[Occupational factors associated with suicide among French employees from the special agricultural social security scheme (MSA) working between 2007 and 2013]. / Facteurs professionnels en lien avec le suicide au sein des salariés affiliés à la Mutualité sociale agricole (MSA) et en activité entre 2007 et 2013.

BACKGROUND: Work and related exposures may play a role in suicide and there has been evidence in the literature that some occupational factors may be associated with suicide. The identification of occupational risk factors of suicide mortality among employees affiliated to the French special agricultural social security scheme (MSA), an understudied population, appears important. The objective of this study was to identify the occupational factors associated with suicide mortality among French employees from the MSA working between 2007 and 2013. METHODS: The study population included all the employees affiliated to the MSA working between 1st January 2007 and 31st December 2013, i.e. 1,699,929 men and 1,201,017 women. The studied occupational factors included: economic activity, skill level, and work contract. Survival analyses (Cox models) stratified on gender were performed using age as time scale and region and year of contract as adjustment variables. RESULTS: Among men, the factors associated with an elevated suicide risk were: economic activities of forestry, agriculture and related activities, and manufacture of food products and beverages (e.g. meat, wine), low-skilled level and working in the regions of Brittany, Burgundy Franche-Comté, Pays de la Loire, Normandy, Grand Est and Centre-Val-de-Loire. No association was observed among women. CONCLUSION: These results suggest that economic activity and low-skilled level may be associated with suicide among men affiliated to the MSA and may contribute to the implementation of prevention interventions. Further studies are needed to confirm and better understand these associations.

[Changes in behaviors and indicators of mental health between 2006 and 2010 in the French working population]. / Évolution des comportements et indicateurs de santé mentale entre 2006 et 2010 dans la population au travail en France.

BACKGROUND: The 2008 economic crisis may have had an impact on mental health but the studies on this topic are sparse, in particular among the working population. However, mental health at work is a crucial issue involving substantial costs and consequences. The aim of the study was to assess changes in behaviors and indicators of mental health in the French working population between 2006 and 2010, and to explore the differential changes according to age, origin, occupation, activity sector, public/private sector, self-employed/employee status and work contract. METHODS: The data came from the prospective national representative Santé et itinéraire professionnel (SIP) survey, including a sample of 5600 French workers interviewed in 2006 and 2010. The behaviors and indicators of mental health studied were excessive alcohol consumption, smoking, sleep problems (sleep disorders and/or insufficient sleep duration), psychotropic drug use (antidepressants, anxiolytics and/or hypnotics), and poor self-reported health. Generalized estimating equations were used to analyze changes in behaviors and indicators of mental health, and the analyses were adjusted for age. Covariates (age, origin, occupation, activity sector, public/private sector, self-employed/employee status and type of contract) were added separately to assess differential changes. RESULTS: Increases in excessive alcohol consumption among women, sleep problems among men, and smoking, insufficient sleep duration and poor self-reported health for both genders were observed in the French working population between 2006 and 2010. Some differential changes were observed, negative changes being more likely to affect young workers and workers with a permanent contract. CONCLUSION: Prevention policies should consider that behavior and indicators of mental health may deteriorate in times of economic crisis, especially among some sub-groups of the working population, such as young workers and workers with a permanent contract. These changes might foreshadow a forthcoming increase in mental disorders.

Musculoskeletal pain at various anatomical sites and socioeconomic position: Results of a national survey.

BACKGROUND: Prevalence of musculoskeletal pain according to sites of pain and associated factors in the community has not been thoroughly documented. The association between pain and socioeconomic position has been studied by several authors, but without details in most studies regarding sites of pain, whereas the relations with social position could differ according to the site of pain. The objective of this study was to explore these differences in the community in France. METHODS: The national Health and Occupational History survey was conducted in France in 2006 in subjects aged 20-74 years. Self-assessment of pain at various sites in the previous year was recorded. Five sites were considered here: back, neck, shoulder, upper limb, and lower limb. After a description of prevalence according to gender and age, the associations with socioeconomic position at the beginning of the subjects' working life, in seven categories, were studied with logistic models adjusted for age. The analyses were limited to those aged 30-74 years and were conducted separately for men and women. RESULTS: Of the 5520 males and 6643 females studied, prevalence was the highest for back pain (35% for males, 37% for females). Pain was globally more frequent for women. For all sites of pain an increase with age was significant for women. This was not observed in men for back pain (highest prevalence in the 40- to 49-year-old age group) or neck pain. Overall, prevalence of pain was the lowest for professionals (reference category in the analyses). For males, the first occupation as a farmer or blue-collar worker was associated with an increased prevalence for most sites of pain, with odds ratios close to 2. For females, prevalence was increased for more socioeconomic categories, as compared to professionals. Among the five sites, neck pain was an exception: for both men and women, no association was observed between neck pain and socioeconomic position. CONCLUSION: Although exploratory, these results are consistent with the available knowledge on occupational and personal risk factors for pain, which differ according to the site of pain. Other studies are needed to better understand the causal mechanisms underlying the associations observed.

Socioeconomic position predicts long-term depression trajectory: a 13-year follow-up of the GAZEL cohort study.

Individuals with low socioeconomic position have high rates of depression; however, it is not clear whether this reflects higher incidence or longer persistence of disorder. Past research focused on high-risk samples, and risk factors of long-term depression in the population are less well known. Our aim was to test the hypothesis that socioeconomic position predicts depression trajectory over 13 years of follow-up in a community sample. We studied 12 650 individuals participating in the French GAZEL study. Depression was assessed by the Center for Epidemiological Studies-Depression scale in 1996, 1999, 2002, 2005 and 2008. These five assessments served to estimate longitudinal depression trajectories (no depression, decreasing depression, intermediate/increasing depression, persistent depression). Socioeconomic position was measured by occupational grade. Covariates included year of birth, marital status, tobacco smoking, alcohol consumption, body mass index, negative life events and preexisting psychological and non-psychological health problems. Data were analyzed using multinomial regression, separately in men and women. Overall, participants in intermediate and low occupational grades were significantly more likely than those in high grades to have an unfavorable depression trajectory and to experience persistent depression (age-adjusted ORs: respectively 1.40, 95% confidence interval (CI) 1.16-1.70 and 2.65, 95% CI 2.04-3.45 in men, 2.48, 95% CI 1.36-4.54 and 4.53, 95% CI 2.38-8.63 in women). In multivariate models, the socioeconomic gradient in long-term depression decreased by 21-59% in men and women. Long-term depression trajectories appear to follow a socioeconomic gradient; therefore, efforts aiming to reduce the burden of depression should address the needs of the whole population rather than exclusively focus on high-risk groups.

Seeking care for lower back pain in the French population aged from 30 to 69: the results of the 2002-2003 Décennale Santé survey.

OBJECTIVES: To describe the frequency with which members of the French general population in the 30-to-69 age class sought care for lower back pain (LBP) from various healthcare professionals and to identify associated parameters. MATERIAL AND METHODS: Data were collected in the 2002-2003 Décennale Santé survey, which is representative of ordinary households in continental France. We assessed the frequency with which the 17,792 surveyed individuals sought care for LBP by considering consultations with healthcare professionals in general and consultations with general practitioners and physiotherapists in particular. RESULTS: Among the survey subjects, 4.5% reported that they had sought treatment for LBP from a healthcare professional at least once during the 2-month survey period. The decision to seek care was correlated with the characteristics of the LBP. The duration of the pain was associated with the frequency of all types of consultation studied here. Sociodemographic, economic and occupational risk factors were also involved. Consultation with a physiotherapist was related to income. CONCLUSION: These results from a representative sample of the French general population show that the factors associated with seeking treatment for LBP differ according to the type of healthcare professional consulted.

Social inequalities in mortality by cause among men and women in France.

BACKGROUND: The aim of this study was to compare inequalities in mortality (all causes and by cause) by occupational group and educational level between men and women living in France in the 1990s. METHODS: Data were analysed from a permanent demographic sample currently including about one million people. The French Institute of Statistics (INSEE) follows the subjects and collects demographic, social and occupational information from the census schedules and vital status forms. Causes of death were obtained from the national file of the French Institute of Health and Medical Research (INSERM). A relative index of inequality (RII) was calculated to quantify inequalities as a function of educational level and occupational group. Overall all-cause mortality, mortality due to cancer, mortality due to cardiovascular disease and mortality due to external causes (accident, suicide, violence) were considered. RESULTS: Overall, social inequalities were found to be wider among men than among women, for all-cause mortality, cancer mortality and external-cause mortality. However, this trend was not observed for cardiovascular mortality, for which the social inequalities were greater for women than for men, particularly for mortality due to ischaemic cardiac diseases. CONCLUSIONS: This study provides evidence for persistent social inequalities in mortality in France, in both men and women. These findings highlight the need for greater attention to social determinants of health. The reduction of cardiovascular disease mortality in low educational level groups should be treated as a major public health priority.

[Changing social disparities and mortality in France (1968-1996): cause of death analysis by educational level]. / Evolution temporelle des inégalités sociales de mortalité en France entre 1968 et 1996. Etude en fonction du niveau d'études par cause de décès.

BACKGROUND: Little information is available on temporal trend in socioeconomic inequalities in cause of death mortality in France. The aim of this paper was to study educational differences in mortality in France by cause of death and their temporal trend. METHODS: We used a representative sample of 1% of the French population and compared four periods (1968-1974, 1975-1981, 1982-1988, 1990-1996). Causes of death were obtained by direct linkage with the French national death registry. Education was measured at the beginning of each period, and educational disparities in mortality were studied among men and women aged 30-64 at the beginning of each period. Analyses were conducted for all deaths and for the following causes of death: all cancers, lung cancer (among men), upper aerodigestive tract cancers (among men), breast cancer (among women), colorectal cancer, other cancers, cardiovascular diseases, ischaemic heart diseases, cerebrovascular diseases, other cardiovascular diseases, external causes, other causes of death. Socioeconomic inequalities were quantified with relative risks and relative indices of inequality. The relative indices of inequality measures socioeconomic inequalities across the population and can be interpreted as the ratio of mortality rates of those with the lowest to those with the highest socioeconomic status. RESULTS: Analyses showed an increase in educational differences in all cause mortality among men (the relative indices of inequality increased from 1.96 to 2.77 from the first to the last period) and among women (the relative indices of inequality increased from 1.87 to 2.53). Socioeconomic inequalities increased for all cause of death studied among women, and for cancer and cardiovascular diseases among men. The contribution of cancer mortality to difference in overall mortality between the lowest and the highest levels of education increased strongly over the whole study period, especially among women. CONCLUSION: This study shows that large socioeconomic inequalities in mortality are observed in France, and that they increase over time among men and women.

Social inequalities in breast cancer mortality among French women: disappearing educational disparities from 1968 to 1996.

We investigated the time trends in social inequalities in breast cancer mortality with an analysis by age at death and birth cohort using a representative 1% sample of the French population and four subcohorts (1968-1974, 1975-1981, 1982-1988 and 1990-1996). Causes of death were obtained by direct linkage with the French national death registry. Education was measured at the beginning of each period, and educational disparities in breast cancer mortality were studied among women aged 35-74 at the beginning of each period. In the 1970s, higher breast cancer mortality was found among higher educated women. This positive association progressively weakened and no association remained in the 1990s although it disappeared earlier among younger women. In an analysis by birth cohort, the same pattern was found among women born before 1925, whereas no association between education and mortality was observed among women born after 1925. Educational disparities in breast cancer mortality are currently changing and the previously observed positive gradient has disappeared. An important question is whether these relations are indirect, and due to changes in the prevalence of risk factors associated with education, but which we could not study.

Socioeconomic position, health, and possible explanations: a tale of two cohorts.

OBJECTIVES: We examined whether the social gradient for measures of morbidity is comparable in English and French public employees and investigated risk factors that may explain this gradient. METHODS: This longitudinal study of 2 occupational cohorts-5825 London civil servants and 6818 French office-based employees-used 2 health outcomes: long spells of sickness absence during a 4-year follow-up and self-reported health. RESULTS: Strong social gradients in health were observed in both cohorts. Health behaviors showed different relations with socioeconomic position in the 2 samples. Psychosocial work characteristics showed strong gradients in both cohorts. Cohort-specific significant risk factors explained between 12% and 56% of the gradient in sickness absence and self-reported health. CONCLUSIONS: Our cross-cultural comparison suggests that some common susceptibility may underlie the social gradient in health and disease, which explains why inequalities occur in cultures with different patterns of morbidity and mortality.

Socioeconomic, demographic, occupational, and health factors associated with participation in a long-term epidemiologic survey: a prospective study of the French GAZEL cohort and its target population.

The purpose of this paper is to examine personal and health factors, both at the beginning of the study and thereafter, associated with participation in the GAZEL cohort, set up in 1989 in a large French company. The authors used logistic regression to analyze the associations between participation and data available for both participants (n = 20,093) and nonparticipants (n = 24,829). Higher participation was associated with male sex, marriage, children, managerial status, and residence in particular regions. Among men, lower participation was associated with sick leave in the year before recruitment and afterwards. During follow-up, participation was negatively associated with several groups of diseases, especially those associated with alcohol consumption. The risk of upper respiratory and digestive tract and lung cancer during follow-up was higher among nonparticipants. The same phenomenon occurred among women, but less markedly, for cancers of the breast and genital organs. During follow-up, mortality among men was higher among nonparticipants, especially for alcohol-related diseases. The association among women was less strong. Among men, but not among women, diseases caused by alcohol, smoking, or dangerous behavior were the primary reason for the health differences observed between participants and nonparticipants. Overall, the most important determinants of participation were cultural factors and lifestyle behaviors.

Occupational factors of anxiety and depressive disorders in the French National Electricity and Gas Company. The Anxiety-Depression Group.

Very few studies described the prevalence of mental disorders in the workplace by using standard diagnostic criteria. A two-stage case-control study of anxiety and depression was initiated by Electricité de France and Gaz de France, the French Nationwide Company producing electricity and gas, using the General Health Questionnaire with 12 items as a screening test and the Composite International Diagnostic Interview as diagnostic instrument. Its aim was to point out occupational situations that promote the occurrence of anxiety and depression crises. Annual prevalence of depression was estimated at 7.6% in men (95% confidence interval [CI], 5.5 to 9.7) and at 17.9% in women (95% CI, 9.9 to 25.8), and that of anxiety at 9.6% (95% CI, 6.9 to 12.3) in men and 26.3% (95% CI, 17.2 to 35.4) in women. Workers in hazardous occupations were found to be protected from these disorders, whereas supervisory staff tended to be prone to developing them. Important changes in work or in its organization seemed to be risk factors. Extra-professional variables and occupational characteristics were included in a logistic regression model. The odds ratios corresponding to recent job changes and a supervisory position were significantly elevated (odds ratios = 1.7 and 2.4, respectively). These results suggest that some occupational events, such as major changes in work content or organization may cause or precipitate anxiety and/or depressive disorders.

[Prevalence of health problems in the Gazel (EDF-GDF) cohort: regional distribution and disparities]. / Prévalence des problèmes de santé dans la cohorte Gazel (EDF-GDF): répartition et disparités régionales.

This study deals with regional differences in annual prevalence of 44 declared diseases or clinical disorders in 1989 in GAZEL cohort participants from "Electricité de France-Gaz de France" company. The studied sample consisted of 20,325 people, from 35 to 50 years old, living in France, who answered to a mail questionnaire in 1989. The collected data from one year were analysed. An overall "regional effect" was searched about every listed disease in the questionnaire. For this purpose, a logistic model, controlling for age and sex, was used. For comparing prevalence of a disease in one region with average prevalence, an odds ratio (OR) was calculated: it was defined here as the ratio of disease odd in the region to the average French odd. The regional effect was studied in greater detail for five diseases, making allowance for extra factors of adjustment (tobacco and alcohol consumption, Quetelet index, salary category, number of declared diseases). The regional effect remained significative for four diseases: hypertension with OR from 1.26 to 1.68 in northern regions, and from 0.63 to 0.75 in southeastern ones; osteoarthrosis with OR lower than 1 in western regions (0.60 to 0.79), and larger in the South (1.24 to 1.46); hyperthyroidism, goiter with OR elevated in Midi-Pyrénées (2.91) and Lorraine (1.82) [corrected]; renal stones with OR high in the South (1.85 in Provence Riviera). These results can be compared to known observations about geographical differences in mortality. They also suggest persistence of hazardous areas for some diseases.

Level of education, lifestyle, and morbidity in two groups of white collar workers.

STUDY OBJECTIVE: The aim was to examine the relationship between level of education, lifestyle, and morbidity in two groups of male white collar workers, and to determine whether any differences found could be related to objective differences in working conditions. DESIGN: The study was a survey of a random sample of commercial travellers and a sample of men with sedentary occupations, representing two different groups of white collar workers. Survey interviews were conducted during the annual compulsory medical examination. Subjects were classified into three levels of education and differences according to level of education were studied in relation to 40 frequent health problems, lifestyle variables, body mass index, height, and working conditions. SUBJECTS: There were 1364 men in the commercial traveller group, mean age 39.5 years, and 525 men in the sedentary group, mean age 36.2 years. There were 22 exclusions because of unclassifiable levels of education and four refused to be interviewed. SETTING: The study took place in 11 towns in France. MAIN RESULTS: When age was taken into account there were only minor differences in the prevalence of health disorders. Lifestyle variables and height were clearly related to the level of education. Observed differences could not be explained by constraints or declared difficulties in working conditions. CONCLUSIONS: Differences in health practices related to level of education are observed even in groups that are relatively homogeneous socially. Lifestyle may be important as an intermediate determinant of health disorders among less educated people.

[Determinants of health in nurses]. / Les déterminants de la santé chez les infirmières.

A cross-sectional survey was carried out in 1980 among 824 nurses in 10 hospitals on the occasion of the annual checkups. The purpose was to describe the relationship between demographic and occupational characteristics and health, stressing the effects of work in shifts. Using Khi-2 tests and logistic models, the negative health effects of arduous shift work appear to be less than expected. This could be a result of the high turnover in the profession, which is characterized by a low average age and a short occupational lifetime.