care approaches.
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Affiliation(s)
- P Verger
- IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Aix Marseille Université, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - B Mmadi Mrenda
- IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Aix Marseille Université, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - S Cortaredona
- IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Aix Marseille Université, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - M Tournier
- Pharmacoepidemiology Research Team, UMR 1219, Bordeaux Population Health Research Center, Inserm, University of Bordeaux, Bordeaux, France.,Centre Hospitalier Charles Perrens, Bordeaux, France
| | - H Verdoux
- Pharmacoepidemiology Research Team, UMR 1219, Bordeaux Population Health Research Center, Inserm, University of Bordeaux, Bordeaux, France.,Centre Hospitalier Charles Perrens, Bordeaux, France
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Verger P, Cortaredona S, Jacqmin-Gadda H, Tournier M, Verdoux H. Eight-Year Follow-up of Hypnotic Delivery by Adults Aged 50 and Older from an Insurance Database. Sleep 2018; 40:4102300. [PMID: 28958019 DOI: 10.1093/sleep/zsx147] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Study objectives This study sought to (1) identify patterns of hypnotic use among persons aged 50 and older for 8 years and (2) describe characteristics and correlates associated with them. Methods A representative sample of national health insurance system beneficiaries was followed up from 2006 through 2013; individuals were grouped according to hypnotic delivery trajectories by latent class mixed models. Results We identified four different temporal trajectories of hypnotic delivery among users. Delivery was occasional for 40% and regular for 60% (quasi-continuous "use": 27%; increasingly frequent over time: 17%; decreasingly frequent: 16%). Quasi-continuous "users" received hypnotics for more than 70% of the follow-up period and occasional "users" for less than 8%. We found no clear evidence of dose escalation. The three regular-delivery trajectories shared similar correlates (psychiatric disorders, somatic comorbidity, and coprescriptions of antidepressants or antipsychotics), but association with somatic comorbidity was highest by far for quasi-continuous "users." Conclusions Our results suggest that chronic hypnotic use covers different patterns resulting from different long-term temporal delivery trajectories. Because difficulties in stopping or reducing use may vary greatly according to these trajectories, patients may need individualized management approaches.
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Affiliation(s)
- Pierre Verger
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Sébastien Cortaredona
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Hélène Jacqmin-Gadda
- University of Bordeaux, U1219, F-33000, Bordeaux, France.,INSERM, U1219, F-33000, Bordeaux, France
| | - Marie Tournier
- University of Bordeaux, U657, F-33000, Bordeaux, France.,INSERM, U657, F-33000, Bordeaux, France.,Centre Hospitalier Charles Perrens, F-33000, Bordeaux, France
| | - Hélène Verdoux
- University of Bordeaux, U657, F-33000, Bordeaux, France.,INSERM, U657, F-33000, Bordeaux, France.,Centre Hospitalier Charles Perrens, F-33000, Bordeaux, France
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Chronic neuropathic pain negatively associated with employment retention of cancer survivors: evidence from a national French survey. J Cancer Surviv 2017; 12:115-126. [PMID: 28975504 DOI: 10.1007/s11764-017-0650-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 09/25/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Chronic neuropathic pain (CNP) is more prevalent among cancer survivors than among the general population. This study aims to investigate the role of CNP on job retention among cancer survivors, 5 years after diagnosis. METHODS In 2015, 2009 individuals diagnosed with cancer in 2010 were interviewed in the French national survey VIe après le CANcer. Logistic regression investigated the relationship between CNP-measured using the seven-item Douleur Neuropathique 4 (DN4) questionnaire-and employment. RESULTS Nine hundred sixty-nine individuals were aged 18-54 and employed at diagnosis and therefore were included. Eighty-two percent were still employed in 2015, 26% had fewer working hours than before diagnosis, and 55% had the same working hours. Thirty percent reported CNP 5 years after diagnosis. These cancer survivors were less likely to be employed in 2015 than those without CNP and, if employed, were more likely to work fewer hours. After adjustment for gender, medical variables (adverse cancer event, prognosis, chemotherapy, and comorbidities) were found to still significantly affect employment retention in cancer survivors, as well as reporting CNP. CONCLUSION Improving CNP screening and management is necessary to reduce its impact on cancer survivors' professional lives. IMPLICATIONS FOR CANCER SURVIVORS Healthcare policy and medical cancer survivor's follow-up must take into account the importance of the substantial impact of CNP on cancer survivors' daily lives. Therefore, in order to ensure greater employment retention for cancer survivors, raising awareness of care providers about diagnosis and management of CNP is needed.
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Casanova L, Cortaredona S, Gaudart J, Launay O, Vanhems P, Villani P, Verger P. Effectiveness of seasonal influenza vaccination in patients with diabetes: protocol for a nested case-control study. BMJ Open 2017; 7:e016023. [PMID: 28821521 PMCID: PMC5629692 DOI: 10.1136/bmjopen-2017-016023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Seasonal influenza vaccination (SIV) is recommended for people with diabetes, but its effectiveness has not been demonstrated. All of the available studies are observational and marred with the healthy vaccine bias, that is, bias resulting from the generally better health behaviours practised by people who choose to be vaccinated against influenza, compared with those who do not. This protocol is intended to study the effectiveness of SIV in people with treated diabetes and simultaneously to control for bias. METHODS AND ANALYSES This case-control study is nested in a historical cohort and is designed to study vaccine effectiveness (VE) assessed by morbidity, mortality and anti-infective drug use. The cohort will comprise a representative sample of health insurance beneficiaries in France and will cover 10 consecutive epidemic seasons. It will include all patients reimbursed three separate times for drugs to treat diabetes. The first study of VE will use reasons for hospitalisation as the primary end point, and the second with the use of neuraminidase inhibitors and of antibiotics as the end points. A case will be defined as any person in the cohort reaching any end point at a given date. The case patient will be matched with the largest possible number of controls (individuals not reaching the end point by this date) according to the propensity score method with an optimal calliper width. A conditional logistic model will be used to estimate ORs to take into account both the matching and the repetition of measurements. The model will be applied separately during and outside of epidemic periods to estimate the residual confounding. ETHICS AND DISSEMINATION The study has been approved by the French Commission on Individual Data Protection and Public Liberties (ref: AT/CPZ/SVT/JB/DP/CR05222O). The study's findings will be published in peer-reviewed journals and disseminated at international conferences and through social media.
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Affiliation(s)
- Ludovic Casanova
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France., Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
- Department of General Practice, Aix Marseille University, Marseille, France
| | - Sébastien Cortaredona
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France., Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Jean Gaudart
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France., Marseille, France
| | - Odile Launay
- Inserm, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), Paris, France
- Paris Descartes University, Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Philippe Vanhems
- Inserm, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), Paris, France
- Infection Control and Epidemiology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Patrick Villani
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France., Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Pierre Verger
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France., Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
- Inserm, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), Paris, France
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