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Allain S, Naouri D, Deroyon T, Costemalle V, Hazo JB. Income and professional inequalities in chronic diseases: prevalence and incidence in France. Public Health 2024; 228:55-64. [PMID: 38306754 DOI: 10.1016/j.puhe.2023.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 02/04/2024]
Abstract
OBJECTIVES In France, almost nine of 10 deaths are caused by non-communicable diseases, and there is significant social inequality in mortality rates. However, it is not easy to collect robust data on the incidence and prevalence of such diseases according to socio-economic status. Based on data from the link between the primary longitudinal population sample and the national health data system, the aim of our study was to compute the standardised incidence and prevalence of seven major groups of chronic diseases according to socio-economic status. STUDY DESIGN Descriptive retrospective cohort study. METHODS This was a descriptive retrospective cohort study on a weighted representative sample of the French population, comprising 3.4 million individuals from data collected 2016-2017. Main chronic disease categories include diabetes, cancers, psychiatric disorders, liver and pancreatic diseases, neurological conditions, respiratory and cardiovascular diseases, calculated from the 2016-2017 period by combining health care consumption and diagnoses received during hospitalisations and/or associated with specific full healthcare coverage. Socio-economic status was measured by disposable income from the 2013-2014 tax returns and census-derived socioprofessional groups, and findings were standardised for age and sex. RESULTS For all disease categories except cancers, standardised incidence rates showed a gradient favouring the wealthiest, with a risk ratio between the first and tenth standard of living deciles ranging from 1.4 (cardiovascular diseases) to 2.8 (diabetes). Incidence of all disease categories, except cancers, was higher for all groups compared with executives and higher academic professions (risk ratios between workers and executives ranged from 2.0 to 1.3 in psychiatric and cardiovascular diseases, respectively). Conversely, cancer incidence rate followed a flat curve, reduced in the two poorest standard of living deciles, and there were no significant differences between socioprofessional groups. Standardised prevalence rates followed the same patterns, although risk ratios were highest for psychiatric diseases, varying according to sex and disease. CONCLUSIONS Deep social inequalities in incidence and prevalence of chronic diseases were observed in a large representative sample of the French population. The reverse social inequalities in cancer incidence and prevalence calls for more detailed research into cancer types and selection mechanisms, the data from which would allow the long-term monitoring of such disparities.
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Affiliation(s)
- Samuel Allain
- Direction de la recherche, des études, de l'évaluation et des statistiques (DREES), French Ministry of Health and Solidarity, France
| | - Diane Naouri
- Direction de la recherche, des études, de l'évaluation et des statistiques (DREES), French Ministry of Health and Solidarity, France
| | - Thomas Deroyon
- Direction de la recherche, des études, de l'évaluation et des statistiques (DREES), French Ministry of Health and Solidarity, France
| | - Vianney Costemalle
- Direction de la recherche, des études, de l'évaluation et des statistiques (DREES), French Ministry of Health and Solidarity, France
| | - Jean-Baptiste Hazo
- Direction de la recherche, des études, de l'évaluation et des statistiques (DREES), French Ministry of Health and Solidarity, France.
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Darnaud N, Mory JE, Romy P, Berger J, Eve K, Lantheaume S. Perceptions and feelings of a French sample regarding lung cancer screening. BMC Public Health 2023; 23:2333. [PMID: 38001431 PMCID: PMC10675874 DOI: 10.1186/s12889-023-17110-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 10/30/2023] [Indexed: 11/26/2023] Open
Abstract
INTRODUCTION This study investigated the perceptions and feelings of a French sample about the possible introduction of lung cancer screening. METHODS A total of 146 individuals, aged between 19- and 64-years, participated in this study conducted between November 2020 and January 2021. Participants were divided into three groups according to their smoking status: (i) active smokers (G1); former smokers (G2); and non-smokers (G3). Each individual completed an online questionnaire evaluating their perceptions and feelings about lung cancer, screening and scans. RESULTS Overall, a higher percentage of former smokers (47%) indicated a greater willingness to participate in lung cancer screening compared to active smokers (19%) and non-smokers (32%). Active smokers and former smokers reported anxiety about the development of lung cancer. Active smokers who wished to participate in screening reported a greater motivation to reduce their tobacco consumption. The perception of lung cancer risk had less influence than age and socio-economic category on the participation in screening. Finally, stigma did not appear to be a barrier to undergoing screening. CONCLUSION Active and former smokers were generally optimistic about screening; however, active smokers showed less inclination to participate in screening compared to former smokers and non-smokers. Three main factors appeared to influence this participation: the perception of the risk of developing cancer, age and socio-economic category.
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Affiliation(s)
- Nicolas Darnaud
- Institut Supérieur Technologique Montplaisir, Valence, France
| | - Jean-Eudes Mory
- Ramsay Santé Hôpital Privé Drôme Ardèche, Guilherand-Granges, France
| | - Pascal Romy
- Ramsay Santé Hôpital Privé Drôme Ardèche, Guilherand-Granges, France
| | - Jacques Berger
- Ramsay Santé Hôpital Privé Drôme Ardèche, Guilherand-Granges, France
| | - Karine Eve
- Institut Supérieur Technologique Montplaisir, Valence, France
| | - Sophie Lantheaume
- Institut Supérieur Technologique Montplaisir, Valence, France.
- Ramsay Santé Hôpital Privé Drôme Ardèche, Guilherand-Granges, France.
- Laboratoire Inter-Universitaire de Psychologie, Personnalité, Cognition, Changement Social (LIP/PC2S), Université Grenoble Alpes, Grenoble, France.
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Quintin C, Chatignoux E, Plaine J, Hamers FF, Rogel A. Coverage rate of opportunistic and organised breast cancer screening in France: Department-level estimation. Cancer Epidemiol 2022; 81:102270. [PMID: 36215917 DOI: 10.1016/j.canep.2022.102270] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 09/19/2022] [Accepted: 09/27/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE In France, the national breast cancer screening programme (NBCSP), targeting women aged 50-74 years was rolled out nationwide in 2004. It aims at reducing breast cancer mortality. In addition to the NBCSP, the use of opportunistic screening is permitted in France. The objective of this study is to estimate both opportunistic use and overall coverage rates of breast cancer screening, among women 40-84 years of age, in France. METHODS The French medico-administrative health data system (SNDS) was used to identify women performing an opportunistic or organised mammography screening in France in 2016-2017. RESULTS The two-yearly opportunistic mammography screening is 18 % among women aged 40-84; it is 11 % among women aged 50-74, i.e., the target age range for organised screening, 36 % among women aged 40-49 and 13 % among women aged 75-84. The overall two-yearly screening coverage is 48 % for all women aged 40-84; it is 60 % among women aged 50-74, 36 % among women 40-49 and 16 % for those aged 75-84. Geographical variations in screening are lessened when the two screening strategies are considered, as they balance each other. CONCLUSION Although coverage in the NBCSP is around 50 % in France, more than one third of the women make use of opportunistic screening within and outside the target age range. Organized screening appears to improve equity of access to mammography screening service. The lack of data on opportunistic screening practices hinders the evaluation of French screening practices as a whole.
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Affiliation(s)
- Cécile Quintin
- National public health agency (Santé publique France), 12 rue du Val d'Osne, 94410 Saint Maurice, France.
| | - Edouard Chatignoux
- National public health agency (Santé publique France), 12 rue du Val d'Osne, 94410 Saint Maurice, France
| | - Julie Plaine
- National public health agency (Santé publique France), 12 rue du Val d'Osne, 94410 Saint Maurice, France
| | - Françoise F Hamers
- National public health agency (Santé publique France), 12 rue du Val d'Osne, 94410 Saint Maurice, France
| | - Agnès Rogel
- National public health agency (Santé publique France), 12 rue du Val d'Osne, 94410 Saint Maurice, France
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Morère JF, Touboul C, Lhomel C, Rouprêt M. Dépistage du cancer de la prostate en France : résultats des enquêtes EDIFICE. Prog Urol 2020; 30:332-338. [DOI: 10.1016/j.purol.2020.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/28/2020] [Accepted: 03/06/2020] [Indexed: 12/12/2022]
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Baert M, Pascual C, Biet-Hornstein A, Nadjingar R, Haremza C, Page C. Usefulness of ENT clinical examinations in hospitalised patients chronically addicted to alcohol and tobacco to detect head and neck squamous cell carcinomas. A retrospective study of 159 patients. Clin Otolaryngol 2019; 44:815-819. [PMID: 31044539 DOI: 10.1111/coa.13355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 03/19/2019] [Accepted: 04/14/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine whether an ENT clinical screening examination done on all patients chronically addicted to alcohol or tobacco would allow the early diagnosis of cancer of the upper aerodigestive tract. STUDY DESIGN Case series with chart review. SETTING Non-university general hospital. SUBJECTS AND METHODS A total of 159 patients presenting chronic addiction to alcohol or tobacco hospitalized in an addiction center or a comprehensive medical clinic were included in this study covering the period 2011-2016. All patients systematically benefitted from an ENT clinical examination to detect mucous membrane lesions. The lesions were categorized as: cancerous, pre-cancerous, or benign. The patients were divided into two groups for comparison: 1) patients with symptoms (dysphagia, dysphonia, dyspnea upon inhalation, cervico-facial pain, secondary otalgia, pharyngeal discomfort unrelated to deglutition, presence of a cervical swelling, or weight loss), and 2) asymptomatic patients. RESULTS The ENT exam was normal in 121 patients (76.1%). Fifty-two patients (32.7%) had at least one symptom. The ENT exam allowed us to detect a benign lesion in 11 patients, a pre-cancerous lesion in 11 patients, and a cancer in 16 (13.22%) patients. All patients with cancer had at least one symptom. CONCLUSION An ENT clinical screening examination done on patients chronically addicted to alcohol or tobacco can allow early diagnosis of cancer, particularly in patients with at least one symptom.
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Affiliation(s)
- Maxime Baert
- ENT and Head & Neck Surgery Department, University Hospital Center, Amiens, France
| | - Caroline Pascual
- ENT and Head & Neck Surgery Department, University Hospital Center, Amiens, France
| | | | | | - Céline Haremza
- ENT and Head & Neck Surgery Department, Beauvais Hospital, Beauvais, France
| | - Cyril Page
- ENT and Head & Neck Surgery Department, University Hospital Center, Amiens, France
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Rat C, Schmeltz H, Rocher S, Nanin F, Gaultier A, Nguyen JM. Factors Related to Prostate-Specific Antigen-Based Prostate Cancer Screening in Primary Care: Retrospective Cohort Study of 120,587 French Men Over the Age of 50 Years. JMIR Public Health Surveill 2018; 4:e10352. [PMID: 30355559 PMCID: PMC6231884 DOI: 10.2196/10352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/29/2018] [Accepted: 07/17/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND International guidelines recommend avoiding prostate-specific antigen (PSA)-based prostate cancer screening in the elderly when life expectancy is less than 10 years. For younger men, most recommendations encourage a shared decision-making process taking into account patient comorbidities. OBJECTIVE The objective was to assess the performance of PSA-based prostate cancer screening in men older than 74 years and assess whether the presence (vs absence) of comorbidities was related to the performance of PSA testing in younger men aged 50 to 74 years who were eligible for screening. METHODS We analyzed data from the French national health care database (Loire-Atlantique geographic area). We reported the follow-up of two cohorts of men from April 1, 2014, to March 31, 2016: 22,480 men aged over 74 years and 98,107 men aged 50 to 74 years. We analyzed whether these patients underwent PSA testing after 2 years of follow-up and whether PSA testing performance was related to the following patient-related variables: age, low income, proxy measures indicative of major comorbidities (repeated ambulance transportation, having one of 30 chronic diseases, taking 5 or more drugs per day), or proxy measures indicative of specific comorbidities (cancer diseases, cardiovascular diseases, or psychiatric disorders). Statistical analysis was based on a multivariate mixed-effects logistic regression. RESULTS The proportion of patients who underwent a PSA-based screening test was 41.35% (9296/22,480) among men older than 74 years versus 41.05% (40,275/98,107) among men aged 50 to 74 years. The following factors were associated with less frequent PSA testing in men older than 74 years-age (odds ratio [OR] 0.89, 95% CI 0.88-0.89), low income (OR 0.18, 95% CI 0.05-0.69), suffering from a chronic disease (OR 0.82, 95% CI 0.76-0.88), repeated ambulance transportation (OR 0.37, 95% CI 0.31-0.44), diabetes requiring insulin (OR 0.51, 95% CI 0.43-0.60), dementia (OR 0.68, 95% CI 0.55-0.84), and antipsychotic treatment (OR 0.62, 95% CI 0.51-0.75)-whereas cardiovascular drug treatment was associated with more frequent PSA testing (OR 1.6, 95% CI 1.53-1.84). The following factors were associated with less frequent PSA testing in men aged 50 to 74 years-low income (OR 0.61, 95% CI 0.55-0.68); nonspecific conditions related to frailty: suffering from a chronic disease (OR 0.80, 95% CI 0.76-0.83), repeated ambulance transportation (OR 0.29, 95% CI 0.23-0.38), or chronic treatment with 5 or more drugs (OR 0.89, 95% CI 0.83-0.96); and various specific comorbidities: anticancer drug treatment (OR 0.67, 95% CI 0.55-0.83), diabetes requiring insulin (OR 0.55, 95% CI 0.49-0.61), and antiaggregant treatment (OR 0.91, 95% CI 0.86-0.96)-whereas older age (OR 1.07, 95% CI 1.07-1.08) and treatment with other cardiovascular drugs (OR 2.23, 95% CI 2.15-2.32) were associated with more frequent PSA testing. CONCLUSIONS In this study, 41.35% (9296/22,480) of French men older than 74 years had a PSA-based screening test. Although it depends on patient comorbidities, PSA testing remains inappropriate in certain populations.
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Affiliation(s)
- Cédric Rat
- Department of General Practice, Faculty of Medicine, University of Nantes, Nantes, France.,Team 2, Unit 1232, French National Institute of Health and Medical Research, Nantes, France
| | - Heloise Schmeltz
- Team 2, Unit 1232, French National Institute of Health and Medical Research, Nantes, France
| | - Sylvain Rocher
- Department of General Practice, Faculty of Medicine, University of Nantes, Nantes, France
| | | | - Aurélie Gaultier
- Department of Epidemiology and Biostatistics, Nantes University Hospital, Nantes, France
| | - Jean-Michel Nguyen
- Team 2, Unit 1232, French National Institute of Health and Medical Research, Nantes, France.,Department of Epidemiology and Biostatistics, Nantes University Hospital, Nantes, France
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Fassier JB, Lamort-Bouché M, Broc G, Guittard L, Péron J, Rouat S, Carretier J, Fervers B, Letrilliart L, Sarnin P. Developing a Return to Work Intervention for Breast Cancer Survivors with the Intervention Mapping Protocol: Challenges and Opportunities of the Needs Assessment. Front Public Health 2018; 6:35. [PMID: 29527521 PMCID: PMC5829033 DOI: 10.3389/fpubh.2018.00035] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 01/31/2018] [Indexed: 01/02/2023] Open
Abstract
Return to work (RTW) is an important step for breast cancer survivors (BCSs). However, they face many barriers that affect particularly women with low socioeconomic status (SES). Health care, workplace, and insurance actors lack knowledge and collaborate poorly. No intervention to date has proven effective to reduce social disparities in employment after breast cancer. The intervention mapping (IM) protocol is being used in France to develop, implement, and evaluate an intervention to facilitate and sustain RTW after breast cancer [FAciliter et Soutenir le retour au TRAvail après un Cancer du Sein (FASTRACS) project]. The research question of this study was to elicit the needs for RTW after breast cancer from various stakeholders' point of view. The aim of this study was to describe the process and the preliminary results of the needs assessment of the FASTRACS project. Different methods were followed to (a) establish and work with a planning group and (b) conduct a needs assessment to create a logic model of the problem. A planning group was organized to gather the stakeholders with the research team. A review of the literature and indicators was conducted to identify the magnitude of the problem and the factors influencing RTW. A qualitative inquiry was conducted with 12 focus groups and 48 individual semi-structured interviews to explore the needs and experience of the stakeholders. The results of these tasks were the proposition of a charter of partnership to structure the participative process, a review of the scientific evidence and indicators, and the description by the stakeholders of their needs and experience. Many stakeholders disagreed with the concept of "early intervention." They advocated for a better support of BCSs during their RTW, emphasized as a process. Anticipation, intersectoral collaboration, and workplace accommodation were mentioned to fit the needs of the BCS and their environment. A logic model of the problem was elaborated from these data. The ability of the model to consider specific characteristics of women with low SES is discussed, with a view to developing the FASTRACS intervention through the next steps of the IM protocol.
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Affiliation(s)
- Jean-Baptiste Fassier
- UMRESTTE UMR T_9405, Unité mixte de recherche Epidémiologique et de Surveillance Transport Travail Environnement, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Service de médecine et santé au travail, Hospices civils de Lyon, Lyon, France
| | - Marion Lamort-Bouché
- UMRESTTE UMR T_9405, Unité mixte de recherche Epidémiologique et de Surveillance Transport Travail Environnement, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Collège universitaire de médecine générale, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Guillaume Broc
- UMRESTTE UMR T_9405, Unité mixte de recherche Epidémiologique et de Surveillance Transport Travail Environnement, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Laure Guittard
- HESPER, Health Services and Performance Research, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Pôle IMER, Hospices civils de Lyon, Lyon, France
| | - Julien Péron
- Laboratoire de Biométrie et Biologie Evolutive LBBE – UMR 5558, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Service d’oncologie médicale. Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), Hospices civils de Lyon, Pierre-Bénite, France
| | - Sabrina Rouat
- GRePS – EA 4163 (Groupe de Recherche en Psychologie Sociale), Université Lumière Lyon 2, Université de Lyon, Lyon, France
| | - Julien Carretier
- Centre Léon Bérard, Département Cancer et Environnement, Lyon, France
| | - Béatrice Fervers
- Centre Léon Bérard, Département Cancer et Environnement, Lyon, France
- Faculté Lyon Est, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Laurent Letrilliart
- Collège universitaire de médecine générale, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- HESPER, Health Services and Performance Research, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Philippe Sarnin
- GRePS – EA 4163 (Groupe de Recherche en Psychologie Sociale), Université Lumière Lyon 2, Université de Lyon, Lyon, France
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Vignot S, L'Allemain G, Bay JO. [Public health and political will: Convergence and divergence]. Bull Cancer 2017; 104:597-598. [PMID: 28734318 DOI: 10.1016/j.bulcan.2017.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Stéphane Vignot
- Institut de cancérologie Jean-Godinot, 51056 Reims cedex, France.
| | - Gilles L'Allemain
- Université de Nice Sophia Antipolis, CNRS-Inserm-UNS, institut de biologie Valrose, 06108 Nice cedex 2, France
| | - Jacques-Olivier Bay
- CHU de Clermont-Ferrand, service de thérapie cellulaire et d'hématologie clinique adulte, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand cedex 1, France
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