Impact of hospitalized vaso-occlusive crises in the previous calendar year on mortality and complications in adults with sickle cell disease: a French population-based study

Background

Historically, sickle cell disease (SCD) patients experiencing frequent hospitalized vaso-occlusive crises (HVOC) have been associated with increased mortality, yet recent data reflecting the widespread use of hydroxyurea and advancements in disease management remain limited. Our study aims to assess the association between HVOC and mortality or severe complications in patients with SCD in this new treatment landscape.

Methods

This was a retrospective observational cohort study using the French national health data system. Between 01-01-2012 and 12-31-2018, all SCD patients ≥16 years old (ICD-10 codes D57.0-2) were included and followed until 12-31-2018. HVOC was defined as a hospitalization of ≥1 night with primary diagnosis of SCD with crisis, following an emergency room visit. The association between HVOC and severe complications was assessed with a Cox proportional hazards model.

Findings

In total, 8018 patients (56.6% females; 4538/8018) were included. The 2018 SCD standardized one-year period prevalence was 17.9 cases/100,000 person-years [17.4; 18.3]. The mean rate was 0.84 (1.88) HVOC/person-year. In 2018, 70% (5323/7605), 22% (1671/7605), and 8% (611/7605) of patients experienced 0, 1-2, or 3+ HVOCs, respectively. The median survival time between HVOCs was 415 days [386; 439]. Overall, 312 patients died (3.9%) with a mean age of 49.8 (19.4). Compared to patients without HVOC, the hazard ratios of death in patients with 1-2 or 3+ HVOCs the year prior to death were 1.67 [1.21; 2.30] and 3.70 [2.30; 5.93], respectively. Incidence of acute chest syndrome, pulmonary embolism, osteonecrosis, and sepsis increased with the HVOCs category, but not stroke. In 2018, 29.5% (180/611) of patients with 3+ HVOCs did not take hydroxyurea.

Interpretation

Patients must be closely monitored during their hospitalizations to intensify treatment and check treatment compliance. Innovative therapies are also required.

Funding

The study was funded by Novartis.

Editor's Choice -- Survival, Limb Salvage, and Management of Patients with Lower Limb Acute Ischaemia: A French National Retrospective Observational Study

OBJECTIVE

The aim was to describe the baseline characteristics of French patients referred with acute limb ischaemia (ALI), and their clinical management and outcome (death, amputation).

METHODS

This retrospective observational cohort study used the National Health Data System. All adults hospitalised for ALI who underwent revascularisation with an endovascular or open surgical approach between 1 January 2015 and 31 December 2020 were included and followed up until death or the end of the study (31 December 2021). A one year look back period was used to capture patients' medical history. The risks of death, and major and minor amputations were described using Kaplan-Meier and Aalen-Johansen estimators. A Cox model was used to report the adjusted association between groups and risk of death and Fine-Gray models for the risk of amputations considering the competing risk of death.

RESULTS

Overall, 51 390 patients (median age 70 years, 69% male) were included and had a median follow up of 2.7 years: 39 411 (76.7%) were treated with an open approach and 11 979 (23.3%) with a percutaneous endovascular approach. The preferred approach for the revascularisation varied between French regions. The one year overall survival was 78.0% and 85.2% in the surgery and endovascular groups, respectively. The surgery group had a higher risk of death (hazard ratio [HR] 1.17, 95% CI 1.12 - 1.21), a higher risk of major amputation (sub-distribution HR 1.20, 95% CI 1.10 - 1.30) and lower risk of minor amputation (sub-distribution HR 0.66, 95% CI 0.60 - 0.71) than the endovascular group. Diabetes and dialysis increased the risk of major amputation by 52% and 78%, respectively. Subsequent ALI was the third most common cause of hospital re-admission within one year.

CONCLUSION

ALI remains a condition at high risk of death and amputation. Individual risk factors and ALI severity need to be considered to choose between approaches. Continued prevention efforts, improved management, and access to the most suitable approach are necessary.

Comparative effectiveness of gonadotropins used for ovarian stimulation during assisted reproductive technologies (ART) in France: A real-world observational study from the French nationwide claims database (SNDS)

This comparative non-interventional study using data from the French National Health Database (Système National des Données de Santé) investigated real-world (cumulative) live birth outcomes following ovarian stimulation, leading to oocyte pickup with either originator recombinant human follicle-stimulating hormone (r-hFSH) products (alfa or beta), r-hFSH alfa biosimilars, or urinaries including mainly HP-hMG (menotropins), and marginally u-hFSH-HP (urofollitropin). Using data from 245,534 stimulations (153,600 women), biosimilars resulted in a 19% lower live birth (adjusted odds ratio (OR) 0.81, 95% confidence interval (CI) 0.76-0.86) and a 14% lower cumulative live birth (adjusted hazard ratio (HR) 0.86, 95% CI 0.82-0.89); and urinaries resulted in a 7% lower live birth (adjusted OR 0.93, 95% CI 0.90-0.96) and an 11% lower cumulative live birth (adjusted HR 0.89, 95% CI 0.87-0.91) versus originator r-hFSH alfa. Results were consistent across strata (age and ART strategy), sensitivity analysis using propensity score matching, and with r-hFSH alfa and beta as the reference group.

Safety Attitude of Operating Room Personnel Associated With Accurate Completion of a Surgical Checklist: A Cross-sectional Observational Study

OBJECTIVE

How the checklist is executed in routine practice may reflect the teamwork and safety climate in the operating room (OR). This cross-sectional study aimed to identify whether the presence of a fully completed checklist in medical records was associated with teams' safety attitudes.

METHODS

Data from 29 French hospitals, including 5677 operated patients and 834 OR professionals, were prospectively collected. The degree of checklist compliance was categorized for each patient in 1 of 4 ways: full, incomplete, inaccurate, and no checklist completed. The members of OR teams were invited to complete a questionnaire including teamwork climate measurement (Safety Attitudes Questionnaire) and their opinion regarding checklist use, checklist audibly reading, and communication change with checklist. Multilevel modeling was performed to investigate the effect of variables related to hospitals and professionals on checklist compliance, after adjustment for patient characteristics.

RESULTS

A checklist was present for 83% of patients, but only 35% demonstrated full completion. Compared with no checklist, full completion was associated with higher safety attitude (high teamwork climate [adjusted odds ratio for full completion, 4.14; 95% confidence interval, 1.75-9.76]; communication change [1.31, 1.04-1.66]; checklist aloud reading [1.16, 1.02-1.32]) and was reinforced by the designation of a checklist coordinator (2.43, 1.06-5.55). Incomplete completion was also associated with enhanced safety attitude contrary to inaccurate completion.

CONCLUSIONS

Compliance with checklists is associated with safer OR team practice and can be considered as an indicator of the extent of safety in OR practice.

The impact of comorbidities and their stacking on short- and long-term prognosis of patients over 50 with community-acquired pneumonia

BACKGROUND

The prognosis of patients hospitalized with community-acquired pneumonia (CAP) with regards to intensive care unit (ICU) admission, short- and long-term mortality is correlated with patient's comorbidities. For patients hospitalized for CAP, including P-CAP, we assessed the prognostic impact of comorbidities known as at-risk (AR) or high-risk (HR) of pneumococcal CAP (P-CAP), and of the number of combined comorbidities.

METHODS

Data on hospitalizations for CAP among the French 50+ population were extracted from the 2014 French Information Systems Medicalization Program (PMSI), an exhaustive national hospital discharge database maintained by the French Technical Agency of Information on Hospitalization (ATIH). Their admission diagnosis, comorbidities (nature, risk type and number), other characteristics, and their subsequent hospital stays within the year following their hospitalization for CAP were analyzed. Logistic regression models were used to assess the associations between ICU transfer, short- and 1-year in-hospital mortality and all covariates.

RESULTS

From 182,858 patients, 149,555 patients aged ≥ 50 years (nonagenarians 17.8%) were hospitalized for CAP in 2014, including 8270 with P-CAP. Overall, 33.8% and 90.5% had ≥ 1 HR and ≥ 1 AR comorbidity, respectively. Cardiac diseases were the most frequent AR comorbidity (all CAP: 77.4%). Transfer in ICU occurred for 5.4% of CAP patients and 19.4% for P-CAP. Short-term and 1-year in-hospital mortality rates were 10.9% and 23% of CAP patients, respectively, significantly lower for P-CAP patients: 9.2% and 19.8% (HR 0.88 [95% CI 0.84-0.93], p < .0001). Both terms of mortality increased mostly with age, and with the number of comorbidities and combination of AR and HR comorbidities, in addition of specific comorbidities.

CONCLUSIONS

Not only specific comorbidities, but also the number of combined comorbidities and the combination of AR and HR comorbidities may impact the outcome of hospitalized CAP and P-CAP patients.

Daily alcohol consumption and sickness absence in the GAZEL cohort

Background

: Previous studies that examined the association between daily alcohol consumption and sickness absences (SA) were mostly retrospective and did not take into account the characteristics of SA.  : A total of 9907 daily drinkers (8442 men and 1465 women) of the GAZEL prospective cohort were included. Daily alcohol consumption over the three previous years was self-reported at baseline and categorized as low, moderate, high or very high risk according to the World Health Organization. Duration of SA (short: ≤7 days; moderate: 8-28; long: >28) was collected from administrative records as well as causes for long SA. Negative binomial regression models were used to estimate Risk Ratios of SA according to alcohol consumption with low-risk category as reference.  : Duration of follow-up (in years) for SA was 8.4 ± 3.7 in men and 11.2 ± 5.4 in women. Increasing alcohol consumption predicted increasing risk of SA with a dose-response relationship ( P < 0.01 for men; P = 0.01 for women). In men, strength of this association increased with SA duration [e.g. RRs from 1.41 (95% CI: 1.12-1.79) to 2.12 (95% CI: 1.49-3.00) in the very high-risk category, for short and long SA, respectively]. In men, even a moderate consumption predicted increased risk of SA whatever their duration (RR = 1.15; 95% CI: 1.07-1.23). In women, a moderate consumption predicted only long SA (RR = 1.22; 95% CI: 1.00-1.50). Daily alcohol consumption was associated with almost all causes of long SA in men, and with respiratory diseases, digestive diseases and injury in women.  : We found a dose-response relationship between daily alcohol consumption and the risk of SA. Even moderate consumption could increase this risk, particularly in men.

Primary Cardiovascular Disease Risk Factors Predicted by Poor Working Conditions in the GAZEL Cohort

The mechanisms by which work environment might influence cardiovascular disease (CVD) risk are still a matter of debate. In particular, the involvement of the main behavioral and clinical risk factors and their relationships with working conditions are not always clear, despite an abundant body of literature. Most studies have investigated the impact of a limited number of characteristics of the work environment on the occurrence of 1 or a few risk factors. In contrast, in this study we used a global approach in which 30 objective and subjective indicators of working conditions were tested as predictors of 9 modifiable CVD risk factors in a well-characterized cohort of 20,625 middle-aged French workers who were followed from the 1990s until they retired or until December 31, 2013. The incidence of 3 CVD risk factors (obesity, sleep complaints, and depression) was predicted by a large number of indicators of working conditions in both age- and sex-adjusted and multivariate-adjusted Cox regression models, whatever the significance threshold retained. These results suggest the existence of close relationships between a poor work environment and a higher risk of developing obesity, sleep complaints, or depression. These risk factors may contribute to increased CVD risk not only when workers are exposed to poor working conditions but also after retirement, as predictors of the appearance of other risk factors.

Performance curves of medical researchers during their career: analysis of scientific production from a retrospective cohort

OBJECTIVES

To establish the pattern of change in individual scientific production over the career of medical researchers.

DESIGN

Retrospective cohort based on prospectively collected data in a hospital information system.

SETTING

Multicentre university hospital in France.

PARTICIPANTS

Two distinct populations of 1835 researchers (full professors vs non-academic physicians) having produced 44 723 publications between 1995 and 2014.

MAIN OUTCOME MEASURES

Annual number of publications referenced in Medline/PubMed with a sensitivity analysis based on publications as first/last author and in high impact journals. The individual volume of publications was modelled by age using generalised estimating equations adjusted for birth cohort, biomedical discipline and academic position of researchers.

RESULTS

Averaged over the whole career, the annual number of publications was 5.28 (95% CI 4.90 to 5.69) among professors compared to 0.82 (95% CI 0.76 to 0.89) among non-academic physicians (p<0.0001). The performance curve of professors evolved in three successive phases, including an initiation phase with a sharp increase in scientific production between 25 and 35 years (adjusted incidence rate ratio 102.20, 95% CI 60.99 to 171.30), a maturation phase with a slower increase from 35 to 50 years (2.10, 95% CI 1.75 to 2.51) until a stabilisation phase with constant production followed by a potential decline at the end of career (0.90, 95% CI 0.77 to 1.06). The non-academic physicians experienced a slower pace of learning curve at the beginning of their careers (42.38, 95% CI 25.37 to 70.81) followed by a smaller increase in the annual number of publications (1.29, 95% CI 1.11 to 1.51).

CONCLUSIONS

Compared to full professors, non-academic physicians had a poor capacity to publish, indicating a low productivity when medical doctors have limited time or little interest in undertaking research. This finding highlights the potential for rethinking the missions of medical doctors towards an enlargement of scientific prerogatives in favour of progress in global knowledge.

A Global View of the Relationships between the Main Behavioural and Clinical Cardiovascular Risk Factors in the GAZEL Prospective Cohort

Although it has been recognized for a long time that the predisposition to cardiovascular diseases (CVD) is determined by many risk factors and despite the common use of algorithms incorporating several of these factors to predict the overall risk, there has yet been no global description of the complex way in which CVD risk factors interact with each other. This is the aim of the present study which investigated all existing relationships between the main CVD risk factors in a well-characterized occupational cohort. Prospective associations between 12 behavioural and clinical risk factors (gender, age, parental history of CVD, non-moderate alcohol consumption, smoking, physical inactivity, obesity, hypertension, dyslipidemia, diabetes, sleep disorder, depression) were systematically tested using Cox regression in 10,736 middle-aged individuals free of CVD at baseline and followed over 20 years. In addition to independently predicting CVD risk (HRs from 1.18 to 1.97 in multivariable models), these factors form a vast network of associations where each factor predicts, and/or is predicted by, several other factors (n = 47 with p<0.05, n = 37 with p<0.01, n = 28 with p<0.001, n = 22 with p<0.0001). Both the number of factors associated with a given factor (1 to 9) and the strength of the associations (HRs from 1.10 to 6.12 in multivariable models) are very variable, suggesting that all the factors do not have the same influence within this network. These results show that there is a remarkably extensive network of relationships between the main CVD risk factors which may have not been sufficiently taken into account, notably in preventive strategies aiming to lower CVD risk.

Is physically arduous work associated with limitations after retirement? Findings from the GAZEL cohort

INTRODUCTION

In the context of delayed retirement age, we aimed to study the association between a score for global evaluation of perceived physical strain (PPS) at work and limitations after retirement in the GAZEL cohort.

METHODS

At baseline in 1989 and every year since then, the PPS question, 'Do you find that your work is physically strenuous?' was used as a proxy measure of general occupational physical exertion or load; it was coded into a score, and divided into four categories for men and three for women. The self-report question about limitations was asked in 1989 and 2012 (difficulties performing some daily life activities). Among men and women without limitations at baseline, relationships were studied between reported limitations in 2012 and a cumulative score based on PPS since 1989, allowing examination of the dose-effect relationship, and adjusted for age and perceived state of health at baseline.

RESULTS

From 1989 to 2012, 9326 participants without limitations at baseline were followed and filled out the 2012 questionnaire. In 2012, 12.1% of men (n=845) and 12.9% of women (n=302) reported limitations. Limitations in 2012 were associated with very high categorical PPS in men (OR 1.7 (1.4 to 2.2)) and high/very high categorical PPS in women (OR 1.6 (1.2 to 2.2)), with a significant trend.

CONCLUSIONS

A positive association was found between preretirement physically arduous working conditions and limitations in daily activities after retirement. Findings offer a new insight for global evaluation of physical exposures during working life.

Carpal tunnel syndrome and computer exposure at work in two large complementary cohorts

OBJECTIVES

The boom in computer use and concurrent high rates in musculoskeletal complaints and carpal tunnel syndrome (CTS) among users have led to a controversy about a possible link. Most studies have used cross-sectional designs and shown no association. The present study used longitudinal data from two large complementary cohorts to evaluate a possible relationship between CTS and the performance of computer work.

SETTINGS AND PARTICIPANTS

The Cosali cohort is a representative sample of a French working population that evaluated CTS using standardised clinical examinations and assessed self-reported computer use. The PrediCTS cohort study enrolled newly hired clerical, service and construction workers in several industries in the USA, evaluated CTS using symptoms and nerve conduction studies (NCS), and estimated exposures to computer work using a job exposure matrix.

PRIMARY AND SECONDARY OUTCOME MEASURES

During a follow-up of 3-5 years, the association between new cases of CTS and computer work was calculated using logistic regression models adjusting for sex, age, obesity and relevant associated disorders.

RESULTS

In the Cosali study, 1551 workers (41.8%) completed follow-up physical examinations; 36 (2.3%) participants were diagnosed with CTS. In the PrediCTS study, 711 workers (64.2%) completed follow-up evaluations, whereas 31 (4.3%) had new cases of CTS. The adjusted OR for the group with the highest exposure to computer use was 0.39 (0.17; 0.89) in the Cosali cohort and 0.16 (0.05; 0.59) in the PrediCTS cohort.

CONCLUSIONS

Data from two large cohorts in two different countries showed no association between computer work and new cases of CTS among workers in diverse jobs with varying job exposures. CTS is far more common among workers in non-computer related jobs; prevention efforts and work-related compensation programmes should focus on workers performing forceful hand exertion.

More than Light Alcohol Consumption Predicts Early Cessation from Employment in French Middle-Aged Men

AIMS

To investigate the association between alcohol consumption and different causes of work cessation and estimate the loss of occupational activity among high consumers compared with low consumers.

METHODS

From the prospective study of men employed in the French gas and electric company, 8442 men during a median follow-up of 8.4 years reported on their alcohol consumption. Information on work cessation was collected from the company administrative records. Hazard Ratios (HRs) by cause of work cessation (death, disability, retirement before or after age 55) were estimated using a competing risk method.

RESULTS

An increasing quantity of daily alcohol consumption was associated with an increased risk of death, disability and retirement before age 55 (P trend ≤ 0.01, = 0.03 and ≤ 0.01, respectively), but not of retirement after age 55 (P trend = 0.56). Moreover, compared with low consumption, moderate, high or very high daily intakes were associated with an increased risk of early work cessation (combination of the three causes: death, disability and retirement before age 55) (HR = 1.14, 95% confidence interval (CI) = 1.05-1.25; HR = 1.23, 95% CI = 1.12-1.35 and HR = 1.49, 95% CI = 1.15-1.92 respectively). Between ages 50 and 60, we estimated that high or very high consumers could gain 6.04 months of occupational activity if they drank like low consumers.

CONCLUSIONS

Our results provide evidence of a dose-effect relationship between alcohol consumption and early work cessation.

Incidence of Chronic and Other Knee Pain in Relation to Occupational Risk Factors in a Large Working Population

OBJECTIVES

The aim of this study was to estimate the incidence of chronic and other knee pain (KP) in relation to occupational and personal risk factors among workers representative of a general working population.

METHODS

Of 3710 workers in a French region included in a surveillance network for musculoskeletal disorders (2002-2005), 2332 completed a follow-up questionnaire in 2007-2009 (Cosali cohort). The questionnaires included questions on musculoskeletal symptoms, and personal and occupational exposure. Incident cases of KP in 2007-2009 (i.e. with KP at follow-up but not at baseline) were dichotomized into chronic KP (>30 days in the previous year) and other KP. Associations between incident KP and personal and occupational factors at baseline were studied separately according to sex using multinomial logistic regression.

RESULTS

Of the 1616 respondents without KP at baseline, 122 (7.5%) reported chronic KP and 243 (15.0%) reported other KP. The incidence rate of chronic KP was estimated at 19.6 per 1000 worker-years (95% CI: 16.3-23.5). After adjustment for age and body mass index, significant associations were found between incident chronic KP and handling loads >4kg [odds ratio (OR) 2.1 (1.2-3.6) for men, OR 2.3 (1.1-5.0) for women] and kneeling >2h a day for men [OR 1.8 (1.0-3.0)].

CONCLUSIONS

This study highlights the high frequency of chronic KP in the working population and the role of occupational factors in its incidence, in particular those kneeling and handling loads.

Long-term persistence of knee pain and occupational exposure in two large prospective cohorts of workers

Background

The persistence of knee pain (KP) and its relationship with occupational factors were investigated in two prospective cohorts of French workers: retirees of the Gazel cohort and workers in the Cosali cohort.

Methods

KP was defined according to the Nordic questionnaire (>1 day in the last year), and the information was extracted from two questionnaires in 2006 and 2012 for the Gazel cohort, and in 2002–2005 and 2007–2010 for the Cosali cohort. The personal and occupational factors and the severity of KP were measured at baseline. Of the 4590 members of the Gazel cohort with KP at baseline, 4140(90.2%) were followed up, as were 637(63.1%) members of the Cosali cohort. Logistic models were used to evaluate associations (ORs) between occupational exposure and the persistence of KP separately by sex, adjusted on indicators of severity of KP.

Results

KP was no longer present at follow-up for 38.3% of Gazel men and 46.0% of Cosali men (33.4% of Gazel women and 50.6% of Cosali women). The persistence of KP in men was associated with carrying or handling heavy loads on univariate analyses and with kneeling on multivariate analyses, with ORs of 1.3(1.0-1.6) (Gazel) and 1.6(1.0-2.6) (Cosali). Climbing stairs was not significantly associated with the persistence of knee pain among men. The persistence of KP in women was not significantly associated with such occupational exposure.

Conclusions

This study highlights the role of occupational factors in the persistence of KP for men, in particular kneeling and handling/carrying loads.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2474-15-411) contains supplementary material, which is available to authorized users.

Self-reported physical exposure association with medial and lateral epicondylitis incidence in a large longitudinal study

INTRODUCTION

Although previous studies have related occupational exposure and epicondylitis, the evidence is moderate and mostly based on cross-sectional studies. Suspected physical exposures were tested over a 3-year period in a large longitudinal cohort study of workers in the USA.

METHOD

In a population-based study including a variety of industries, 1107 newly employed workers were examined; only workers without elbow symptoms at baseline were included. Baseline questionnaires collected information on personal characteristics and self-reported physical work exposures and psychosocial measures for the current or most recent job at 6 months. Epicondylitis (lateral and medial) was the main outcome, assessed at 36 months based on symptoms and physical examination (palpation or provocation test). Logistic models included the most relevant associated variables.

RESULTS

Of 699 workers tested after 36 months who did not have elbow symptoms at baseline, 48 suffered from medial or lateral epicondylitis (6.9%), with 34 cases of lateral epicondylitis (4.9%), 30 cases of medial epicondylitis (4.3%) and 16 workers who had both. After adjusting for age, lack of social support and obesity, consistent associations were observed between self-reported wrist bending/twisting and forearm twisting/rotating/screwing motion and future cases of medial or lateral epicondylitis (ORs 2.8 (1.2 to 6.2) and 3.6 (1.2 to 11.0) in men and women, respectively).

CONCLUSIONS

Self-reported physical exposures that implicate repetitive and extensive/prolonged wrist bend/twisting and forearm movements were associated with incident cases of lateral and medial epicondylitis in a large longitudinal study, although other studies are needed to better specify the exposures involved.

Impact of diabetes mellitus onset on sickness absence from work--a 15-year follow-up of the GAZEL Occupational Cohort Study

AIMS

Previous studies do not provide an accurate estimate of the burden of diabetes on sickness absence. The aim of this study was to measure the impact of diabetes onset on absenteeism starting from the earliest occurrence of the disease.

METHODS

The authors used data from a subsample of the French GAZEL cohort of 506 employees with incident diabetes and 2530 matched diabetes-free participants. Medically certified sickness absence data were obtained from company records (1989-2007). Number of sickness absence days and incidence rates of overall and cause-specific absence spells were compared according to diabetes status across three 5-year periods ranging from 10 years before to 5 years after onset of cases' diabetes.

RESULTS

The mean number of sickness absence days was persistently higher in participants with diabetes compared with those without diabetes. This difference increased from 16.4 days (95% confidence interval 7.2-25.5) during the 5-year period preceding diabetes onset to 28.5 days (95% CI 16.1-40.9) during the following 5-year period (P = 0.04). This was due to a steeper relative increase in the incidence of long (but not short) absence spells in participants with diabetes versus those without diabetes [incidence rate ratios 1.33 (95% CI 1.08-1.64) and 1.75 (95% CI 1.43-2.14), respectively; P = 0.02]. Diabetes onset was associated with increased rates of circulatory and metabolic absence spells.

CONCLUSIONS

Onset of diabetes is associated with a substantial increase in sickness absence. This suggests that in addition to its burden on work cessation, diabetes weighs heavily on working ability among people who manage to remain employed.

Impact of diabetes on work cessation: data from the GAZEL cohort study

OBJECTIVE

To measure the impact of diabetes on work cessation, i.e., on the risks of work disability, early retirement, and death while in the labor force.

RESEARCH DESIGN AND METHODS

We used data from the GAZEL prospective cohort of 20,625 employees of the French national gas and electricity company "EDF-GDF." We identified 506 employees with diabetes and randomly selected 2,530 nondiabetic employed control subjects matched for major sociodemographic and occupational characteristics. Using a multistate Cox model, we estimated hazard ratios (HRs) comparing the risks of transition from employment to disability, retirement, and death over time between participants with versus without diabetes.

RESULTS

Employment rate decreased more rapidly in participants with diabetes (51.9 and 10.1% at 55 and 60 years, respectively) compared with nondiabetic participants (66.5 and 13.4%, respectively). Participants with diabetes had significantly increased risks of transition from employment to disability (HR 1.7 [95% CI 1.0-2.9]), retirement (HR 1.6 [1.5-1.8]), and death (HR 7.3 [3.6-14.6]) compared with participants without diabetes. Between 35 and 60 years, each participant with diabetes lost an estimated mean time of 1.1 year in the workforce (95% CI 0.99-1.14) compared with a nondiabetic participant.

CONCLUSIONS

Our results provide evidence for a profound negative impact of diabetes on workforce participation in France. Social and economic consequences are major for patients, employers, and society-a burden that is likely to increase as diabetes becomes more and more common in the working-aged population.

Accounting for genetic heterogeneity in homozygosity mapping: application to Mendelian susceptibility to mycobacterial disease

INTRODUCTION

Genome-wide homozygosity mapping is a powerful method for locating rare recessive Mendelian mutations. However, statistical power decreases dramatically in the presence of genetic heterogeneity.

METHODS

The authors applied an empirical approach to test for linkage accounting for genetic heterogeneity by calculating the sum of positive per-family multipoint LOD scores (S) across all positions, and obtaining corresponding empirical p values (EmpP) through permutations.

RESULTS

The statistical power of the approach was found to be consistently higher than the classical heterogeneity LOD by simulations. Among 21 first-cousin matings with a single affected child, for five families linked to a locus of interest and 16 families to other loci, S/EmpP achieved a power of 40% versus 28% for heterogeneity LOD at an α level of 0.001. The mean size of peak linkage regions was markedly higher for true loci than false positive regions. The S/EmpP approach was applied to a sample of 17 consanguineous families with Mendelian susceptibility to mycobacterial disease, leading to the identification of two mutations in IL12RB1 and TYK2 from the largest of six linkage regions at p<10(-3).

CONCLUSIONS

The S/EmpP approach is a flexible and powerful approach that can be applied to linkage analysis of families with suspected Mendelian disorders.