Socioeconomic inequalities to accessing vaccination against human papillomavirus in France: Results of the Health, Health Care and Insurance Survey, 2012.

BACKGROUND: In France, human papillomavirus (HPV) vaccination coverage among adolescents and young women is low and decreasing. We analysed data from the 2012 Health, Health Care and Insurance Survey with the aim of identifying factors associated with this vaccination. We also compared the socioeconomic profile of unvaccinated young women to that of women who do not undergo cervical cancer screening (CCS). METHODS: Data were collected through interviews and self-administered questionnaires completed by a randomised sample of Health insurance beneficiaries. Two analyses were performed using Poisson regression: one to investigate the determinants of CCS uptake in women aged 25-65 years old (n=4508), the other to investigate the determinants of HPV vaccination in young women aged 16-24 years old (n=899). A sub-analysis was performed in 685 "daughter-mother" couples from the same household in order to analyse the association between participation to CCS in mothers and HPV vaccination in daughters. RESULTS: Factors significantly associated both to a lower CCS uptake and to an insufficient HPV vaccination were the lack of a complementary private health insurance (P=0.023 and P=0.037, respectively) and living in a family with a low household income (P<0.001 and P=0.005, respectively). A low education level was associated to a lower CCS uptake (P<0.001). The absence of CCS uptake in the last three years in mothers was associated to a lower level of HPV vaccination in their daughter (P=0.014). CONCLUSION: Women who do not undergo CCS and HPV unvaccinated young women tend to be of modest socioeconomic status. Unvaccinated young females tend to have mothers who do not undergo CCS and are therefore at risk of benefiting from none of the two cervical cancer preventive measures. The current implementation strategy concerning HPV vaccination in France may therefore increase inequalities regarding cervical cancer prevention.

Characteristics of women using organized or opportunistic breast cancer screening in France. Analysis of the 2006 French Health, Health Care and Insurance Survey.

BACKGROUND: This study aimed at (i) estimating the 2-year self-reported breast cancer screening coverage rate; and (ii) analyzing the relationships between sociodemographic characteristics and healthcare access of women and breast cancer screening (opportunistic or organized) practices. METHODS: From a 2006 French health survey, 2056 women aged 50 to 74 years were selected and divided into three groups according to their breast cancer screening practices during the previous 2 years: organized screening, opportunistic screening, or no screening. The three groups were compared according to self-reported sociodemographic status, healthcare access, screening behaviors, and perceived health, using polytomic regression. RESULTS: The 2-year self-reported coverage rate was 75.8%. It was high among women aged 50 to 69 years and lower among older women. Questions relating to medical access (i.e. having consulted a GP in the last 12 months, having consulted a gynecologist in the last 12 months, and having had a Pap smear in the last 3 years) were the variables most commonly associated with a recent mammogram. Women having a regular follow-up by a gynecologist or having had cervical cancer screening within the last three years used organized breast cancer screening more often and used opportunistic breast cancer screening even more often than other women. CONCLUSION: The study confirmed the key role of gynecologists and general practitioners in encouraging women to have a mammogram. Awareness among healthcare professionals and women of the benefits of organized breast cancer screening compared to opportunistic screening should be sustained and strengthened.

Adult intensive-care patients with 2009 pandemic influenza A(H1N1) infection.

In France, the surveillance of hospitalized cases of pandemic influenza was implemented in July 2009 and restricted to intensive-care unit (ICU) patients in November. We described the characteristics of the 1065 adult patients admitted to ICUs and analysed risk factors for severe outcome (mechanical ventilation or death). Eighty-seven percent of cases were aged 15-64 years. The case-fatality ratio was 20%. The risk for severe outcome increased with age and obesity while this association was negative for chronic respiratory disease. Late antiviral therapy was associated with a severe outcome in ICU patients with risk factors (adjusted OR 2·0, 95% CI 1·4-3·0). This study confirms the considerable contribution of young adults to A(H1N1) 2009 mortality. It shows the role of obesity as an independent risk factor for severe disease, and of early antiviral therapy as a protective factor, at least in patients with risk factors.

Severe hospitalised 2009 pandemic influenza A(H1N1) cases in France, 1 July-15 November 2009.

From 1 July 2009 to 15 November 2009, 244 patients with 2009 pandemic influenza A(H1N1) were admitted to intensive care unit (ICU) and were compared with 514 cases hospitalised in medical wards in France until 2 November 2009. Detailed case-based epidemiological information and outcomes were gathered for all hospitalised cases. Infants and pregnant women are overrepresented among cases admitted to ICU with seven per cent for both groups respectively, and twenty per cent of ICU cases did not belong to a risk group. Chronic respiratory disease was the most common risk factor among cases but obesity (body mass index >or= 30 Kg/m(2)), chronic cardiac disease and immunosuppression were risk factors associated with severe illness after adjustment for age and for other co-morbidities.

Mortality with Alzheimer's disease and dementia in France, 2006.

BACKGROUND: Alzheimer's and related diseases have become a major public health issue in all developed countries, particularly with the aging of the population. Given the potential burden of these pathologies, the French government launched a third National Alzheimer's Strategic Plan 2008-2012 in 2008. The aim of the study was to provide French data on the mortality statistics of Alzheimer's and related diseases by age, gender, and geographical area. METHODS: Analyses were based on the number of deaths from Alzheimer's disease (AD) and dementia, extracted from the 2000-2006 French National Mortality Registry (Inserm-Centre d'épidémiologie sur les causes médicales de décès [CépiDc]). Underlying and multiple causes of death were taken into account. Gender, age, area of residence, and place of death were noted for all subjects deceased with AD or dementia. Mortality rates were standardized on the truncated 60+ French 2006 population. Mortality rates were also estimated by 5-year age groups. Causes of death in demented and nondemented people were compared by estimating an age-adjusted relative-risk ratio. RESULTS: In France, in 2006, AD or dementia was reported as the underlying cause or a multiple cause of death on 45,597 death certificates. Among these death certificates, 70% were women and the mean age at death was 85.9 years. Age-standardized mortality rates were 341/100,000 person-years for men and 333/100,000 person-years for women. Age-specific mortality rates increased with age and were higher in women than in men over 90 years of age. The analysis of the changes in mortality rates showed an overall increase of 11.3% between 2000 and 2006. The most frequent underlying cause when AD or dementia was mentioned as an associated cause were cardiovascular diseases (40.5%), neoplasms (11.9%), and endocrine diseases (8.5%). CONCLUSION: The analysis of mortality data on AD and dementia provides insight into the burden of these diseases in France. If carried out regularly, these analyses can provide trend analyses of mortality rates.

[Which factors influence screening practices for female cancer in France?]. / Quels facteurs influencent la pratique du dépistage des cancers féminins en France?

BACKGROUND: The two aims of the study were, first to estimate the declared two-year coverage of breast cancer and cervical cancer screenings, and second to determine the main factors influencing female cancer screening behaviors. METHODS: Three groups of women from the 2003 French decennial health interview survey were analyzed: 3378 women aged 50-74 years who answered the question on mammography use, 7912 women aged 25-65 years who answered the question on Pap-smear use, and 2528 women aged 50-65 years who answered both questions. RESULTS: The declared coverage of breast cancer screening was 71.2%, the declared coverage of cervical cancer screening was 76.3%. Almost 18% of women declared having undergone neither a mammography nor a Pap-smear in the last two years. The main factor linked to a more frequent practice of one or both cancer screenings (breast or cervix) was to have undergone recently the other screening. The other factors linked to mammography use were mainly healthcare and practitioner access variables. Those linked to Pap-smear use were mainly socioeconomic and socio-demographic variables, healthcare and practitioner access variables being also linked. The main factors linked to having undergone none of these two screenings were of financial nature, particularly household income and home ownership. CONCLUSION: The study showed that it is appropriate to communicate on both screenings at the same time since they have a positive effect each other. Finally, practitioners continue to play a central role in collecting information on cancer screenings and encouraging screening in women not regularly screened.

Consequences of iron depletion on health in menstruating women.

OBJECTIVE: To examine the consequences of single iron depletion on health in menstruating women, a common but rarely investigated situation in industrialized countries. DESIGN: We studied data issued from the SU.VI.MAX. cohort via a transversal and a longitudinal (2-y follow-up) approach. SUBJECTS AND METHODS: Iron-depleted menstruating women (ferritin &<15 micro g/l, n=472) were compared with iron-sufficient (ferritin 30-80 micro g/l, n=393) menstruating women (aged 35-51 y) in terms of health variables and quality of life (DUKE score) using logistic regression and analysis of variance. RESULTS: The risk of any infection or of specific types of infections was not increased by iron deficiency. Regarding the DUKE health profile, no specific score was significantly different between the two groups: only the scores reflecting 'physical health' (P=0.09) and 'perceived health' (P=0.12) showed a trend toward a lower level, while the best score for 'mental health' (P=0.11) was found in the group of iron-depleted women. The only significant difference between iron-depleted and iron-sufficient women concerned memory disorders, which were significantly less common in iron-depleted women, Odds ratio=0.7 (0.6-0.9; P=0.03). CONCLUSION: There is no conclusive evidence that an absence of iron stores has negative consequences; however, we must consider that in the case of a worsening of the iron balance, it may lead to a rapid decrease in the level of functional compounds. SPONSORSHIP: The laboratory Robapharm, Pierre Fabre, France.

"The SU.VI.MAX Study": a primary prevention trial using nutritional doses of antioxidant vitamins and minerals in cardiovascular diseases and cancers. SUpplementation on VItamines et Minéraux AntioXydants.

The "SUpplementation en VItamines et Minéraux AntioXydants" (SU.VI.MAX) Study is a randomized double-blind, placebo-controlled, primary-prevention trial which started in 1994 in France. This epidemiologic study is designed to test the efficacy of a daily supplementation with antioxidant vitamins (vitamin C, 120 mg, vitamin E, 30 mg, and beta-carotene, 6 mg) and minerals (selenium, 100 microg, and zinc, 20 mg) at nutritional doses, in reducing the main causes of premature death (cancers and cardiovascular diseases); 12,735 eligible subjects (women aged 35 to 60 years, and men aged 45 to 60 years) were included in 1994 and and will be followed up for 8 years. Participants undergo a yearly visit consisting, every other year, of either biological sampling or clinical examination. They also regularly provide information on health events and dietary intake by filling out computerized questionnaires using the Minitel Telematic Network. After 2 years of supplementation, biochemical indicators of vitamin and trace element status reach reasonable level without reaching concentrations as high as those observed in intervention studies, which tested relatively high doses of antioxidants, and ended up with higher risk of pathology.