Allocation aux adultes handicapés : pathologies et recours aux soins des bénéficiaires en 2017.

OBJECTIVE: We described the pathologies and health care utilization of beneficiaries of the general health insurance scheme via the Allocation Adulte Handicapé (AAH - Adult Disability Allowance) compared to the general population. METHOD: Mapping of pathologies and expenditures allowed the identification of 58 pathologies and chronic treatments in the SNDS, thanks to ICD-10 codes for long-term conditions or hospitalizations, specific drugs or medical procedures, among all beneficiaries of the general health insurance scheme aged 20 to 64 years with reimbursed care (>1€) in 2017. The prevalence and annual rates of care utilization among all beneficiaries of the general scheme via AAH (“AAH” group) and in the rest of the population (“non-AAH”) were standardized and described. RESULTS: Among the 793,934 (2.51% of the population) “AAH” persons, all the pathologies studied were more frequent than among the “non-AAH”, with 44% having psychiatric pathologies (compared with 3.2%), and 14% a neurological pathology (compared with 1%). AAH beneficiaries were more likely to use hospital care (63% versus 40%), but less likely to use specialist care (63% versus 68%) and dental care (37% versus 45%). CONCLUSION: The beneficiaries of the general scheme via the AAH had mainly psychiatric and neurological pathologies, but other pathologies were also much more frequent than in the general population. The lower use of dental and specialist care was probably related to a lack of access to care, potentially caused by the absence of 100% coverage of care.

[Arguments for centralization of surgical treatment of ovarian cancer in France based on morbidity and mortality data]. / Intérêts de la centralisation de la chirurgie du cancer de l'ovaire en France.

OBJECTIVE: To examine the current state for ovarian cancer surgery in France from 2009 to 2016 and to examine the impact of the volume of activity on morbidity and mortality by institution. MATERIAL AND METHOD: National retrospective study analyzing surgical sessions for ovarian cancer from the program of medicalization of information systems (PMSI), from January 2009 to December 2016. Institutions were divided according to the number of annual curative procedures into 3 groups: A<10; B: 10-19; C≥20. A propensity score (PS) and the Kaplan-Meier method were employed for statistical analyses. RESULTS: In total, 27,105 patients were included. The 1-month mortality rate in group A, B and C was 1.6; 1 and 0.7 %, respectively (P<0.001). Compared to group C, the Relative Risk (RR) of death within the first month was 2.22 for group A and 1.32 for group B (P<0.01). After MS, the 3- and 5-year survival in group A+B and group C were 71.4 and 60.3% (P<0.05) and 56.6, and 60.3% (P<0.05), respectively. The 1-year recurrence rate was significantly lower in group C (P<0.0001). CONCLUSION: An annual volume of activity>20 advanced stage ovarian cancers is associated with a decrease in morbidity, mortality, recurrence rate and improved survival.

Association of Age With Short-term and Long-term Mortality Among Patients Discharged From Intensive Care Units in France.

Importance: An aging population is increasing the need for intensive care unit (ICU) beds. The benefit of ICU admission for elderly patients remains a subject of debate; however, long-term outcomes across all adult age strata are unknown. Objective: To describe short-term and long-term mortality (up to 3 years after discharge) across age strata in adult patients admitted to French ICUs. Design, Setting, and Participants: Using data extracted from the French national health system database, this cohort study determined in-hospital mortality and mortality at 3 months and 3 years after discharge of adult patients (older than 18 years) admitted to French ICUs from January 1 to December 31, 2013, focusing on age strata. The dates of analysis were November 2017 to December 2018. Exposure: Intensive care unit admission. Main Outcomes and Measures: In-hospital mortality and mortality at 3 months and 3 years after hospital discharge. Results: The study included 133 966 patients (median age, 65 years [interquartile range, 53-76 years); 59.9% male). Total in-hospital mortality was 19.0%, and 3-year mortality was 39.7%. For the 108 539 patients discharged alive from the hospital, 6.8% died by 3 months, and 25.8% died by 3 years after hospital discharge. After adjustment for sex, comorbidities, reason for hospitalization, and organ support (invasive ventilation, noninvasive ventilation, vasopressors, inotropes, fluid resuscitation, blood products administration, cardiopulmonary resuscitation, renal replacement therapy, and mechanical circulatory support), risk of mortality increased progressively across all age strata but with a sharp increase in those 80 years and older. In-hospital and 3-year postdischarge mortality rates, respectively, were 30.5% and 44.9% in patients 80 years and older compared with 16.5% and 22.5% in those younger than 80 years. Total 3-year mortality was 61.4% among patients 80 years and older vs 35.1% in those younger than 80. After age and sex standardization, excess mortality was highest among young patients during their first year after hospital discharge and persisted into the second and third years. In contrast, the mortality risk was close to the general population risk among elderly patients (≥80 years). Age and reason for hospitalization were strongly associated with long-term mortality (9-, 13-, and 20-fold increase in the risk of death 3 years after ICU discharge in patients aged 80-84, 85-89, and ≥90 years, respectively, compared with patients aged <35 years), while organ support use during ICU showed a weaker association (all organ support had 1.3-fold or lower increase in the risk of death). Conclusions and Relevance: Results of this study suggest that aging was associated with an increased risk of mortality in the 3 years after hospital discharge that included an ICU admission, with a sharp increase in those 80 years and older. However, compared with the general population matched by age and sex, excess long-term mortality was high in young surviving patients but not in elderly patients.