1
|
Meguellati N, Regaiguia N, Rayane T, Boulahia Y, Chiad M, Saidani M, Saadi MT, Hanba M. Incidence de la maladie rénale chronique stade 5 traitée dans le Sud-Est algérien. LA TUNISIE MEDICALE 2024; 102:423-428. [PMID: 38982968 PMCID: PMC11358792 DOI: 10.62438/tunismed.v102i7.4785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 05/28/2024] [Indexed: 07/11/2024]
Abstract
INTRODUCTION Chronic kidney disease (CKD) stage 5 is a common pathology, the increase in its incidence and prevalence has been noted worldwide. In Algeria, few studies have been done on the epidemiology of chronic kidney disease, the real extent of its incidence in southern Algeria remains unknown. AIM To determine the incidence in 2017 of chronic kidney disease stage 5 treated by renal replacement in southeastern Algeria. METHOD During our multicenter, prospective longitudinal regional study, from January 1, 2017 to December 31, 2017, all resident incident cases of CKD stage 5 treated in the region by renal replacement were recruited. RESULTS The crude incidence of stage 5 CKD treated in 2017 in southeastern Algeria was 75 pmh. The age-standardized incidence rate was 100 pmh, with a male predominance, a M/F sex ratio of 1.59. The average age of incident cases was 48.50 ± 19.12 years. The incidence varies by age group and by wilaya. Diabetes (26.7%) and hypertensive nephropathy (22.6%) represent almost half of the cases and primary glomerulonephritis represents 5.9%. CONCLUSION CKD stage 5 treated, due to its high incidence in Algeria, with large geographical variations, represents a major public health challenge. It mainly affects young people. Diabetes and high blood pressure represent the two main causes, encouraging prevention efforts to be focused on hypertensives and diabetics in high-risk wilayas.
Collapse
Affiliation(s)
- Nassim Meguellati
- Department of Nephrology, Military Regional University Hospital of Constantine, Algeria
| | - Nacereddine Regaiguia
- Department of Nephrology, Military Regional University Hospital of Constantine, Algeria
| | - Taher Rayane
- University Benyoucef Benkhedda - Faculty of Medicine Algiers, Algeria
| | - Younes Boulahia
- Department of Nephrology, Central Army Hospital Alger, Algeria
| | - Mahmoud Chiad
- Department of Nephrology, Central Army Hospital Alger, Algeria
| | - Messaoud Saidani
- Department of Nephrology, Beni Messous University Hospital, Alger, Algeria
| | - Mohamed Tayeb Saadi
- Department of Epidemiology and Preventive Medicine, Regional University Military Hospital of Constantine, Algeria
| | - Mustapha Hanba
- Department of Epidemiology and Preventive Medicine, Military Regional University Hospital of Oran, Algeria
| |
Collapse
|
2
|
Driollet B, Couchoud C, Bacchetta J, Boyer O, Hogan J, Morin D, Nobili F, Tsimaratos M, Bérard E, Bayer F, Launay L, Leffondré K, Harambat J. Social Deprivation and Incidence of Pediatric Kidney Failure in France. Kidney Int Rep 2024; 9:2269-2277. [PMID: 39081742 PMCID: PMC11284436 DOI: 10.1016/j.ekir.2024.04.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 04/12/2024] [Accepted: 04/17/2024] [Indexed: 08/02/2024] Open
Abstract
Introduction Approximately 8 per million children and young adults aged < 20 years initiate kidney replacement therapy (KRT) per year in France. We hypothesize that social deprivation could be a determinant of childhood-onset kidney failure. The objective of this study was to estimate the incidence of pediatric KRT in France according to the level of social deprivation. Methods All patients < 20 years who initiated KRT from 2010 to 2015 in metropolitan France were included. Data were collected from the comprehensive French registry of KRT French Renal Epidemiology and Information network (REIN). We used a validated ecological index to assess social deprivation, the 2011 French version of the European Deprivation Index (EDI). We estimated the age standardized incidence rates according to the quintiles of EDI using direct standardization and incidence rate ratio using Poisson regression. Results We included 672 children with kidney failure (58.6% males, 30.7% with glomerular or vascular disease, 43.3% starting KRT between 11 and 17 years). 38.8% were from the most deprived areas (quintile 5 of EDI). The age standardized incidence rate increased with quintile of EDI, from 5.45 (95% confidence interval [CI] = 4.25-6.64) per million children per year in the least deprived quintile to 8.46 (95% CI = 7.41-9.51) in the most deprived quintile of EDI (incidence rates ratio Q5 vs. Q1 1.53-fold; 95% CI = 1.18-2.01). Conclusion This study showed that even in a country with a universal health care system, there is a strong association between the incidence of pediatric KRT and social deprivation showing that social health inequalities appear from KRT initiation. This study highlights the need to look further into social inequalities in the earliest stage of chronic kidney disease (CKD).
Collapse
Affiliation(s)
- Bénédicte Driollet
- University of Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
- INSERM, Clinical Investigation Center-Clinical Epidemiology CIC-1401, Bordeaux, France
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Quebec, Canada
| | - Cécile Couchoud
- REIN registry, Agence de la Biomédecine, La Plaine-Saint Denis, France
| | - Justine Bacchetta
- Pediatric Nephrology Unit, Centre de Référence des Maladies Rénales Rares Nephrogones, Femme Mère Enfants Hospital, Hospices Civils de Lyon, Bron, France
| | - Olivia Boyer
- Pediatric Nephrology Unit, Centre de Référence des Maladies Rénales Rares MARHEA, Necker-Enfants Malades Hospital, Imagine Institute, Université Paris Cité, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Julien Hogan
- Pediatric Nephrology Unit, Centre de Référence des Maladies Rénales Rares Marhea, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Denis Morin
- Pediatric Nephrology Unit, Centre de Référence des Maladies Rénales Rares Sorare, Arnaud de Villeneuve Hospital, Montpellier University Hospital, Montpellier, France
| | - François Nobili
- Department of Pediatrics, Besançon University Hospital, Besançon, France
| | - Michel Tsimaratos
- REIN registry, Agence de la Biomédecine, La Plaine-Saint Denis, France
- Pediatric Nephrology Unit, La Timone University Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Etienne Bérard
- Department of Pediatrics, Nice University Hospital, Nice, France
| | - Florian Bayer
- REIN registry, Agence de la Biomédecine, La Plaine-Saint Denis, France
| | - Ludivine Launay
- INSERM-UCN U1086 Anticipe, Equipe Labellisée Ligue Contre le Cancer, Centre de Lutte contre le Cancer François Baclesse, Caen, France
| | - Karen Leffondré
- University of Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
- INSERM, Clinical Investigation Center-Clinical Epidemiology CIC-1401, Bordeaux, France
| | - Jérôme Harambat
- University of Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
- INSERM, Clinical Investigation Center-Clinical Epidemiology CIC-1401, Bordeaux, France
- Pediatric Nephrology Unit, Centre de Référence Maladies rénales rares Sorare, Pellegrin-Enfants Hospital, Bordeaux University Hospital, Bordeaux, France
| |
Collapse
|
3
|
Kazes I, Solignac J, Lassalle M, Mercadal L, Couchoud C. Twenty years of the French Renal Epidemiology and Information Network. Clin Kidney J 2024; 17:sfad240. [PMID: 38186909 PMCID: PMC10768769 DOI: 10.1093/ckj/sfad240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Indexed: 01/09/2024] Open
Abstract
Background The French Renal Epidemiology and Information Network (REIN) is 20 years old. It is not just a national data registry, but rather an epidemiological and informational network serving patients with chronic kidney disease, nephrology teams and health services. Methods The past 10-year trends of the incidence and prevalence of renal replacement therapy by dialysis or kidney transplantation and waitlist activity are presented. To detect potential significant changes in trends from 2012 and 2021, a Joinpoint regression model was used. Results The overall incidence of treated end-stage kidney disease (ESKD) was 169 per million population (pmp) in 2021. It was stable despite an increase in the incidence of diabetes. We found a decreasing trend in the proportion of patients starting dialysis in an emergency but an increase in those starting haemodialysis (HD) with a temporary catheter. Peritoneal dialysis decreased by 1.7% each year, whereas home HD, although involving only 1% of dialysis patients, increased by 10% each year. For patients not treated at home, the median time to drive from the patient's home to the dialysis unit was 17 min. The proportion of patients on the transplantation waitlist at the start of dialysis increased from 7% to 12%. Among the 111 263 new ESKD patients from 2012 to 2021, 8% received a first transplant at 1 year and 20% at 5 years. Among kidney transplant recipients, the mean time on the waitlist increased from 13.8 to 22.6 months. Living donor transplants increased in frequency, representing 15% of kidney transplants. Conclusions Data from the REIN registry allow for the evaluation of needs and provide a planning tool for French authorities. The progressive implementation of automatic data retrieval from dialysis informatics charts might alleviate the burden of data collection. Furthermore, the research activity the REIN engenders, resulting in renewed confidence by health authorities in the dynamism of French nephrology, allows for an optimistic outlook for the REIN.
Collapse
Affiliation(s)
- Isabelle Kazes
- Service de Néphrologie, Centre Hospitalo-Universitaire de Reims, Reims, France
| | - Justine Solignac
- Service de Néphrologie, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Mathilde Lassalle
- Registre REIN, Agence de la biomédecine, Saint Denis La Plaine, France
| | - Lucile Mercadal
- Service de Néphrologie, Hôpital de la Pitié Salpêtrière, APHP, Paris, France
| | - Cécile Couchoud
- Registre REIN, Agence de la biomédecine, Saint Denis La Plaine, France
| |
Collapse
|
4
|
Kazes I, Béchade C, Lobbedez T, Couchoud C, Lassalle M. Incidence of End Stage Kidney Disease and context of dialysis initiation. Nephrol Ther 2023; 18:19-24. [PMID: 37638503 DOI: 10.1016/s1769-7255(22)00562-4] [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] [Indexed: 01/15/2023]
Abstract
On the occasion of the 20th anniversary of the REIN (French Renal Epidemiology and Information Network), a summary work on the contributions of the national French ESKD register was carried out. On the issue of ESKD incidence, the following key messages were retained. Thanks to several studies conducted using data from the REIN registry, the spatial variations of incidence of stage 5 chronic kidney disease in the replacement stage could be explained, in part, by the health condition of the general population as well as by the socio-economic context and differences in practices. Just like what is observed in other countries, the incidence is stabilising, or even decreasing, especially among people who do not have diabetes. Thanks to the registry having provided an indicator on the initiation of the dialysis, a decrease in the rate of initiation of emergency dialysis (i.e., initiated less than 24 hours after a nephrology evaluation considering a vital risk for the patient) has been observed, resulting from an effort to understand and better anticipate the starting of the replacement.
Collapse
Affiliation(s)
- Isabelle Kazes
- Coordination régionale Champagne-Ardenne, CHU Reims, France
| | | | | | - Cécile Couchoud
- Coordination nationale REIN, Agence de la biomédecine, Saint-Denis-La Plaine, France
| | - Mathilde Lassalle
- Coordination nationale REIN, Agence de la biomédecine, Saint-Denis-La Plaine, France
| |
Collapse
|
5
|
Bundó D, Cunillera O, Arbiol-Roca A, Cobo-Guerrero S, Romano J, Gil-Terron N, Fulladosa X, Comas J, Rama I, Cruzado JM, Salvador-Gonzalez B. Final Stage of Chronic Kidney Disease with Conservative Kidney Management or Renal Replacement Therapy: A Primary-Care Population Study. J Clin Med 2023; 12:4602. [PMID: 37510717 PMCID: PMC10380812 DOI: 10.3390/jcm12144602] [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: 06/07/2023] [Revised: 06/29/2023] [Accepted: 07/02/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Studies focus on the incidence and risk factors (RFs) associated with reaching the final stage of chronic kidney disease (CKD-G5) and receiving kidney replacement therapy (KRT). Analysis of those related to reaching CKD-G5 while receiving conservative kidney management (CKM) has been neglected. METHODS Retrospective cohort study analysing electronic health records of individuals aged ≥ 50 with eGFR < 60 mL/min/m2. Cumulative incidence rates of CKD-G5, with and without KRT, were calculated. Multinomial regression models determined odds ratios (ORs) for CKD-G5 progression with KRT, CKM, or death. RESULTS Among 332,164 patients, the cumulative incidence of CKD-G5 was 2.79 cases per 100 person-years. The rates were 1.92 for CKD-G5 with KRT and 0.87 for CKD-G5 with CKM. Low eGFR and albuminuria were the primary RFs. Male gender and uncontrolled blood pressure had a greater impact on KRT (OR = 2.63 CI, 1.63) than on CKD-G5 with CKM (OR = 1.45 CI, 1.31). Increasing age and rurality reduced the probability of KRT but increased the probability of CKD-G5 with CKM. Higher incomes decreased the likelihood of developing CKD-G5 with and without KRT (OR = 0.49 CI). CONCLUSION One-third of CKD-G5 cases receive CKM. Those are typically older, female, rural residents with lower incomes and with lesser proteinuria or cardiovascular RF. The likelihood of receiving KRT is influenced by location and socioeconomic disparities.
Collapse
Affiliation(s)
- Daniel Bundó
- Centre Atenció Primària Alt Penedès, Direcció d'Atenció Primària Metropolitana Sud, Institut Català de la Salut, 08720 Vilafranca del Penedès, Barcelona, Spain
- Malaltia Cardiovascular i Renal en Atenció Primària (MACAP), Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, 08007 Barcelona, Barcelona, Spain
- Unitat de Suport a la Recerca Metropolitana Sud, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Oriol Cunillera
- Malaltia Cardiovascular i Renal en Atenció Primària (MACAP), Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, 08007 Barcelona, Barcelona, Spain
- Unitat de Suport a la Recerca Metropolitana Sud, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ariadna Arbiol-Roca
- Malaltia Cardiovascular i Renal en Atenció Primària (MACAP), Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, 08007 Barcelona, Barcelona, Spain
- Unitat de Suport a la Recerca Metropolitana Sud, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08907 L'Hospitalet de Llobregat, Barcelona, Spain
- Laboratori Clínic Territorial Metropolitana Sud, Institut Català de la Salut, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sílvia Cobo-Guerrero
- Malaltia Cardiovascular i Renal en Atenció Primària (MACAP), Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, 08007 Barcelona, Barcelona, Spain
- Unitat de Suport a la Recerca Metropolitana Sud, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08907 L'Hospitalet de Llobregat, Barcelona, Spain
- Centre Atenció Primària Gavarra, Direcció d'Atenció Primària Metropolitana Sud, Institut Català de la Salut, 08940 Cornellà de Llobregat, Barcelona, Spain
| | - Jose Romano
- Malaltia Cardiovascular i Renal en Atenció Primària (MACAP), Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, 08007 Barcelona, Barcelona, Spain
- Unitat de Suport a la Recerca Metropolitana Sud, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08907 L'Hospitalet de Llobregat, Barcelona, Spain
- Centre Atenció Primària Sant Josep, Direcció d'Atenció Primària Metropolitana Sud, Institut Català de la Salut, 08901 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Neus Gil-Terron
- Malaltia Cardiovascular i Renal en Atenció Primària (MACAP), Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, 08007 Barcelona, Barcelona, Spain
- Unitat de Suport a la Recerca Metropolitana Sud, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08907 L'Hospitalet de Llobregat, Barcelona, Spain
- Centre Atenció Primària El Pla, Direcció d'Atenció Primària Metropolitana Sud, Institut Català de la Salut, 08980 Sant Feliu de Llobregat, Barcelona, Spain
| | - Xavier Fulladosa
- Nephrology Department, Hospital Universitari de Bellvitge, Institut Català de la Salut, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Comas
- Organització Catalana de Trasplantaments (OCATT), 08005 Barcelona, Barcelona, Spain
| | - Inés Rama
- Nephrology Department, Hospital Universitari de Bellvitge, Institut Català de la Salut, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Josep M Cruzado
- Nephrology Department, Hospital Universitari de Bellvitge, Institut Català de la Salut, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Betlem Salvador-Gonzalez
- Malaltia Cardiovascular i Renal en Atenció Primària (MACAP), Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, 08007 Barcelona, Barcelona, Spain
- Unitat de Suport a la Recerca Metropolitana Sud, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08907 L'Hospitalet de Llobregat, Barcelona, Spain
- Direcció d'Atenció Primària Metropolitana Sud, Institut Català de la Salut, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| |
Collapse
|
6
|
Grant CH, Salim E, Lees JS, Stevens KI. Deprivation and chronic kidney disease-a review of the evidence. Clin Kidney J 2023; 16:1081-1091. [PMID: 37398697 PMCID: PMC10310512 DOI: 10.1093/ckj/sfad028] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Indexed: 06/27/2024] Open
Abstract
The relationship between socioeconomic deprivation and health is inequitable. Chronic kidney disease (CKD) is an archetypal disease of inequality, being more common amongst those living in deprivation. The prevalence of CKD is rising driven by an increase in lifestyle-related conditions. This narrative review describes deprivation and its association with adverse outcomes in adults with non-dialysis-dependent CKD including disease progression, end-stage kidney disease, cardiovascular disease and all-cause mortality. We explore the social determinants of health and individual lifestyle factors to address whether patients with CKD who are socioeconomically deprived have poorer outcomes than those of higher socioeconomic status. We describe whether observed differences in outcomes are associated with income, employment, educational attainment, health literacy, access to healthcare, housing, air pollution, cigarette smoking, alcohol use or aerobic exercise. The impact of socioeconomic deprivation in adults with non-dialysis-dependent CKD is complex, multi-faceted and frequently under-explored within the literature. There is evidence that patients with CKD who are socioeconomically deprived have faster disease progression, higher risk of cardiovascular disease and premature mortality. This appears to be the result of both socioeconomic and individual lifestyle factors. However, there is a paucity of studies and methodological limitations. Extrapolation of findings to different societies and healthcare systems is challenging, however, the disproportionate effect of deprivation in patients with CKD necessitates a call to action. Further empirical study is warranted to establish the true cost of deprivation in CKD to patients and societies.
Collapse
Affiliation(s)
- Christopher H Grant
- The Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital, Govan, Glasgow, UK
- College of Medical, Veterinary & Life Sciences, The University of Glasgow, Glasgow, UK
| | - Ehsan Salim
- College of Medical, Veterinary & Life Sciences, The University of Glasgow, Glasgow, UK
| | - Jennifer S Lees
- The Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital, Govan, Glasgow, UK
- College of Medical, Veterinary & Life Sciences, The University of Glasgow, Glasgow, UK
| | - Kate I Stevens
- The Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital, Govan, Glasgow, UK
- College of Medical, Veterinary & Life Sciences, The University of Glasgow, Glasgow, UK
| |
Collapse
|
7
|
Su CC, Lee KJ, Yen CT, Wu LH, Huang CH, Lu MZ, Cheng CL. Use of spatial panel-data models to investigate factors related to incidence of end-stage renal disease: a nationwide longitudinal study in Taiwan. BMC Public Health 2023; 23:247. [PMID: 36747222 PMCID: PMC9901115 DOI: 10.1186/s12889-023-15189-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/19/2023] [Accepted: 02/02/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The assumptions of conventional spatial models cannot estimate the responses across space and over time. Here we propose new spatial panel data models to investigate the association between the risk factors and incidence of end-stage renal disease (ESRD). METHODS A longitudinal (panel data) study was conducted using data from the National Health Insurance Database in Taiwan. We developed an algorithm to identify the patient's residence and estimate the ESRD rate in each township. Corresponding covariates, including patient comorbidities, history of medication use, and socio-environmental factors, were collected. Local Indicators of Spatial Association were used to describe local spatial clustering around an individual location. Moreover, a spatial panel data model was proposed to investigate the association between ESRD incidence and risk factors. RESULTS In total, 73,995 patients with ESRD were included in this study. The western region had a higher proportion of high incidence rates than the eastern region. The proportion of high incidence rates in the eastern areas increased over the years. We found that most "social environmental factors," except average income and air pollution (PM 2.5 and PM10), had a significant influence on the incidence rate of ESRD when considering spatial dependences of response and explanatory variables. Receiving non-steroidal anti-inflammatory drugs and aminoglycosides within 90 days prior to ESRD had a significant positive effect on the ESRD incidence rate. CONCLUSION Future comprehensive studies on townships located in higher-risk clusters of ESRD will help in designing healthcare policies for suitable action.
Collapse
Affiliation(s)
- Chien-Chou Su
- grid.412040.30000 0004 0639 0054Clinical Innovation and Research Center, National Cheng Kung University Hospital, Tainan City, Taiwan
| | - Kuo-Jung Lee
- grid.64523.360000 0004 0532 3255Department of Statistics, Institute of Data Science, National Cheng Kung University, No.1, University Road, 701 Tainan City, Taiwan
| | - Chi-Tai Yen
- grid.410770.50000 0004 0639 1057Department of Nephrology , Tainan Hospital, Ministry of Health and Welfare , Tainan City, Taiwan
| | - Lu-Hsuan Wu
- grid.412040.30000 0004 0639 0054Department of Pharmacy, National Cheng Kung University Hospital, Tainan City, Taiwan ,grid.64523.360000 0004 0532 3255School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, National Cheng Kung University, No. 1 University Road, 701 Tainan city, Taiwan
| | - Chien-Huei Huang
- grid.412040.30000 0004 0639 0054Department of Pharmacy, National Cheng Kung University Hospital, Tainan City, Taiwan
| | - Meng-Zhan Lu
- grid.64523.360000 0004 0532 3255School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, National Cheng Kung University, No. 1 University Road, 701 Tainan city, Taiwan
| | - Ching-Lan Cheng
- Department of Pharmacy, National Cheng Kung University Hospital, Tainan City, Taiwan. .,School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, National Cheng Kung University, No. 1 University Road, 701, Tainan city, Taiwan.
| |
Collapse
|
8
|
Desmarets M, Ayav C, Diallo K, Bayer F, Imbert F, Sauleau EA, Monnet E. Fine-scale geographic variations of rates of renal replacement therapy in northeastern France: Association with the socioeconomic context and accessibility to care. PLoS One 2020; 15:e0236698. [PMID: 32722704 PMCID: PMC7386572 DOI: 10.1371/journal.pone.0236698] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 07/12/2020] [Indexed: 11/25/2022] Open
Abstract
Background The strong geographic variations in the incidence rates of renal replacement therapy (RRT) for end-stage renal disease are not solely related to variations in the population's needs, such as the prevalence of diabetes or the deprivation level. Inequitable geographic access to health services has been involved in different countries but never in France, a country with a generous supply of health services and where the effect of the variability of medical practices was highlighted in an analysis conducted at the geographic scale of districts. Our ecological study, performed at the finer scale of townships in a French area of 8,370,616 inhabitants, investigated the association between RRT incidence rates, socioeconomic environment and geographic accessibility to healthcare while adjusting for morbidity level and medical practice patterns. Methods Using data from the Renal Epidemiology and Information Network registry, we estimated age-adjusted RRT incidence rates during 2010–2014 for the 282 townships of the area. A hierarchical Bayesian Poisson model was used to examine the association between incidence rates and 18 contextual variables describing population health status, socioeconomic level and health services characteristics. Relative risks (RRs) and 95% credible intervals (95% CrIs) for each variable were estimated for a 1-SD increase in incidence rate. Results During 2010–2014, 6,835 new patients ≥18 years old (4231 men, 2604 women) living in the study area started RRT; the RRT incidence rates by townships ranged from 21 to 499 per million inhabitants. In multivariate analysis, rates were related to the prevalence of diabetes [RR (95% CrI): 1.05 (1.04–1.11)], the median estimated glomerular filtration rate at dialysis initiation [1.14 (1.08–1.20)], and the proportion of incident patients ≥ 85 years old [1.08 (1.03–1.14)]. After adjusting for these factors, rates in townships increased with increasing French deprivation index [1.05 (1.01–1.08)] and decreased with increasing mean travel time to reach the closest nephrologist [0.92 (0.89–0.95]). Conclusion These data confirm the influence of deprivation level, the prevalence of diabetes and medical practices on RRT incidence rates across a large French area. For the first time, an association was found with the distance to nephrology services. These data suggest possible inequitable geographic access to RRT within the French health system.
Collapse
Affiliation(s)
- Maxime Desmarets
- CIC-1431 INSERM, CHU Besançon, Université de Franche-Comté, Besançon, France
- UMR1098 RIGHT, Université Bourgogne Franche-Comté, EFS, INSERM, Besançon, France
| | - Carole Ayav
- CIC-1433 Epidémiologie Clinique, INSERM, CHRU Nancy, Université de Lorraine, Nancy, France
| | - Kadiatou Diallo
- CIC-1431 INSERM, CHU Besançon, Université de Franche-Comté, Besançon, France
| | - Florian Bayer
- Agence de la Biomédecine, Saint Denis La Plaine, France
| | - Frédéric Imbert
- Observatoire Régional de la Santé d'Alsace, Strasbourg, France
| | - Erik André Sauleau
- Laboratoire de Biostatistique, ICube UMR CNRS 7357, Université de Strasbourg, Strasbourg, France
| | - Elisabeth Monnet
- CIC-1431 INSERM, CHU Besançon, Université de Franche-Comté, Besançon, France
- * E-mail:
| | | |
Collapse
|
9
|
Toms R, Feng X, Mayne DJ, Bonney A. Role of Area-Level Access to Primary Care on the Geographic Variation of Cardiometabolic Risk Factor Distribution: A Multilevel Analysis of the Adult Residents in the Illawarra-Shoalhaven Region of NSW, Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4297. [PMID: 32560149 PMCID: PMC7344656 DOI: 10.3390/ijerph17124297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/13/2020] [Accepted: 06/14/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Access to primary care is important for the identification, control and management of cardiometabolic risk factors (CMRFs). This study investigated whether differences in geographic access to primary care explained area-level variation in CMRFs. METHODS Multilevel logistic regression models were used to derive the association between area-level access to primary care and seven discrete CMRFs after adjusting for individual and area-level co-variates. Two-step floating catchment area method was used to calculate the geographic access to primary care for the small areas within the study region. RESULTS Geographic access to primary care was inversely associated with low high density lipoprotein (OR 0.94, CI 0.91-0.96) and obesity (OR 0.91, CI 0.88-0.93), after adjusting for age, sex and area-level disadvantage. The intra-cluster correlation coefficient (ICCs) of all the fully adjusted models ranged between 0.4-1.8%, indicating low general contextual effects of the areas on CMRF distribution. The area-level variation in CMRFs explained by primary care access was ≤10.5%. CONCLUSION The findings of the study support proportionate universal interventions for the prevention and control of CMRFs, rather than any area specific interventions based on their primary care access, as the contextual influence of areas on all the analysed CMRFs were found to be minimal. The findings also call for future research that includes other aspects of primary care access, such as road-network access, financial affordability and individual-level acceptance of the services in order to gain an overall picture of the area-level contributing role of primary care on CMRFs in the study region.
Collapse
Affiliation(s)
- Renin Toms
- School of Medicine, University of Wollongong, Wollongong NSW 2522, Australia; (D.J.M.); (A.B.)
- Illawarra Health and Medical Research Institute, Wollongong NSW 2522, Australia;
| | - Xiaoqi Feng
- Illawarra Health and Medical Research Institute, Wollongong NSW 2522, Australia;
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong NSW 2500, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney NSW 2033, Australia
| | - Darren J Mayne
- School of Medicine, University of Wollongong, Wollongong NSW 2522, Australia; (D.J.M.); (A.B.)
- Illawarra Health and Medical Research Institute, Wollongong NSW 2522, Australia;
- Illawarra Shoalhaven Local Health District, Public Health Unit, Warrawong NSW 2502, Australia
- School of Public Health, The University of Sydney, Sydney NSW 2006, Australia
| | - Andrew Bonney
- School of Medicine, University of Wollongong, Wollongong NSW 2522, Australia; (D.J.M.); (A.B.)
- Illawarra Health and Medical Research Institute, Wollongong NSW 2522, Australia;
| |
Collapse
|
10
|
Intraregional differences in renal function in the Northern Netherlands: The Lifelines Cohort Study. PLoS One 2019; 14:e0223908. [PMID: 31613916 PMCID: PMC6793867 DOI: 10.1371/journal.pone.0223908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 10/01/2019] [Indexed: 11/24/2022] Open
Abstract
Background Although the interregional disparity in chronic kidney disease (CKD) prevalence has been reported globally, little is known about differences in CKD prevalence within a region. We aimed to study the intraregional distribution of renal function in the Northern Netherlands and identify determinants of geographical differences in renal function. Methods We included 143,735 participants from the Lifelines population-based cohort in the Northern Netherlands. Spatial analysis was performed to identify regional clusters of lower eGFR (cold spots) and higher eGFR (hot spots) at the postal code level, without and with adjustment for clinical risk factors. Multivariate logistic regression was used to identify the contribution of neighborhood-level health-related behaviors, socioeconomic status, and environmental factors (air pollution parameters, urbanity) to regional clustering of lower eGFR. Results Significant spatial clustering of renal function was found for eGFR as well as for early stage renal function impairment (eGFR<90 ml/min/1.73 m2), (p<0.001). Spatial clustering persisted after adjustment of eGFR for clinical risk factors. In adjusted cold spots, the aggregate eGFR was lower (mean ± SD: 96.5±4.8 vs. 98.5±4.0 ml/min/1.73 m2, p = 0.001), and the prevalence of early stage renal function impairment (35.8±10.9 vs. 28.7±9.8%, p<0.001) and CKD stages 3–5 was higher (median (interquartile range): 1.2(0.1–2.4) vs 0(0–1.4)%, p<0.001) than in hot spots. In multivariable logistic regression, exposure to NO2 (Odd ratio [OR], 1.45; 95% confidence interval [95% CI], 1.19 to 1.75, p<0.001) was associated with cold spots (lower renal function), whereas proportion of fat intake in the diet (OR, 0.68; 95%CI, 0.48–0.97, P = 0.031) and income (OR, 0.91; 95%CI, 0.86–0.96, p<0.001) for median level income) were inversely related. Conclusions Significant intraregional clustering of renal function, early renal function impairment and CKD were observed in the Northern Netherlands even after adjustment for renal function-related clinical risk factors. Environmental (air pollution), neighborhood-level socioeconomic factors and diet are determinants of intraregional renal function distribution. Spatial analysis might be a useful adjunct to guide public health strategies for the prevention of CKD.
Collapse
|
11
|
Bilgel F. Spatial distribution of inequalities in end-stage renal disease in the United States. Spat Spatiotemporal Epidemiol 2019; 30:100282. [DOI: 10.1016/j.sste.2019.100282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 03/15/2019] [Accepted: 05/02/2019] [Indexed: 10/26/2022]
|
12
|
Detourmignies L, Leroyer A, Ligier K, Plouvier S, Genin M. Population-based incidence of lymphomas in the French Nord-Pas-de-Calais region between 2001 and 2005: Annual estimations and spatial analysis. Rev Epidemiol Sante Publique 2019; 67:319-327. [PMID: 31327522 DOI: 10.1016/j.respe.2019.05.010] [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: 12/19/2017] [Revised: 05/07/2019] [Accepted: 05/10/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Non-Hodgkin's lymphomas (NHL) are the seventh most commonly diagnosed cancer in France. Nord-Pas-de-Calais is ranked as the region with the highest incidence of cancers and deaths by cancer in France. With its rich industrial past and its contrasted population densities between urban and rural territories, Nord-Pas-de-Calais represents a geographic area of interest to study the overall incidence of NHL and examine spatial variation of NHL incidence between the 170 cantons of the region. METHODS LYMPHONOR was a population-based multicentre retrospective study of patients residing in the Nord-Pas-de-Calais region and diagnosed with NHL between January 2001 and December 2005. Spatial distribution of NHL incidence in Nord-Pas-de-Calais was explored using two complementary approaches: adjusted smoothed standardised incidence ratio (SIR) and spatial scan statistics (detection of atypical clusters). RESULTS Between 2001 and 2005, 2132 new cases of NHL were diagnosed in the Nord-Pas-de-Calais region. In 2005, age-standardised NHL incidence rates were 10.2 and 7.0 cases per 100,000 person-years in male and female residents, respectively. No significant spatial disparities in NHL incidence were found within the Nord-Pas-de-Calais region. The age-adjusted smoothed SIR varied from 0.82 to 1.25 between cantons. Consistently, spatial scan statistics did not detect any significant atypical cluster of high NHL incidence. CONCLUSION Comparison with national data collected during the same period does not show an overincidence of NHL in the Nord-Pas-de-Calais region. In addition, no evidence for spatial heterogeneity and clustering of NHL incidence was found within this region. Future epidemiological research using large-scale registries is needed to better appraise spatial variation of NHL incidence in France and to investigate possible reasons for significant clusters.
Collapse
Affiliation(s)
- L Detourmignies
- Service d'hématologie clinique, Hôpital de Roubaix, 11-17, boulevard Lacordaire, 59056 Roubaix, France.
| | - A Leroyer
- Université de Lille, CHU de Lille, Institut Pasteur de Lille, EA 4483, IMPECS, IMPact of Environmental Chemicals on human health, 59000 Lille, France; CHU de Lille, Pôle de Santé Publique, 59000 Lille, France; Institut Pasteur de Lille, 59000 Lille, France
| | - K Ligier
- Registre général des cancers de Lille et de sa région, C2RC, 59037 Lille, France; Conseil Départemental du Pas-de-Calais, 62018 Arras, France
| | - S Plouvier
- Registre général des cancers de Lille et de sa région, C2RC, 59037 Lille, France
| | - M Genin
- Université de Lille, EA 2694 - Santé Publique : épidémiologie et qualité des soins, 59000 Lille, France
| |
Collapse
|
13
|
Abstract
The objective of this review is to illustrate the interests of registries in terms of clinical research, using practical examples from the French REIN registry. In addition to their interest in terms of observation and decision-making for public health, registries may also be used to compare structures, and to evaluate causality in clinical research. Indeed, even though randomized controlled trials are the gold standard to assess causality, they may be difficult to perform, with an applicability in daily life that remains to be demonstrated since patients are highly selected patients with a very close follow-up. In contrast, observational studies from registries have other advantages, and notably high number of patients, low cost, relatively rapid research, focus on specific sub-groups. In the future, data mining with an implementation of a huge number of data for patients (hospitalization data, genetics, ambulatory care, etc.) will dramatically improve the databases. We may even imagine running RCTs directly in registries, with lower costs and patients closer to reality. However, many challenges remain to be solved, and notably the ethical issues of confidentiality and protection of patients in these "mega-databases". Cet article fait partie du numéro supplément Innovations en Néphrologie réalisé avec le soutien institutionnel de Vifor Fresenius Medical Care Renal Pharma.
Collapse
Affiliation(s)
- Gabriel Choukroun
- Service de néphrologie, médecine interne, dialyse, transplantation et réanimation, université de Picardie Jules-Verne, CHU d'Amiens, 80000 Amiens, France.
| | - Bruno Moulin
- Service de néphrologie et transplantation, Nouvel Hôpital civil, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France.
| |
Collapse
|
14
|
Geographic and area-level socioeconomic variation in cardiometabolic risk factor distribution: a systematic review of the literature. Int J Health Geogr 2019; 18:1. [PMID: 30621786 PMCID: PMC6323718 DOI: 10.1186/s12942-018-0165-5] [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] [Received: 09/04/2018] [Accepted: 12/31/2018] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION A growing number of publications report variation in the distribution of cardiometabolic risk factors (CMRFs) at different geographic scales. A review of these variations may help inform policy and health service organisation. AIM To review studies reporting variation in the geographic distribution of CMRFs and its association with various proxy measures of area-level socioeconomic disadvantage (ASED) among the adult ( ≥ 18 years) population across the world. METHODS A systematic search for published articles was conducted in four databases (MEDLINE (Ovid), PubMed, Scopus and Web of Science) considering the interdisciplinary nature of the review question. Population-based cross-sectional and cohort studies on geographic variations of one or more biological proxies of CMRFs with/without an analysed contextual association with ASED were included. Two independent reviewers screened the studies and PRISMA guidelines were followed in the study selection and reporting. RESULT A total of 265 studies were retrieved and screened, resulting in 24 eligible studies. The review revealed reports of variation in the distribution of CMRFs, at varying geographic scales, in multiple countries. In addition, consistent associations between ASED and higher prevalence of CMRFs were demonstrated. The reports were mainly from industrialised nations and small area geographic units were frequently used. CONCLUSION Geographic variation in cardiometabolic risk exists across multiple spatial scales and is positively associated with ASED. This association is independent of individual-level factors and provides an imperative for area-based approaches to informing policy and health service organisation. The study protocol is registered in International prospective register of systematic reviews (Register No: CRD42018115294) PROSPERO 2018.
Collapse
|
15
|
Feged-Rivadeneira A, Ángel A, González-Casabianca F, Rivera C. Malaria intensity in Colombia by regions and populations. PLoS One 2018; 13:e0203673. [PMID: 30208075 PMCID: PMC6135511 DOI: 10.1371/journal.pone.0203673] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 08/26/2018] [Indexed: 12/15/2022] Open
Abstract
Determining the distribution of disease prevalence among heterogeneous populations at the national scale is fundamental for epidemiology and public health. Here, we use a combination of methods (spatial scan statistic, topological data analysis and epidemic profile) to study measurable differences in malaria intensity by regions and populations of Colombia. This study explores three main questions: What are the regions of Colombia where malaria is epidemic? What are the regions and populations in Colombia where malaria is endemic? What associations exist between epidemic outbreaks between regions in Colombia? Plasmodium falciparum is most prevalent in the Pacific Coast, some regions of the Amazon Basin, and some regions of the Magdalena Basin. Plasmodium vivax is the most prevalent parasite in Colombia, particularly in the Northern Amazon Basin, the Caribbean, and municipalities of Sucre, Antioquia and Cordoba. We find an acute peak of malarial infection at 25 years of age. Indigenous and Afrocolombian populations experience endemic malaria (with household transmission). We find that Plasmodium vivax decreased in the most important hotspots, often with moderate urbanization rate, and was re-introduced to locations with moderate but sustained deforestation. Infection by Plasmodium falciparum, on the other hand, steadily increased in incidence in locations where it was introduced in the 2009-2010 generalized epidemic. Our findings suggest that Colombia is entering an unstable transmission state, where rapid decreases in one location of the country are interconnected with rapid increases in other parts of the country.
Collapse
Affiliation(s)
- Alejandro Feged-Rivadeneira
- Department of Anthropology, Stanford University, Stanford, CA, United States of America
- Department of Urban Management and Design, Universidad del Rosario, Bogotá, Colombia
- * E-mail:
| | - Andrés Ángel
- Department of Mathematics, Universidad de los Andes, Bogotá, Colombia
- Department of Mathematics and Statistics, Universidad del Norte, Barranquilla, Colombia
| | | | - Camilo Rivera
- Walmartlabs, Sunnyvale, CA, United States of America
| |
Collapse
|
16
|
Roussel A, Michel M, Lefevre-Utile A, De Pontual L, Faye A, Chevreul K. Impact of social deprivation on length of stay for common infectious diseases in two French university-affiliated general pediatric departments. Arch Pediatr 2018; 25:359-364. [PMID: 30041884 DOI: 10.1016/j.arcped.2018.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 05/14/2018] [Accepted: 06/20/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Adult deprived patients consume more healthcare resources than others, particularly in terms of increased length of stay (LOS) and costs. Very few pediatric studies have focused on LOS, although the effect of deprivation could be greater in children due to the vulnerability of this population. Our objective was to compare LOS between deprived and nondeprived children hospitalized for acute infectious diseases in two university-affiliated pediatric departments located in a low-income area of northern Paris. METHODS We performed a prospective observational multicenter study in two university-affiliated hospitals, Hôpital Robert-Debré and Hôpital Jean-Verdier. All the patients under 15 years of age admitted to the general pediatric department for pneumonia, bronchiolitis, gastroenteritis, or pyelonephritis between 20 October 2016 and 20 March 2017 were included. Deprivation was assessed with an individual questionnaire and score (EPICES). Endpoints included length of stay, costs, and readmission rates at 15 days in each quintile of deprivation. Multivariate regression assessed the association between deprivation and each endpoint. RESULTS A total of 556 patients were included in the study and 540 were analyzed. Sixty percent were boys and the mean age was 9 months±18. Bronchiolitis was the most frequent diagnosis (67.8%). Fifty-six percent of patients were considered to be deprived based on the EPICES questionnaire. Mean LOS was 4.6±3.5 days and we found no significant difference in LOS between the different deprivation quintiles (P=0.83). Multivariate regression did not show an association between LOS and deprivation. CONCLUSION There was no difference between deprived and nondeprived patients in terms of LOS. Deprivation may therefore impact hospitals in other ways such as admission rates. The impact of deprivation during hospitalization for chronic diseases should also be investigated.
Collapse
Affiliation(s)
- A Roussel
- Service de pédiatrie générale, hôpital Robert-Debré, Assistance publique des Hôpitaux de Paris, 48, boulevard Sérurier, 75019 Paris, France; Inserm, ECEVE, U1123, 10, boulevard de Verdun, 75010 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, 10, boulevard de Verdun, 75010 Paris, France.
| | - M Michel
- Inserm, ECEVE, U1123, 10, boulevard de Verdun, 75010 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, 10, boulevard de Verdun, 75010 Paris, France; URC Eco Île-de-France, DRCD, Assistance publique-Hôpitaux de Paris, Hôtel Dieu, 1, place du Parvis-de-Notre-Dame, 75004 Paris, France
| | - A Lefevre-Utile
- Service de pédiatrie générale, hôpital Robert-Debré, Assistance publique des Hôpitaux de Paris, 48, boulevard Sérurier, 75019 Paris, France
| | - L De Pontual
- Service de pédiatrie générale, hôpital Jean-Verdier, Assistance publique-Hôpitaux de Paris, avenue du 14-Juillet, 93143 Bondy cedex, France
| | - A Faye
- Service de pédiatrie générale, hôpital Robert-Debré, Assistance publique des Hôpitaux de Paris, 48, boulevard Sérurier, 75019 Paris, France; Inserm, ECEVE, U1123, 10, boulevard de Verdun, 75010 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, 10, boulevard de Verdun, 75010 Paris, France
| | - K Chevreul
- Inserm, ECEVE, U1123, 10, boulevard de Verdun, 75010 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, 10, boulevard de Verdun, 75010 Paris, France; URC Eco Île-de-France, DRCD, Assistance publique-Hôpitaux de Paris, Hôtel Dieu, 1, place du Parvis-de-Notre-Dame, 75004 Paris, France
| |
Collapse
|
17
|
Friedlander L, Choquet R, Galliani E, de Chalendar M, Messiaen C, Ruel A, Vazquez MP, Berdal A, Alberti C, De La Dure Molla M. Management of rare diseases of the Head, Neck and Teeth: results of a French population-based prospective 8-year study. Orphanet J Rare Dis 2017; 12:94. [PMID: 28526043 PMCID: PMC5437557 DOI: 10.1186/s13023-017-0650-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 05/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the last ten years, national rare disease networks have been established in France, including national centres of expertise and regional ones, with storage of patient data in a bioinformatics tool. The aim was to contribute to the development and evaluation of health strategies to improve the management of patients with rare diseases. The objective of this study has been to provide the first national-level data concerning rare diseases of the head, neck and teeth and to assess the balance between demand and supply of care in France. METHODS Centres of expertise for rare diseases record a minimum data set on their clinical cases, using a list of rare Head, Neck and Teeth diseases established in 2006. The present analysis focuses on 2008 to 2015 data based on the Orphanet nomenclature. Each rare disease RD "case" was defined by status "affected" and by the degree of diagnostic certainty, encoded as: confirmed, probable or non-classifiable. Analysed parameters, presented with their 95% confidence intervals using a Poisson model, were the following: time and age at diagnosis, proportions of crude and standardized RD prevalence by age, gender and geographical site. The criteria studied were the proportions of patients in Paris Region and the "included cases geography", in which these proportions were projected onto the other French Regions, adjusting for local populations. RESULTS In Paris Region, estimated prevalence of these diseases was 5.58 per 10,000 inhabitants (95% CI 4.3-7.1). At December 31st 2015, 11,342 patients were referenced in total in France, of whom 7294 were in Paris Region. More than 580 individual clinical entities (ORPHA code) were identified with their respective frequencies. Most abnormalities were diagnosed antenatally. Nearly 80% of patients recorded come to Paris hospitals to obtain either diagnosis, care or follow up. We observed that the rarer the disease, the more patients were referred to Paris hospitals. CONCLUSIONS A health network covering a range of aspects of the rare diseases problematic from diagnostics to research has been developed in France. Despite this, there is still a noticeable imbalance between health care supply and demand in this area.
Collapse
Affiliation(s)
- Lisa Friedlander
- Université Paris Diderot - Sorbonne Paris Cité, INSERM, Laboratoire ECEVE UMR1123, Paris, France.
- Centre de référence des malformations rares de la face et de la cavité buccale, Hôpital Rothschild, AP-HP, Paris, France.
| | - Rémy Choquet
- Banque Nationale de Données Maladies Rares, Hôpital Necker Enfants Malades, AP-HP, Paris, France
| | - Eva Galliani
- Centre de référence des malformations rares de la face et de la cavité buccale, Hôpital Necker, AP-HP, Paris, France
- Université Paris Descartes-Sorbonne Paris Cité, Paris, France
- Service de chirurgie maxillo-faciale et de chirurgie plastique, Hôpital Necker, AP-HP, Paris, France
| | - Myriam de Chalendar
- Filière de santé maladies rares TETECOU: malformations rares de la tête, du cou et des dents, Hôpital Necker, Paris, France
| | - Claude Messiaen
- Banque Nationale de Données Maladies Rares, Hôpital Necker Enfants Malades, AP-HP, Paris, France
| | - Amélie Ruel
- Banque Nationale de Données Maladies Rares, Hôpital Necker Enfants Malades, AP-HP, Paris, France
| | - Marie-Paule Vazquez
- Centre de référence des malformations rares de la face et de la cavité buccale, Hôpital Necker, AP-HP, Paris, France
- Université Paris Descartes-Sorbonne Paris Cité, Paris, France
- Service de chirurgie maxillo-faciale et de chirurgie plastique, Hôpital Necker, AP-HP, Paris, France
- Filière de santé maladies rares TETECOU: malformations rares de la tête, du cou et des dents, Hôpital Necker, Paris, France
| | - Ariane Berdal
- Centre de référence des malformations rares de la face et de la cavité buccale, Hôpital Rothschild, AP-HP, Paris, France
- Université Paris Diderot - Sorbonne Paris Cité, INSERM, Laboratoire de physiopathologie orale et moléculaire, UMRS 1138, Paris, France
| | - Corinne Alberti
- Université Paris Diderot - Sorbonne Paris Cité, INSERM, Laboratoire ECEVE UMR1123, Paris, France
| | - Muriel De La Dure Molla
- Centre de référence des malformations rares de la face et de la cavité buccale, Hôpital Rothschild, AP-HP, Paris, France
- INSERM UMR_S1163 Bases moléculaires et physiopathologiques des ostéochondrodysplasies, Institut Imagine, Necker, Paris, France
| |
Collapse
|
18
|
Bowe B, Xie Y, Xian H, Lian M, Al-Aly Z. Geographic Variation and US County Characteristics Associated With Rapid Kidney Function Decline. Kidney Int Rep 2016; 2:5-17. [PMID: 29142937 PMCID: PMC5678675 DOI: 10.1016/j.ekir.2016.08.016] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 08/20/2016] [Accepted: 08/22/2016] [Indexed: 12/12/2022] Open
Abstract
Introduction Geographic variation in the prevalence of chronic kidney disease and incidence of end-stage renal disease has been previously reported. However, the geographic epidemiology of rapid estimated glomerular filtration rate (eGFR) decline has not been examined. Methods We built a longitudinal cohort of 2,107,570 US veterans to characterize the spatial epidemiology of and examine the associations between US county characteristics and rapid eGFR decline. Results There were 169,029 (8.02%) with rapid eGFR decline (defined as eGFR slope < –5 ml/min per 1.73 m2/year). The prevalence of rapid eGFR decline adjusted for age, race, gender, diabetes, and hypertension varied by county from 4.10%–6.72% in the lowest prevalence quintile to 8.41%–22.04% in the highest prevalence quintile (P for heterogeneity < 0.001). Examination of adjusted prevalence showed substantial geographic variation in those with and without diabetes and those with and without hypertension (P for heterogeneity < 0.001). Cohort participants had higher odds of rapid eGFR decline when living in counties with unfavorable characteristics in domains including health outcomes (odds ratio [OR] = 1.15; confidence interval [CI] = 1.09–1.22), health behaviors (OR = 1.08; CI = 1.03–1.13), clinical care (OR = 1.11; CI = 1.06–1.16), socioeconomic conditions (OR = 1.15; CI = 1.09–1.22), and physical environment (OR = 1.15; CI = 1.01–1.20); living in counties with high percentage of minorities and immigrants was associated with rapid eGFR decline (OR = 1.25; CI = 1.20–1.31). Spatial analyses suggest the presence of cluster of counties with high prevalence of rapid eGFR decline. Discussion Our findings show substantial geographic variation in rapid eGFR decline among US veterans; the variation persists in analyses stratified by diabetes and hypertension status; results show associations between US county characteristics in domains capturing health, socioeconomic, environmental, and diversity conditions, and rapid eGFR decline.
Collapse
Affiliation(s)
- Benjamin Bowe
- Clinical Epidemiology Center, Research and Education Service, VA Saint Louis Health Care System, Saint Louis, Missouri, USA
| | - Yan Xie
- Clinical Epidemiology Center, Research and Education Service, VA Saint Louis Health Care System, Saint Louis, Missouri, USA
| | - Hong Xian
- Clinical Epidemiology Center, Research and Education Service, VA Saint Louis Health Care System, Saint Louis, Missouri, USA
- Department of Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, USA
| | - Min Lian
- Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Ziyad Al-Aly
- Clinical Epidemiology Center, Research and Education Service, VA Saint Louis Health Care System, Saint Louis, Missouri, USA
- Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA
- Department of Medicine, Division of Nephrology, VA Saint Louis Health Care System, Saint Louis, Missouri, USA
- Correspondence: Ziyad Al-Aly, Clinical Epidemiology Center, Research and Education Service, VA Saint Louis Health Care System, 915 North Grand Boulevard, 151-JC Saint Louis, Missouri 63106, USA.Clinical Epidemiology CenterResearch and Education ServiceVA Saint Louis Health Care System915 North Grand Boulevard, 151-JC Saint LouisMissouri 63106USA
| |
Collapse
|