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Merville O, Rollet Q, Dejardin O, Launay L, Guillaume É, Launoy G. Area-based social inequalities in adult mortality: construction of French deprivation-specific life tables for the period 2016-2018. Front Public Health 2023; 11:1310315. [PMID: 38174081 PMCID: PMC10762790 DOI: 10.3389/fpubh.2023.1310315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
Background In order to tackle social inequalities in mortality, it is crucial to quantify them. We produced French deprivation-specific life tables for the period 2016-2018 to measure the social gradient in adult all-cause mortality. Methods Data from the Permanent Demographic Sample (EDP) were used to provide population and death counts by age, sex and deprivation quintile. The European Deprivation Index (EDI), applied at a sub-municipal geographical level, was used as an ecological measure of deprivation. Smoothed mortality rates were calculated using a one-dimensional Poisson counts smoothing method with P-Splines. We calculated life expectancies by age, sex and deprivation quintile as well as interquartile mortality rate ratios (MRR). Results At the age of 30, the difference in life expectancy between the most and least deprived groups amounted to 3.9 years in males and 2.2 years in females. In terms of relative mortality inequalities, the largest gaps between extreme deprivation groups were around age 55 for males (MRR = 2.22 [2.0; 2.46] at age 55), around age 50 in females (MRR = 1.77 [1.48; 2.1] at age 47), and there was a decrease or disappearance of the gaps in the very older adults. Conclusions There is a strong social gradient in all-cause mortality in France for males and females. The methodology for building these deprivation-specific life tables is reproducible and could be used to monitor its development. The tables produced should contribute to improving studies on net survival inequalities for specific diseases by taking into account the pre-existing social gradient in all-cause mortality.
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Affiliation(s)
- Ophélie Merville
- U1086 “ANTICIPE” INSERM Labelled ≪ Ligue Contre le Cancer ≫, Centre François Baclesse, University of Caen Normandie, Caen, France
| | - Quentin Rollet
- U1086 “ANTICIPE” INSERM Labelled ≪ Ligue Contre le Cancer ≫, Centre François Baclesse, University of Caen Normandie, Caen, France
- Inequalities in Cancer Outcomes Network (ICON), Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Olivier Dejardin
- U1086 “ANTICIPE” INSERM Labelled ≪ Ligue Contre le Cancer ≫, Centre François Baclesse, University of Caen Normandie, Caen, France
| | - Ludivine Launay
- U1086 “ANTICIPE” INSERM Labelled ≪ Ligue Contre le Cancer ≫, Centre François Baclesse, University of Caen Normandie, Caen, France
| | - Élodie Guillaume
- U1086 “ANTICIPE” INSERM Labelled ≪ Ligue Contre le Cancer ≫, Centre François Baclesse, University of Caen Normandie, Caen, France
| | - Guy Launoy
- U1086 “ANTICIPE” INSERM Labelled ≪ Ligue Contre le Cancer ≫, Centre François Baclesse, University of Caen Normandie, Caen, France
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Bell ML, Banerjee G, Pereira G. Residential mobility of pregnant women and implications for assessment of spatially-varying environmental exposures. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2018; 28:470-480. [PMID: 29511287 DOI: 10.1038/s41370-018-0026-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 10/21/2015] [Accepted: 10/25/2015] [Indexed: 05/24/2023]
Abstract
Health studies on spatially-varying exposures (e.g., air pollution) during pregnancy often estimate exposure using residence at birth, disregarding residential mobility. We investigated moving patterns in pregnant women (n = 10,116) in linked cohorts focused on Connecticut and Massachusetts, U.S., 1988-2008. Moving patterns were assessed by race/ethnicity, age, marital status, education, working status, population density, parity, income, and season of birth. In this population, 11.6% of women moved during pregnancy. Movers were more likely to be younger, unmarried, and living in urban areas with no previous children. Among movers, multiple moves were more likely for racial/ethnic minority, younger, less educated, unmarried, and lower income women. Most moves occurred later in pregnancy, with 87.4% of first moves in the second or third trimester, although not all cohort subjects enrolled in the first few weeks of pregnancy. Distance between first and second residence had a median value of 5.2 km (interquartile range 11.3 km, average 57.8 km, range 0.0-4277 km). Women moving larger distances were more likely to be white, older, married, and work during pregnancy. Findings indicate that residential mobility may impact studies of spatially-varying exposure during pregnancy and health and that subpopulations vary in probability of moving, and timing and distance of moves.
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Affiliation(s)
- Michelle L Bell
- School of Forestry and Environmental Studies, Yale University, 195 Prospect St., New Haven, CT, 06511, USA.
| | - Geetanjoli Banerjee
- School of Public Health, Brown University, 121S Main St., Providence, RI, 02902, USA
| | - Gavin Pereira
- School of Public Health, Curtin University of Technology, GPO Box U1987, Perth Western Australia, 6845, Perth, Australia
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Belot A, Remontet L, Rachet B, Dejardin O, Charvat H, Bara S, Guizard AV, Roche L, Launoy G, Bossard N. Describing the association between socioeconomic inequalities and cancer survival: methodological guidelines and illustration with population-based data. Clin Epidemiol 2018; 10:561-573. [PMID: 29844706 PMCID: PMC5961638 DOI: 10.2147/clep.s150848] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Describing the relationship between socioeconomic inequalities and cancer survival is important but methodologically challenging. We propose guidelines for addressing these challenges and illustrate their implementation on French population-based data. METHODS We analyzed 17 cancers. Socioeconomic deprivation was measured by an ecological measure, the European Deprivation Index (EDI). The Excess Mortality Hazard (EMH), ie, the mortality hazard among cancer patients after accounting for other causes of death, was modeled using a flexible parametric model, allowing for nonlinear and/or time-dependent association between the EDI and the EMH. The model included a cluster-specific random effect to deal with the hierarchical structure of the data. RESULTS We reported the conventional age-standardized net survival (ASNS) and described the changes of the EMH over the time since diagnosis at different levels of deprivation. We illustrated nonlinear and/or time-dependent associations between the EDI and the EMH by plotting the excess hazard ratio according to EDI values at different times after diagnosis. The median excess hazard ratio quantified the general contextual effect. Lip-oral cavity-pharynx cancer in men showed the widest deprivation gap, with 5-year ASNS at 41% and 29% for deprivation quintiles 1 and 5, respectively, and we found a nonlinear association between the EDI and the EMH. The EDI accounted for a substantial part of the general contextual effect on the EMH. The association between the EDI and the EMH was time dependent in stomach and pancreas cancers in men and in cervix cancer. CONCLUSION The methodological guidelines proved efficient in describing the way socioeconomic inequalities influence cancer survival. Their use would allow comparisons between different health care systems.
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Affiliation(s)
- Aurélien Belot
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Non-Communicable Diseases and Trauma Direction, The French Public Health Agency, Saint-Maurice, France
- Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France
| | - Laurent Remontet
- Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France
- UMR 5558, Biometry and Evolutionary Biology Laboratory, Biostatistics Health Group, CNRS, University Lyon 1, Lyon, France
| | - Bernard Rachet
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Olivier Dejardin
- National Institute of Health and Medical Research U1086 ANTICIPE, Caen, France
- Calvados Digestive Cancer Registry, Centre Hospitalier Universitaire, Caen, France
| | - Hadrien Charvat
- Prevention Division, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Simona Bara
- Manche General Cancer Registry, Centre Hospitalier Public du Cotentin, Cherbourg-en-Cotentin, France
| | - Anne-Valérie Guizard
- National Institute of Health and Medical Research U1086 ANTICIPE, Caen, France
- Calvados General Cancer Registry, Centre François Baclesse, Caen, France
| | - Laurent Roche
- Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France
- UMR 5558, Biometry and Evolutionary Biology Laboratory, Biostatistics Health Group, CNRS, University Lyon 1, Lyon, France
| | - Guy Launoy
- National Institute of Health and Medical Research U1086 ANTICIPE, Caen, France
- Calvados Digestive Cancer Registry, Centre Hospitalier Universitaire, Caen, France
| | - Nadine Bossard
- Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France
- UMR 5558, Biometry and Evolutionary Biology Laboratory, Biostatistics Health Group, CNRS, University Lyon 1, Lyon, France
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Ribeiro AI, Krainski ET, Carvalho MS, Launoy G, Pornet C, de Pina MDF. Does community deprivation determine longevity after the age of 75? A cross-national analysis. Int J Public Health 2018; 63:469-479. [PMID: 29480326 DOI: 10.1007/s00038-018-1081-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 01/27/2018] [Accepted: 02/10/2018] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Analyze the association between socioeconomic deprivation and old-age survival in Europe, and investigate whether it varies by country and gender. METHODS Our study incorporated five countries (Portugal, Spain, France, Italy, and England). A 10-year survival rate expressing the proportion of population aged 75-84 years who reached 85-94 years old was calculated at area-level for 2001-11. To estimate associations, we used Bayesian spatial models and a transnational measure of deprivation. Attributable/prevention fractions were calculated. RESULTS Overall, there was a significant association between deprivation and survival in both genders. In England that association was stronger, following a dose-response relation. Although lesser in magnitude, significant associations were observed in Spain and Italy, whereas in France and Portugal these were even weaker. The elimination of socioeconomic differences between areas would increase survival by 7.1%, and even a small reduction in socioeconomic differences would lead to a 1.6% increase. CONCLUSIONS Socioeconomic deprivation was associated with survival among older adults at ecological-level, although with varying magnitude across countries. Reasons for such cross-country differences should be sought. Our results emphasize the importance of reducing socioeconomic differences between areas.
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Affiliation(s)
- Ana Isabel Ribeiro
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-600, Porto, Portugal. .,i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal. .,INEB-Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal. .,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.
| | - Elias Teixeira Krainski
- The Norwegian University for Science and Technology, Trondheim, Norway.,Departamento de Estatística, Universidade Federal do Paraná, Curitiba, Brazil
| | - Marilia Sá Carvalho
- PROCC-Programa de Computação Científica, Fundação Oswaldo Cruz, Rio De Janeiro, Brazil
| | - Guy Launoy
- U1086 INSERM-University of Caen Normandy (FRANCE), CHU Caen, Caen, France
| | - Carole Pornet
- Public Health Department, Regional Health Agency of Normandy, Caen, France
| | - Maria de Fátima de Pina
- i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,INEB-Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal.,ICICT/FIOCRUZ, Instituto de Comunicação e Informação Científica e Tecnológica em Saúde/Fundação Oswaldo Cruz, Rio De Janeiro, Brazil.,CARTO, FEN/UERJ, Departamento de Engenharia Cartográfica, Faculdade de Engenharia da, Universidade do Estado do Rio de Janeiro, Rio De Janeiro, Brazil
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Krieger N, Feldman JM, Kim R, Waterman PD. Cancer Incidence and Multilevel Measures of Residential Economic and Racial Segregation for Cancer Registries. JNCI Cancer Spectr 2018; 2:pky009. [PMID: 31360840 PMCID: PMC6649696 DOI: 10.1093/jncics/pky009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 03/01/2018] [Accepted: 03/06/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The handful of studies (<30) on cancer and residential segregation have focused on racial segregation, primarily at the city/town level. We tested a priori hypotheses about choice of measure and level by extending use of the Index of Concentration at the Extremes (ICE) to quantify both economic and racial residential segregation, singly and combined, and conducted analyses for the total population and stratified by race/ethnicity. METHODS Outcomes comprised Massachusetts incidence rates (2010-2014) for invasive breast, cervical, and lung cancer, analyzed in relation to census tract and city/town ICE measures for income, race/ethnicity, race/ethnicity + income, and the federal poverty line. Multilevel Poisson regression modeled observed counts of incident cases. RESULTS Both choice of metric and level mattered. As illustrated by cervical cancer, in models including both the census tract and city/town levels, the rate ratio for the worst to best quintile for the total population was greatest at the census tract level for the ICE for racialized economic segregation (3.0, 95% confidence interval [CI] = 2.1 to 4.3) and least for the poverty measure (1.9, 95% CI = 1.4 to 2.6), with null associations at the city/town level. In analogous models with both levels for lung cancer, however, for the non-Hispanic black and Hispanic populations, the rate ratios for, respectively, the ICE and poverty measures, were larger (and excluded 1) at the city/town compared with the census tract level. CONCLUSIONS Our study suggests that the ICE for racialized economic segregation, at multiple levels, can be used to improve monitoring and analysis of cancer inequities.
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Affiliation(s)
- Nancy Krieger
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Justin M Feldman
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Rockli Kim
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Pamela D Waterman
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
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Hughes AE, Pruitt SL. The utility of EMR address histories for assessing neighborhood exposures. Ann Epidemiol 2017; 27:20-26. [PMID: 27663209 PMCID: PMC5482357 DOI: 10.1016/j.annepidem.2016.07.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 07/22/2016] [Accepted: 07/27/2016] [Indexed: 01/23/2023]
Abstract
PURPOSE Electronic medical records (EMRs) include residential address histories, which may alleviate exposure misclassification caused by exclusion of patient spatiotemporal location. EMR data are increasingly available but rarely leveraged as a measure of cumulative environmental exposure, in part due to limited understanding of the validity of EMR-derived address histories. METHODS We compared EMR address histories to self-reported histories among 100 patients of a safety-net health care system completing a telephone survey. We assessed agreement and compared seven neighborhood-level environmental exposures as assessed using both data sources. RESULTS While 17.1% of respondents did not live at the most recent EMR-derived address during the survey, nearly all (98%) lived there at some point. For respondents with more than one EMR-derived address (N = 64), 87.5% had once lived at the previous EMR address. Of these, 30.4% lived at 1 or more additional residences between the two most recent EMR address. For all measures, neighborhood-level environmental exposures did not differ when using EMR-derived versus self-report addresses. CONCLUSIONS More recent EMR-derived addresses are more accurate, and differences compared to self-reported addresses in neighborhood-level exposures are negligible. EMR-derived address histories are incomplete and likely suffer from collection bias; future research should further assess their validity and reliability.
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Affiliation(s)
- Amy E Hughes
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas.
| | - Sandi L Pruitt
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas; Harold C. Simmons Comprehensive Cancer Center, Dallas, TX
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Ribeiro AI, Krainski ET, Autran R, Teixeira H, Carvalho MS, de Pina MDF. The influence of socioeconomic, biogeophysical and built environment on old-age survival in a Southern European city. Health Place 2016; 41:100-109. [PMID: 27583526 DOI: 10.1016/j.healthplace.2016.08.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 07/15/2016] [Accepted: 08/09/2016] [Indexed: 10/21/2022]
Abstract
Old-age survival is a good indicator of population health and regional development. We evaluated the spatial distribution of old-age survival across Porto neighbourhoods and its relation with physical (biogeophysical and built) and socioeconomic factors (deprivation). Smoothed survival rates and odds ratio (OR) were estimated using Bayesian spatial models. There were important geographical differentials in the chances of survival after 75 years of age. Socioeconomic deprivation strongly impacted old-age survival (Men: least deprived areas OR=1.31(1.05-1.63); Women OR=1.53(1.24-1.89)), explaining over 40% of the spatial variance. Walkability and biogeophysical environment were unrelated to old-age survival and also unrelated to socioeconomic deprivation, being fairly evenly distributed through the city.
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Affiliation(s)
- Ana Isabel Ribeiro
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Portugal; i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal; INEB-Instituto de Engenharia Biomédica, Universidade do Porto, Portugal; Departamento de Epidemiologia Clínica, Medicina Preditiva e Saúde Pública, Faculdade de Medicina, Universidade do Porto, Portugal.
| | - Elias Teixeira Krainski
- Departamento de Estatística, Universidade Federal do Paraná, Curitiba, Brazil; The Norwegian University for Science and Technology, Trondheim, Norway.
| | - Roseanne Autran
- Centro de Investigação em Atividade Física, Saúde e Lazer-Faculdade de Desporto da Universidade do Porto, Portugal.
| | - Hugo Teixeira
- i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal; INEB-Instituto de Engenharia Biomédica, Universidade do Porto, Portugal.
| | - Marilia Sá Carvalho
- PROCC-Programa de Computação Científica, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
| | - Maria de Fátima de Pina
- i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal; ICICT/FIOCRUZ-Instituto de Comunicação e Informação Científica e Tecnológica em Saúde/Fundação Oswaldo Cruz, Rio de Janeiro, Brazil; CARTO-FEN/UERJ-Departamento de Engenharia Cartográfica, Faculdade de Engenharia da Universidade do Estado do Rio de Janeiro, Brazil.
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Singer S, Roick J, Briest S, Stark S, Gockel I, Boehm A, Papsdorf K, Meixensberger J, Müller T, Prietzel T, Schiefke F, Dietel A, Bräunlich J, Danker H. Impact of socio-economic position on cancer stage at presentation: Findings from a large hospital-based study in Germany. Int J Cancer 2016; 139:1696-702. [PMID: 27244597 DOI: 10.1002/ijc.30212] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 03/23/2016] [Accepted: 04/19/2016] [Indexed: 12/20/2022]
Abstract
We explored the relationship between socio-economic characteristics and cancer stage at presentation. Patients admitted to a university hospital for diagnosis and treatment of cancer provided data on their education, vocational training, income, employment, job, health insurance and postcode. Tumor stage was classified according to the Union International Contre le Cancer (UICC). To analyze disparities in the likelihood of late-stage (UICC III/IV vs. I/II) diagnoses, logistic regression models adjusting for age and gender were used. Out of 1,012 patients, 572 (59%) had late-stage cancer. Separately tested, increased odds of advanced disease were associated with post-compulsory education compared to college degrees, with apprenticeship and no vocational training, with unemployment, disability pension, jobs with a low hierarchy level, blue collar jobs and with low income. Health insurance and community size were not related with late-stage cancer. Jointly modelled, there was evidence for an independent effect of unemployment (odds ratio (OR) 1.7, CI 1.0-2.8), disability pension (OR 1.8, CI 1.0-3.2) and very low income (OR 2.6, CI 1.1-6.1) on the likelihood of advanced disease stage. It is of great concern that these socio-economic gradients occur even in systems with equal access to health care.
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Affiliation(s)
- Susanne Singer
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre, Mainz, Germany.,University Cancer Centre, Mainz, Germany.,Mainz-Frankfurt, German Consortium of Translational Cancer Research, Germany
| | - Julia Roick
- Department of Medical Psychology and Medical Sociology, University Medical Centre, Leipzig, Germany
| | - Susanne Briest
- Department of Obstetrics and Gynaecology, University Medical Centre, Leipzig, Germany
| | - Sylvia Stark
- Department of Obstetrics and Gynaecology, University Medical Centre, Leipzig, Germany
| | - Ines Gockel
- Department of General Surgery, University Medical Centre, Leipzig, Germany
| | - Andreas Boehm
- Department of Otolaryngology, University Medical Centre, Leipzig, Germany
| | - Kirsten Papsdorf
- Department of Radiation-Oncology, University Medical Centre, Leipzig, Germany
| | | | - Tobias Müller
- Department of Hepatology and Gastroenterology, University Medical Centre Charité, Campus Virchow Clinic, Berlin, Germany
| | - Torsten Prietzel
- Department of Orthopaedics, University Medical Centre, Leipzig, Germany
| | - Franziska Schiefke
- Department of Maxillofacial Surgery, University Medical Centre, Leipzig, Germany
| | - Anja Dietel
- Department of Urology, University Medical Centre, Leipzig, Germany
| | - Jens Bräunlich
- Department of Pneumology, University Medical Centre, Leipzig, Germany
| | - Helge Danker
- Department of Medical Psychology and Medical Sociology, University Medical Centre, Leipzig, Germany
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