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AIM: Nationwide data on the evolution of diabetes incidence and prevalence are scarce in France. For this reason, our objectives were to determine type 2 diabetes prevalence and incidence rates between 2010 and 2017, stratified by gender, age and region, and to assess annual time trends over the study period in adults aged≥45 years. METHODS: Diabetes cases in the National Health Data System (SNDS), which covers the entire French population (66 million people), were identified through a validated algorithm. Gender- and age-specific prevalence and incidence rates were estimated. Negative binomial models, adjusted for gender, age and region, were used to assess annual time trends for prevalence and incidence throughout the study period. RESULTS: During 2017, 3,144,225 diabetes cases aged≥45 years were identified. Over the study period, prevalence increased slightly (men from 11.5% to 12.1%, women from 7.9% to 8.4%) whereas incidence decreased (men from 11 to 9.7, women from 7.2 to 6.2 per 1000 person-years). In only four groups did prevalence rates decrease: men aged 45-65 years; women aged 45-60 years; women in Reunion; and women in Martinique. An increasing annual time trend was observed for prevalence (men: +0.9% [95% CI: +0.7%, +1%]; women: +0.4% [95% CI: +0.2%, +0.6%]) with a decreasing annual time trend for incidence in both genders (men: -2.6% [95% CI: -3.1%, -2.0%]; women: -3.9% [95% CI: -4.5%, -3.4%]). CONCLUSION: Further efforts towards diabetes prevention are required to ensure that incidence rates in France continue to diminish, as the disorder continues to represent an important public-health burden.
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Diabetes Mellitus Tipo 2/epidemiología , Anciano , Anciano de 80 o más Años , Femenino , Francia/epidemiología , Humanos , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: French national surveys among the homeless population in 2001 and 2012 provided a general description of the homeless beneficiaries of medical and social aids. However, given the increasing number of women in this population, mostly born abroad and accompanied by their children, a descriptive study of homeless women according to the fact of being born in France or abroad was conducted. METHODS: A probability sample of 1470 French-speaking homeless women was recruited for the Insee-Ined 2012 survey. Socio-demographic characteristics, life trajectories, work and employment over the last 12 months, perceived health, reported morbidity, use of care and medical coverage have been described, comparing homeless women born abroad with those born in France. RESULTS: Homeless women are young (median age=34 y.), often single (55%), without a partner (71%) and often accompanied by children (52%). The vast majority (60%) reported no salary during the previous 12 months. Housing conditions were less precarious in women born in France, but these women had a more difficult life history, a more unfavorable perception of their health status, and a higher frequency of chronic health problems. Homeless women born abroad seemed to have more precarious conditions of life and more difficulties to access aids and medical coverage. Overall, despite a relatively good availability of medical insurance, homeless women, regardless of the place of birth, often reported health problems, which were not treated. CONCLUSION: This study suggests that homeless women often have to deal with chronic health problems that are not treated. Homeless women born abroad are characterized by more precarious living conditions that women born in France. Although younger, with an overall favorable perception of their health and declaring less often an addiction, their general state of health appears to be as fragile as for women born in France. Actions towards homeless women should be implemented to promote their access to care.
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Emigrantes e Inmigrantes/estadística & datos numéricos , Estado de Salud , Personas con Mala Vivienda/estadística & datos numéricos , Características de la Residencia/estadística & datos numéricos , Adulto , Estudios Transversales , Empleo/estadística & datos numéricos , Composición Familiar , Femenino , Francia/epidemiología , Disparidades en Atención de Salud , Humanos , Persona de Mediana Edad , Morbilidad , Encuestas y Cuestionarios , Adulto JovenRESUMEN
BACKGROUND: Circannual variations in the incidence and mortality of pulmonary embolism (PE) have been previously described although conflicting observations have been reported. However, the association between age and seasonal variations of incidence and mortality rates is not established. This nationwide study aimed to assess the seasonal pattern in hospitalizations and mortality for PE along with the effect of age. METHODS: Comprehensive records from the French hospital discharge databases between 2002 and 2013 and death certificates between 2000 and 2010 were used. For each outcome and separately for each sex, monthly event counts were analyzed using quasi-Poisson models with tensor-products of regression splines, including a seasonal component and controlling for the underlying time trend, age of patients and population size changes. RESULTS: During the period studied, 599,432 patients with PE were hospitalized and 150,404 death certificates mentioned a PE. Compared with summer months, the winter peak was associated with 25% increasing rates in hospitalizations and mortality. The rates ratio of hospitalizations between the winter peak and the summer trough increased with age. The winter excess of incidence raised from 10%, IC 95% [5-16] in 30-year-old men to 33% [31-35] in 75year-old men. In the same way, the incidences at the peak time was 13% [9-18] and 34% [31-36] higher in 30 and 75-year-old women respectively. CONCLUSION: Based on large nationwide study, our study showed a clear seasonal pattern both on PE incidence and mortality. In addition, our data supported an association of age on the PE seasonal variations.
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Embolia Pulmonar/epidemiología , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Femenino , Hospitalización , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Alta del Paciente , Densidad de Población , Embolia Pulmonar/mortalidad , Estaciones del AñoRESUMEN
AIMS: To estimate the nationwide prevalence of diagnosed and undiagnosed diabetes and pre-diabetes in adults residing in France. METHODS: A probability sample of a non-institutionalized civilian population residing throughout the whole of continental France was recruited from February 2006 to March 2007 for the French Nutrition and Health Survey. All individuals aged between 18 and 74 years who agreed to participate in the survey were included; thus there were 3115 participants, 2102 of whom were undergoing biochemical assessments. The prevalence of diagnosed diabetes was estimated using self-reported diabetes history and the prevalence of undiagnosed diabetes was estimated using fasting plasma glucose ≥ 7.0 mmol/l or HbA(1c) ≥ 6.5% (≥ 48 mmol/mol). RESULTS: The prevalence of diagnosed diabetes was 4.6%, 95% CI 3.6-5.7. The prevalence of undiagnosed diabetes according to standard fasting plasma glucose criteria was 1% (95% CI 0.6-1.7) and contributed to less than 20% of all cases of diabetes. This proportion decreased with age from 30% in 30- to 54-year-olds to 12% in 55- to 74-year-olds. Based on HbA(1c) criteria, the prevalence of undiagnosed diabetes was 0.8% (95% CI 0.4-1.6). CONCLUSIONS: The prevalence of diagnosed diabetes in adults in France is comparable with recent estimates from Northern Europe. The percentage of total diabetes that is undiagnosed is low in France, which may be explained by a widely practised strategy of opportunist screening. During the past years, improvements in diabetes care and increased awareness may have contributed towards decreasing the prevalence of undiagnosed diabetes more widely in Europe, and studies should further monitor such improvements.
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Diabetes Mellitus/epidemiología , Estado Prediabético/epidemiología , Adolescente , Adulto , Anciano , Diabetes Mellitus/diagnóstico , Femenino , Francia/epidemiología , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Probabilidad , Encuestas y Cuestionarios , Población Blanca , Adulto JovenRESUMEN
SUMMARY: A survey conducted between May and September 2005 in the Paris Region collected 67 cases of accidental "falls from heights" among the children under the age of 15. Most of the injured children were under the age of 6 (72%), the majority were boys (72%). More than half of the children's families were from extra-European origin, mostly from Sub-Saharan Africa. In 32% of the cases, the fall occurred as the opening had a protection. A piece of furniture was in place beneath the window or was disposed by the child in 55% of the cases; 33% of the children climbed the parapet or the opening. In third of the falls, there was an adult present with the child in the room. Seven children died (10%) and eight (12%) had sequelae. The risk of fall due to the lack of surveillance is not enough known by adults. It is therefore recommended to organise prevention campaigns. To prevent falls, one should revise the regulations for building the parapet and the mechanisms for opening the windows.
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Accidentes por Caídas/estadística & datos numéricos , Cuidadores , Traumatismos Craneocerebrales/epidemiología , Traumatismo Múltiple/epidemiología , Accidentes por Caídas/mortalidad , Accidentes por Caídas/prevención & control , Adolescente , Adulto , Niño , Cuidado del Niño , Preescolar , Traumatismos Craneocerebrales/mortalidad , Traumatismos Craneocerebrales/prevención & control , Planificación Ambiental , Femenino , Escala de Consecuencias de Glasgow , Encuestas Epidemiológicas , Humanos , Incidencia , Lactante , Puntaje de Gravedad del Traumatismo , Masculino , Traumatismo Múltiple/mortalidad , Traumatismo Múltiple/prevención & control , Paris/epidemiología , Factores de Riesgo , Encuestas y Cuestionarios , Salud UrbanaRESUMEN
This article proposes a simple method to determine single or multiple temporal clustering on a variable size population. By a transformation of the data set, the method based on a regression model allows consideration of a variable population size during the time of study. A model selection procedure and a resampling method are used to select the number of clusters. The results have applications in epidemiological studies of rare diseases.