1
|
Couret A, Lapeyre-Mestre M, Renoux A, Gardette V. Healthcare use according to deprivation among French Alzheimer's Disease and Related Diseases subjects: a national cross-sectional descriptive study based on the FRA-DEM cohort. Front Public Health 2024; 12:1284542. [PMID: 38487186 PMCID: PMC10937384 DOI: 10.3389/fpubh.2024.1284542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 02/06/2024] [Indexed: 03/17/2024] Open
Abstract
Introduction Pluriprofessional and coordinated healthcare use is recommended for Alzheimer's Disease and Related Diseases (ADRD). Despite a protective health system, France is characterized by persistent and significant social inequalities in health. Although social health inequalities are well documented, less is known about social disparities in healthcare use in ADRD, especially in France. Therefore, this study aimed to describe healthcare use according to socioeconomic deprivation among ADRD subjects and the possible potentiating role of deprivation by age. Methods We studied subjects identified with incident ADRD in 2017 in the French health insurance database (SNDS). We described a large extent of their healthcare use during the year following their ADRD identification. Deprivation was assessed through French deprivation index (Fdep), measured at the municipality level, and categorized into quintiles. We compared healthcare use according to the Fdep quintiles through chi-square tests. We stratified the description of certain healthcare uses by age groups (40-64 years, 65-74 years, 75-84 years, 85 years, and older), number of comorbidities (0, 1, 2-3, 4 comorbidities and more), or the presence of psychiatric comorbidity. Results In total, 124,441 subjects were included. The most deprived subjects had less use of physiotherapy (28.56% vs. 38.24%), ambulatory specialists (27.24% vs. 34.07%), ambulatory speech therapy (6.35% vs. 16.64%), preventive consultations (62.34% vs. 69.65%), and were less institutionalized (28.09% vs. 31.33%) than the less deprived ones. Conversely, they were more exposed to antipsychotics (11.16% vs. 8.43%), benzodiazepines (24.34% vs. 19.07%), hospital emergency care (63.84% vs. 57.57%), and potentially avoidable hospitalizations (12.04% vs. 10.95%) than the less deprived ones. Discussion and conclusion The healthcare use of subjects with ADRD in France differed according to the deprivation index, suggesting potential health renunciation as in other diseases. These social inequalities may be driven by financial barriers and lower education levels, which contribute to health literacy (especially for preventive care). Further studies may explore them.
Collapse
Affiliation(s)
- Anaïs Couret
- Agence Régionale de Santé Occitanie, Toulouse, France
- Maintain Aging Research Team, CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
| | - Maryse Lapeyre-Mestre
- Centre Hospitalier Universitaire de Toulouse, Department of Pharmacology, Toulouse, France
- Centre d'Investigation Clinique 1436, Team PEPSS “Pharmacologie En Population cohorteS et biobanqueS,” Centre Hospitalier Universitaire de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
| | - Axel Renoux
- Maintain Aging Research Team, CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Virginie Gardette
- Maintain Aging Research Team, CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
- Centre Hospitalier Universitaire de Toulouse, Department of Epidemiology and Public Health, Toulouse, France
| |
Collapse
|
2
|
Lesaine E, Francis F, Domecq S, Miganeh-Hadi S, Sevin F, Sibon I, Rouanet F, Pradeau C, Coste P, Cetran L, Vandentorren S, Saillour F. Social and clinical vulnerability in stroke and STEMI management during the COVID-19 pandemic: a registry-based study. BMJ Open 2024; 14:e073933. [PMID: 38171619 PMCID: PMC10773394 DOI: 10.1136/bmjopen-2023-073933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 12/10/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE This study aims to evaluate whether the first wave of the COVID-19 pandemic resulted in a deterioration in the quality of care for socially and/or clinically vulnerable stroke and ST-segment elevation myocardial infarction (STEMI) patients. DESIGN Two cohorts of STEMI and stroke patients in the Aquitaine neurocardiovascular registry. SETTING Six emergency medical services, 30 emergency units, 14 hospitalisation units and 11 catheterisation laboratories in the Aquitaine region in France. PARTICIPANTS This study involved 9218 patients (6436 stroke and 2782 STEMI patients) in the neurocardiovascular registry from January 2019 to August 2020. PRIMARY OUTCOME MEASURES Care management times in both cohorts: first medical contact-to-procedure time for the STEMI cohort and emergency unit admission-to-imaging time for the stroke cohort. Associations between social (deprivation index) and clinical (age >65 years, neurocardiovascular history) vulnerabilities and care management times were analysed using multivariate linear mixed models, with an interaction on the time period (pre-wave, per-wave and post-first COVID-19 wave). RESULTS The first medical contact procedure time was longer for elderly (p<0.001) and 'very socially disadvantaged' (p=0.003) STEMI patients, with no interaction regarding the COVID-19 period (age, p=0.54; neurocardiovascular history, p=0.70; deprivation, p=0.64). We found no significant association between vulnerabilities and the admission imaging time for stroke patients, and no interaction with respect to the COVID-19 period (age, p=0.81; neurocardiovascular history, p=0.34; deprivation, p=0.95). CONCLUSIONS This study revealed pre-existing inequalities in care management times for vulnerable STEMI and stroke patients; however, these inequalities were neither accentuated nor reduced during the first COVID-19 wave. Measures implemented during the crisis did not alter the structured emergency pathway for these patients. TRIAL REGISTRATION NUMBER NCT04979208.
Collapse
Affiliation(s)
- Emilie Lesaine
- CIC-EC 14-01, CHU de Bordeaux, Bordeaux, France
- University of Bordeaux, ISPED, Centre INSERM U1219, Bordeaux Population Health, Bordeaux, France
| | - Florence Francis
- University of Bordeaux, ISPED, Centre INSERM U1219, Bordeaux Population Health, Bordeaux, France
- Pôle de santé publique, Service d'Information Médicale, CHU de Bordeaux, Bordeaux, France
| | - Sandrine Domecq
- CIC-EC 14-01, CHU de Bordeaux, Bordeaux, France
- University of Bordeaux, ISPED, Centre INSERM U1219, Bordeaux Population Health, Bordeaux, France
| | - Sahal Miganeh-Hadi
- CIC-EC 14-01, CHU de Bordeaux, Bordeaux, France
- University of Bordeaux, ISPED, Centre INSERM U1219, Bordeaux Population Health, Bordeaux, France
| | - Floriane Sevin
- CIC-EC 14-01, CHU de Bordeaux, Bordeaux, France
- University of Bordeaux, ISPED, Centre INSERM U1219, Bordeaux Population Health, Bordeaux, France
| | - Igor Sibon
- Stroke Unit, CHU Bordeaux GH Pellegrin, Bordeaux, France
- CNRS UMR 5287, INCIA, Bordeaux, France
| | | | | | - Pierre Coste
- Coronary Care Unit, CHU de Bordeaux Hôpital Cardiologique, Pessac, France
| | - Laura Cetran
- Coronary Care Unit, CHU de Bordeaux Hôpital Cardiologique, Pessac, France
| | - Stephanie Vandentorren
- University of Bordeaux, ISPED, Centre INSERM U1219, Bordeaux Population Health, Bordeaux, France
- Sante publique France, Saint-Maurice, France
| | - Florence Saillour
- University of Bordeaux, ISPED, Centre INSERM U1219, Bordeaux Population Health, Bordeaux, France
- Pôle de santé publique, Service d'Information Médicale, CHU de Bordeaux, Bordeaux, France
| |
Collapse
|
3
|
Diakiese BM, Féron V. [Induced abortion and COVID-19 : What changed with the pandemic in 2020]. Rev Epidemiol Sante Publique 2022; 70:277-285. [PMID: 36123204 PMCID: PMC9452417 DOI: 10.1016/j.respe.2022.06.310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/24/2022] [Accepted: 06/01/2022] [Indexed: 12/02/2022] Open
Abstract
Contexte L'année 2020 a été marquée par la pandémie du SARS-CoV2 dont les mesures de gestion ont fortement perturbé l'organisation de la société en général et particulièrement l'organisation du système de soins. Cette étude avait pour objectif d'analyser l’évolution des indicateurs des interruptions volontaires de grossesse (IVG) dans la région parisienne au cours de l'année 2020 et d'analyser particulièrement ce qui a changé au cours du premier confinement. Méthode Les données issues du Système national des données de santé (SNDS) ont été analysées pour comparer les indicateurs de 2020 à ceux de 2016–2019. En 2020, les indicateurs ont été étudiés mensuellement. L’âge des femmes, la méthode utilisée pour interrompre la grossesse, le terme de la grossesse au moment de l'IVG et le département de résidence de la femme ont été analysés. Résultats Après cinq années consécutives d'augmentation du taux de recours à l'IVG, l'année 2020 a été marquée par un recul du nombre d'IVG (50 615), soit une baisse de 5,6 % par rapport à 2019 (53 601). Le taux de recours est passé de 17,3 IVG/1000 femmes de 15–49 ans en 2019 à 16,3 ‰ en 2020. Ce recul a été observé dans les quatre semaines ayant suivi le premier confinement. Il concernait plus particulièrement les IVG réalisées à l'hôpital et les IVG des femmes jeunes (< 25 ans). En 2020, les proportions des IVG médicamenteuses et des IVG instrumentales sous anesthésie locale ont augmenté comparativement aux quatre années précédant la crise sanitaire. Par ailleurs, on a dénombré moins d'IVG tardives en 2020 (IVG sur grossesse > 12 semaines d'aménorrhée). Cette analyse met également en évidence une baisse du nombre de naissances dans les huit à neuf mois ayant suivi le premier confinement. Discussion et conclusion La crise liée à la COVID-19 a entraîné d'autres conséquences sanitaires non imputables directement au virus. En termes de reproduction, la crise sanitaire, particulièrement le premier confinement, est associée à un recul des conceptions se traduisant par une baisse du nombre de grossesses, qu'elles soient désirées ou non, avec comme conséquence une baisse de recours à l'IVG dans les semaines suivant le premier confinement et un recul de la natalité dans les neuf mois suivants.
Collapse
Affiliation(s)
- B Matulonga Diakiese
- Observatoire régional de santé Île-de-France, 75015, Paris, France; Institut Paris Région, 75015, Paris, France.
| | - V Féron
- Observatoire régional de santé Île-de-France, 75015, Paris, France; Institut Paris Région, 75015, Paris, France
| |
Collapse
|
4
|
Burnier M, Kjeldsen SE, Narkiewicz K, Egan B, Kreutz R. Hypertension management during the COVID-19 pandemic: what can we learn for the future? Blood Press 2022; 31:47-49. [DOI: 10.1080/08037051.2022.2058909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Michel Burnier
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Sverre E. Kjeldsen
- Department of Cardiology, University of Oslo, Ullevaal Hospital, Oslo, Norway
- Department of Nephrology, University of Oslo, Ullevaal Hospital, Oslo, Norway
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Brent Egan
- University of South Carolina, Greenville, SC, USA
| | - Reinhold Kreutz
- Institut für Klinische Pharmakologie und Toxikologie, Berlin, Germany
| |
Collapse
|