SARS-CoV-2 testing, infection and places of contamination in France, a national cross-sectional study, December 2021.

BACKGROUND: This study aimed to describe the use of diagnostic testing for SARS-CoV-2 in France until December 2021, the characteristics of people infected, and places of contamination. METHODS: Data were collected from the national 2021 Health Barometer cross-sectional study, which was conducted between February and December 2021 and included French-speaking individuals aged 18-85 years old selected through randomly generated landline and mobile phone numbers. Participants were interviewed about COVID-19-like symptoms in the previous 12 months, diagnostic testing for SARS-CoV-2, positive diagnosis for SARS-CoV-2, and the place(s) of contamination. Determinants of diagnostic testing and of infection were studied using univariate and multivariate Poisson regressions. RESULTS: A total of 24,514 persons participated in the study. We estimated that 66.4% [65.0-67.7] of persons had been tested for SARS-CoV-2 the last time they experienced COVID-19-like symptoms, and that 9.8% [9.3-10.3] of the population in France - with or without symptoms - had been tested positive. Diagnostic testing was less frequent in men, unemployed persons, and people living alone; it was also less frequent during the first months of the pandemic. The estimated proportion of the population infected was higher in healthcare professionals (PRa: 1.5 [1.3-1.7]), those living in large cities ( > = 200 000 inhabitants, and Paris area) (1.4 [1.2-1.6]), and in households comprising > 3 persons (1.7 [1.5-2.0]). It was lower in retired persons (0.8 [0.6-0.97]) and those over 65 years old (0.6 [0.4-0.9]). Almost two-thirds (65.7%) of infected persons declared they knew where they were contaminated; 5.8% [4.5-7.4] reported being contaminated outdoors, 47.9% [44.8-51.0] in unventilated indoor environments, and 43.4% [40.3-46.6] in ventilated indoor environments. Specifically, 51.1% [48.0-54.2] declared they were contaminated at home or in a family of friend's house, 29.1% [26.4-31.9] at their workplace, 13.9% [11.9-16.1] in a healthcare structure, and 9.0% [7.4-10.8] in a public eating place (e.g., cafeteria, bar, restaurant). CONCLUSIONS: To limit viral spread, preventive actions should preferentially target persons tested least frequently and those at a higher risk of infection. They should also target contamination in households, healthcare structures, and public eating places. Importantly, contamination is most frequent in places where prevention measures are most difficult to implement.

Uses and perceptions of medications among French older adults: results from the 2020 French Health Barometer survey.

BACKGROUND: There are few studies reporting on self-medication, perceptions or difficulties older adults have with their medications. This study aimed to describe the uses and the perceptions of medications among older adults in France and to identify patient groups based on that information. METHODS: We used data from the 2020 'French Health Barometer' - a nationally-representative cross-sectional survey. We assessed polypharmacy (five or more medications), self-medication, and patient perceptions of medications. Robust Poisson regression was used to investigate socio-demographic and health-related factors associated with the outcomes. Latent class analysis was used to identify patient groups classified by the use and the perceptions of medications. Factors associated with group assignment were investigated by multinomial logistic regression. All analyses were weighted. RESULTS: The study sample comprised 1,623 respondents aged 70-85 years. Polypharmacy and self-medication were reported in 23.5 and 48.7% of the older population, respectively. Polypharmacy was associated with increasing age, low education, and impaired health status. Self-medication was associated with female sex and high education. Among individuals taking at least 1 medication, 8.2% reported not to understand all their medications, and 9.7% having difficulty taking medications as prescribed. Among individuals taking at least 2 medications, 23.2% thought that they took too many medications. Three patient groups were identified: 'Non-polypharmacy, positive perceptions' (62.5%), 'Polypharmacy, positive perceptions' (28.0%), and 'Negative perceptions' (9.5%). CONCLUSIONS: Polypharmacy and self-medication are common in French older adults. One segment of people reported negative perceptions of their medications regardless of their polypharmacy status. This underlines the difference between the objective and perceived measures of polypharmacy.

Moving towards a single-frame cell phone design in random digit dialing surveys: considerations from a French general population health survey.

BACKGROUND: Over the last two decades, telephone surveys based on random digit dialing have developed considerably. At the same time, however, the proportion of the population with a cell phone has increased, whereas landline frame coverage has declined, thus raising the possibility of discontinuing landline phone surveys. This paper aims to assess the impact of using a single-frame (SF) cell phone design instead of a dual-frame (DF) design with landlines and cell phones in the context of repeated health surveillance surveys in the general population. We analyze data from a random digit dialing health survey of the French population and assess differences between the DF and the counterfactual SF design that excludes the landline phone sample from the DF design. We evaluate the quality of the two survey designs in terms of survey productivity, response rates, representativeness, balancing of external covariates, and prevalence estimates of key health behavior indicators. RESULTS: Our results show that a SF cell phone survey has several advantages over a combined DF landline and cell phone survey. Cell numbers require fewer call attempts to complete an interview, leading to a substantial reduction in the mean data collection duration and weight dispersion. The global representativeness of the SF design was slightly better than its DF counterpart, although the elderly were underrepresented. After calibration, differences in health behavior estimates were small for the seven health indicators analyzed. CONCLUSIONS: Switching from a DF random telephone survey to a SF cell phone design has a number of practical advantages and would have a minimal impact on general population health surveys for monitoring health behavior at the population level. However, the different aspects of the survey quality had to be studied to make a decision. Further studies are needed to explore the scope of possibilities.

Increased awareness and knowledge of Lyme Borreliosis and tick bite prevention among the general population in France: 2016 and 2019 health barometer survey.

BACKGROUND: Lyme borreliosis (LB) is the most frequent tick-borne disease in France. In the absence of a vaccine, LB prevention mainly relies on reducing tick bites. In 2016, the French Ministry of Health launched a national plan against tick-borne infections, including a prevention component. To evaluate the impact of this prevention strategy, we assessed knowledge and practices of tick bite prevention using the 2016 and 2019 national surveys on health attitudes and beliefs known as the French Health Barometer. METHODS: The Health Barometer is a repeated nationwide phone survey conducted annually on a random sample aged 18 to 75 years living in mainland France. In 2016 and 2019, participants were asked, among others, about their exposure to ticks, their behavior and practices regarding tick bites, and their knowledge about LB and its prevention. RESULTS: In 2019, 30% of the population reported a lifetime tick bite and 6% in the last year, an increase from 25% and 4%, respectively, in 2016 (p < 0.001). In 2019, 25% of the population felt exposed to tick bites compared to 23% in 2016 (p < 0.001). The proportion of participants who had heard about LB and who considered themselves well informed respectively increased from 66% and 29% in 2016 to 79% and 41% in 2019, (p < 0.001). In 2019 compared to 2016, a greater part of the French population applied protective measures against tick bites, particularly wearing protective clothing (74% vs 66%, p < 0.001) and regular tick checks and prompt tick removal after exposure (54% vs 47%, p < 0.001). CONCLUSIONS: A substantial proportion of French residents are exposed to tick bites and apply protective measures. Our findings indicate a trend toward an increased knowledge and awareness of tick bites and LB between 2016 and 2019 in France. Our results can be used to target future information campaigns to specific age groups or at-risk areas in addition to the general population. However, we need to further study the barriers to the use of preventive measures.

Alteration in perceived health status of those aged 55 to 65 between 2010 and 2017 in France: role of socioeconomic determinants.

BACKGROUND: While life expectancy increases, it is necessary to evaluate whether the additional years are lived in good health, particularly in order to adapt the health care provision and social measures available to support these individuals. Since the 1990s, improvements in perceived health and capacities have been observed among older people, however the changes appear to be far less favourable among the working-age population and, in particular, the generation of people approaching retirement age. The aim of this study was to examine the change in the perceived health status of those aged 55 to 65 in France and investigate the role of socioeconomic factors in this change. METHODS: Self-reported health (SRH), chronic condition and activity limitation were assessed in 2010 and in 2017 in the French Health Barometer, a general population phone survey conducted on over 25,000 persons living in the community. The prevalence of all three indicators in 2017, and their evolution between 2010 and 2017 were studied according to the main socioeconomic determinants. RESULTS: Between 2010 and 2017, there was a sharp increase in the proportion of individuals aged 55-65 reporting poor SRH, chronic condition or activity limitation. A much more marked deterioration was observed in the three indicators among those aged 55-65 than in older age groups, as well as different changes according to socioeconomic determinants. The category of workers with an average level of education was particularly affected by the deterioration. CONCLUSIONS: This study confirms that the generation approaching retirement age presents a more significant deterioration in health status than those of previous generations. The question of how these trends will be reflected in terms of the burden of dependency at later ages remains open and should encourage increased monitoring of and prevention among this population in future years.

Effect of the woman's age on discontinuation of IVF treatment.

Treatment discontinuations are an important issue in IVF programmes. In the French context, financial constraint does not intervene in discontinuation until older ages. This study examined treatment discontinuation in IVF programmes, according to the woman's age and when there is no financial burden for couples. Medical records were collected for 3037 women who began their IVF programme between 1998 and 2002 in two French IVF units. Up to four attempts were taken into consideration. Cumulative success (delivery) rates were calculated, as well as discontinuation rates. Multiple imputation was applied to estimate a theoretical cumulative success rate as if no woman discontinued treatment before the end of the IVF programme without delivering. Cumulative discontinuation rates at the end of the IVF programme increased with the woman's age (41% for age <35, 56% for age 35-39, 80% for age ⩾40). The benefit in terms of delivery rates of pursuing treatment would be smaller for older women (∼10% for age <35, 7% for age 35-39, 4% for age ⩾40). Even when treatment is reimbursed, the discontinuation rate is high for older women, suggesting that the strong decrease in success rate with age induces older women to discontinue. Treatment discontinuations are an important issue in IVF programmes. In the French context, financial constraint does not intervene in discontinuation until older ages. We aimed to examine treatment discontinuation in IVF programmes, according to the woman's age and when there is no financial burden for couples. Medical records were collected for 3037 women who began their IVF programme between 1998 and 2002 in two French IVF units. Up to four attempts were taken into consideration. Cumulative success (delivery) rates were calculated, as well as discontinuation rates. Multiple imputation was applied to estimate a theoretical cumulative success rate as if no woman discontinued treatment before the end of the IVF programme without delivering. Cumulative discontinuation rates at the end of the IVF programme increased with the woman's age (41% for age <35, 56% for age 35-39, 80% for age ⩾40). The benefit in terms of delivery rates of pursuing treatment would be smaller for older women (∼10% for age <35, 7% for age 35-39, 4% for age ⩾40). Even when treatment is reimbursed, the discontinuation rate is high for older women, suggesting that the strong decrease in success rate with age induces older women to discontinue.

Multiple imputation for estimation of an occurrence rate in cohorts with attrition and discrete follow-up time points: a simulation study.

BACKGROUND: In longitudinal cohort studies, subjects may be lost to follow-up at any time during the study. This leads to attrition and thus to a risk of inaccurate and biased estimations. The purpose of this paper is to show how multiple imputation can take advantage of all the information collected during follow-up in order to estimate the cumulative probability P(E) of an event E, when the first occurrence of this event is observed at t successive time points of a longitudinal study with attrition. METHODS: We compared the performance of multiple imputation with that of Kaplan-Meier estimation in several simulated attrition scenarios. RESULTS: In missing-completely-at-random scenarios, the multiple imputation and Kaplan-Meier methods performed well in terms of bias (less than 1%) and coverage rate (range = [94.4%; 95.8%]). In missing-at-random scenarios, the Kaplan-Meier method was associated with a bias ranging from -5.1% to 7.0% and with a very poor coverage rate (as low as 0.2%). Multiple imputation performed much better in this situation (bias <2%, coverage rate >83.4%). CONCLUSIONS: Multiple imputation shows promise for estimation of an occurrence rate in cohorts with attrition. This study is a first step towards defining appropriate use of multiple imputation in longitudinal studies.