Mortality related to chronic hepatitis B and chronic hepatitis C in France: evidence for the role of HIV coinfection and alcohol consumption

BACKGROUND/AIMS

Mortality related to HCV and HBV infections was estimated in France.

METHODS

A random sample (n=999) of death certificates was obtained from all death certificates listing HBV, HCV, hepatitis, liver disease, possible complication of cirrhosis, bacterial infection, HIV, or transplantation (n=65,000) in France in 2001. Physicians who reported the deaths were sent a questionnaire to identify how many deaths were related to HBV/HCV infection. Completed forms were independently analyzed by a panel of hepatologists. Death rates were estimated according to national population census data.

RESULTS

Estimated annual number of deaths associated with HCV and HBV infection was 3618 and 1507, respectively (6.1 and 2.5 deaths per 100,000 inhabitants, respectively). Estimated number of deaths attributable to HCV or HBV infection was 2646 and 1327, respectively (4.5 and 2.2 deaths per 100,000 inhabitants, respectively). In the HCV infection group, 95 percent had cirrhosis; 33 percent had hepatocellular carcinoma (HCC). In the HBV infection group, 93 percent had cirrhosis; 35 percent had HCC. Eleven percent of deaths occurred in patients with HIV coinfection. Deaths related to HBV or HCV infection occurred at an earlier age in patients with a history of excessive alcohol consumption.

CONCLUSIONS

In France, 4000-5000 deaths related to HCV and HBV infection occurred in 2001. Alcohol consumption and HIV infection were important co-factors. These data emphasize the need for ongoing, efficient public health programs that include screening, management, and counseling for HCV- and HBV-infected individuals.

A French survey of paediatric airway management use in tonsillectomy and appendicectomy

BACKGROUND

There are no epidemiological data describing tracheal intubation and laryngeal mask airway (LMATM) use in paediatric anaesthesia. This analysis focused on the factors leading to the indication for an airway management procedure, i.e. tracheal intubation and laryngeal mask airway vs face mask during general anaesthesia for tonsillectomy and appendicectomy.

METHODS

The data were recorded in the French survey of Practical Anaesthesia performed in 1996. Two main types of surgical procedures were selected: tonsillectomy and appendicectomy because of the number of patients and the need to use an invasive airway management technique.

RESULTS

During a 1-year period, 627 anaesthetics for appendicectomy and 653 anaesthetics for tonsillectomy were recorded in the sample under consideration. Tracheal intubation or laryngeal mask airway was undertaken in 66% of tonsillectomies and 84% of appendicectomies. Univariate analysis showed that tracheal intubation/laryngeal mask were used significantly more often in older children, with long duration of anaesthesia, in nonambulatory procedures and in procedures performed at an academic centre. When these variables were included in a multivariate analysis, the duration of anaesthesia over 30 min was a factor linked to the use of tracheal intubation/laryngeal mask airway for the two types of surgery (P < 0.0001). For tonsillectomy, inpatients were 2.9 times more likely to be intubated (or have an laryngeal mask airway) than were outpatients. For appendicectomy, older children were 3.4 times more likely to be intubated (or have an laryngeal mask airway) than younger children.

CONCLUSIONS

This large French survey shows that the use of tracheal intubation/laryngeal mask airway in this country is primarily related to a predicted long duration of anaesthesia.

Evolution of the anaesthetic workload--the French experience

The use of anaesthesia has shown major growth during the period 1975-1985. Increases safety in anaesthesia safety have permitted its use in surgery and in other exploratory procedures involving older patients and those with more severe clinical conditions. A survey, designed by the French Society of Anaesthesiologists, collected and analysed data relating to anaesthesia performed in France in 1996 from a representative sample collected in all French hospitals and clinics; the results of this survey were compared with an earlier survey performed in 1980. The participation rate of hospitals was 98%. The results of this survey showed that, between 1980 and 1996, the number of anaesthetic procedures had increased by 120% and the annual rate had increased from 6.6 to 13.5 anaesthetic procedures per 100 population. The annual rate varied between 5.4 per 100 in girls 5-14 years of age and 30.2 per 100 in men 75-84 years of age. The second important phenomenon which occurred between 1980 and 1996 was a marked increase in regional anaesthesia--from 4 to 23% of all cases. This represents a 14-fold increase in the number of cases involving regional anaesthesia. Anaesthesia for obstetric procedures represented 9% of all cases. Seventy-six per cent of all anaesthetics which were started between midnight and 7.00 a.m. were related to obstetric activities. Changes that occurred in the practice of anaesthesia could be explained by changes in the types of procedure requiring anaesthesia: in 1980, 88% of anaesthetics were required for surgical procedures, while in 1996 surgery accounted for 71% of all cases, obstetrics for 9%, and other procedures for the remaining 20%. The practice of epidural anaesthesia for deliveries has developed markedly in France during recent years, increasing from 1.5 to 51% of all deliveries between 1980 and 1996. This survey has offered an interesting overview of recent developments in anaesthesia--which are probably representative of the evolutionary trends in most industrialized countries. These changes can be summarized in three major points: (i) a global increase in the use of anaesthesia related to improvements in its safety; (ii) a significantly increased use of anaesthesia in elderly patients; and (iii) a marked increase in regional anaesthesia.

[Quality of suicide mortality data]

Prevention of suicide is a public health priority in France. Indicators of suicide mortality have been widely used to describe epidemiological situations or to evaluate public health actions. It is therefore essential to examine the quality of suicide mortality data. The purpose of this work was to identify potential biases affecting the quality of such data and their comparability between different countries as well as to determine how they can affect conclusions. Potential biases were identified by studying the characteristics of the death certificate system and analyzing the international literature on data quality. The impact of biases was assessed by analyzing the causes of "concurrent" death with suicide in the official statistics (trauma and poisoning caused in an undetermined way concerning intention and unknown causes). The proportion of suicides listed as "concurrent" causes of death, estimated from specific surveys was extrapolated to official data. This method was also used to correct the international data. Practices concerning death certificates for violent deaths vary considerably from one country to another: type of certifying physician, frequency of medicolegal investigations, frequency of autopsies, suicide definition criteria, confidentiality regulations, religious and culture context. These practical differences lead to variability in undetermined and unknown causes. The corrections made on the mortality data after taking into account for these potential biases showed that the rate of suicide determined from official data is considerably underestimated, but that sociodemographic and geographic factors of suicide change little after correction. Likewise, the order by country was similar after taking into consideration concurrent causes. A reliable evaluation of the rate of suicide for a given country is of course important. However, it is possible to characterize populations at risk and analyze the determinants of suicidal behavior without necessarily recording all suicides, as long as the declaration bias is stable. Statistical analysis of death by suicide in France shows that, despite under-reporting, the principal sociodemographic and geographic features and trends over time can be considered as valid. A series of recommendations is proposed however to improve data quality and homogeneity for death certificate reporting. Designing operational criteria for deciding when to declare suicide as the cause of death would be helpful to guide physicians who report deaths. Classical autopsies could be completed by "psychological autopsies" with friends and family of the deceased. The death certificate form could be improved to include items for complementary information favoring or not suicide.

[Trends in infant mortality in France: frequency and causes from 1950 to 1997]

OBJECTIVES

To present an analysis of the infant mortality trends and causes of death in France from the beginning of the 1950s, neonatal (0-27 days) and post-neonatal mortality (27-364 days) being considered separately.

MATERIAL AND METHODS

We used the data from the national registries of births computed by INSEE (National Institute of Statistics and Economic Surveys) and of causes of deaths computed by Inserm (National Institute of Health and Medical Research). We analysed the evolution of the infant death rates from 1950 to 1997, the overall mortality for males and the percentages of causes of death at three different periods.

RESULTS

Mortality has changed according to neonatal or post-neonatal ages. A constant improvement was recorded for neonatal mortality up to 1995 (2.9 per 1,000), while there was a stagnation for post-neonatal mortality between 1979 and 1993, followed by a sharp decrease (2.0 per 1,000 in 1995). During the neonatal age the main causes of death are conditions generated in the neonatal period and congenital abnormalities, both decreasing regularly; during the post-neonatal age the main cause is sudden infant death syndrome, which fell dramatically during the last four years.

CONCLUSION

Several factors related to medical care, nursing and type of registration are contributing simultaneously to the important variations in mortality found in our results.

[Importance of medicolegal data for national cause of death statistics]

OBJECTIVE

The validity of French cause of death statistics largely depends on the transmission of the medical information reported on the dedicated part of the death certificate. Data referring to death causes are collected and analyzed at the Information Department on the cause of death (INSERM SC8). In major urban areas with one or more forensic institutions, it has been observed that the proportion of death certificates indicating ìno particular cause of deathî is higher than the national average. We therefore examined deaths occurring in 1996 in the Lyons region.

METHODS

This retrospective study involved 5,208 deaths recorded in Lyons France in 1996. Complementary information on these deaths was obtained from INSERM SC8 and Lyons Medicolegal Institute.

RESULTS

It was observed that a large portion of violent deaths occurring in this city in 1996 (more than 30%) were not recorded appropriately in the national statistics due to a lack of communication after autopsy.

CONCLUSION

Considering the importance of epidemiology and suicide prevention in the national public health strategy, improved information transmission must be developed in the near future.

[Changes in food intake in 2 year old children between 1973 and 1986]

The food intake time changes in 2-year-old children was evaluated on the basis of two studies conducted in 1973 and 1986. An increase in the consumption of dairy products, vegetables and fruits, fish and poultry was observed. In addition, the choice in dairy products and fat has changed: more semi-skimmed milk, less butter and more vegetable oil are consumed resulting in a better fatty acid balance in 1986. However, iron intake remains lower than the recommended dietary allowance given by the Centre de Coordination des Etudes et Recherches sur la Nutrition et l'Alimentation. Knowledge on the tendencies of food intake behaviour is useful to improve information and prevention.

[Longitudinal study of the feeding of children of 10 months, 2 and 4 years of age]

A longitudinal study of feeding habits in children aged 10 months, 2 years and 4 years was undertaken in 2 health centers for children in the Paris area. The evolution of the feeding of the same children was studied according to age and the nutritional intakes were compared with the recommended dietary allowances of the Centre National de Coordination des Etudes et Recherches sur la Nutrition et l'Alimentation (CNERNA). The results show that there are excesses and insufficiencies common or specific to the 3 ages. High protein and saccharose or sugar supplemented diets were observed at ages 10 months, 2 and 4 years as it was for lipids at age 4 years. Insufficient intakes of iron, essential fatty acids and vitamin E were present at the 3 ages studied. Insufficient zinc and vitamin B1 intakes were found since age 2 years, and insufficient folic acid and vitamin B6 at 4 years. The energy intakes increased between 10 months and 4 years, especially between 10 months and 2 years, where mean increase was twice as important as between 2 and 4 years. Some children received decreasing intakes: 6% ate less at 2 years than at 10 months and 22% less at 4 years than at 2 years. The quantities of aliments taken increased with age except for some aliments such as vegetables, potatoes and fruit. On the basis of the observation of the evolution of children's behavior, one could propose dietary advices, in order to improve the problems described here.(ABSTRACT TRUNCATED AT 250 WORDS)

Influence of body fat distribution during childhood on body fat distribution in adulthood: a two-decade follow-up study

Development of body fat distribution was assessed in a two-decade follow-up study. The present article describes the development of various trunk/extremity ratios and gives the figures by age and sex between 1 month to 21 years. The relationship between adult and childhood skinfold (SF) ratio measurements is weak in boys and slightly better in girls. From the present and our previous study, we can select adiposity measurements in children which both are associated to pathologies and have the best correlations with adult values, i.e. the body mass index (BMI) in both sexes, trunk SF in boys and the subscapular/arm SF ratio in girls. Consequently, a boy with both high BMI and trunk SF values or a girl with both high BMI and subscapular/arm SF values have an increased risk of centralized obesity at adult age.