Spatial distribution and differences of stroke occurrence in the Rhone department of France (STROKE 69 cohort).

In France, 110,000 patients are admitted to hospital per year for stroke. Even though the relationship between stroke and risk factors such as low socio-economic status is well known, research in the spatial distribution (SD) of stroke as a contributing risk factor is less documented. Understanding the geographic differences of the disease may improve stroke prevention. In this study, a statistical spatial analysis was performed using a French cohort (STROKE 69) to describe spatial inequalities in the occurrence of stroke. STROKE 69 was a cohort study of 3,442 patients, conducted in the Rhône department of France, from November 2015 to December 2016. The cohort included all consecutive patients aged 18 years or older, with a likelihood of acute stroke within 24 hours of symptoms onset. Patients were geolocated, and incidence standardized rates ratio were estimated. SD models were identified using global spatial autocorrelation analysis and cluster detection methods. 2,179 patients were selected for analysis with spatial autocorrelation methods, including 1,467 patients with stroke, and 712 with a transient ischemic attack (TIA). Within both cluster detection methods, spatial inequalities were clearly visible, particularly in the northern region of the department and western part of the metropolitan area where rates were higher. Geographic methods for SD analysis were suitable tools to explain the spatial occurrence of stroke and identified potential spatial inequalities. This study was a first step towards understanding SD of stroke. Further research to explain SD using socio-economic data, care provision, risk factors and climate data is needed in the future.

A Comparative Study of the Physiological and Socio-Economic Vulnerabilities to Heat Waves of the Population of the Metropolis of Lyon (France) in a Climate Change Context.

Increases in the frequency and intensity of heat waves are direct consequences of global climate change with a higher risk for urban populations due to the urban heat island effect. Reducing urban overheating is a priority, as is identifying the most vulnerable people to establish targeted and coordinated public health policies. There are many ways of understanding the concept of vulnerability and multiple definitions and applications exist in the literature. To date, however, nothing has been done on the territory of this study, the metropolis of Lyon (France). The objective is thus to construct two vulnerability indices: physiological, focusing on the organism's capacities to respond to heat waves; and socio-economic, based on the social and economic characteristics and capacities of the community. To this end, two complementary methodologies have been implemented: the AHP (Analytic Hierarchy Process) and the PCA (Principal Component Analysis) with Varimax rotation, respectively. The results were then spatialized to the smallest demographic census unit in France. The areas highlighted differed due to conceptual and methodological differences: the highest physiological vulnerabilities are in the center while the socio-economic ones are in the eastern periphery of the urban area. The location of these areas will enable prevention campaigns to be carried out, targeted according to the publics concerned.

Access to treatment among persons with hemophilia: A spatial analysis assessment in the Rhone-Alpes region, France.

OBJECTIVES: In France, only hospital pharmacies can dispense clotting factor concentrates to persons with hemophilia, which limits the access to care for the treatment and the prevention of bleeding episodes. Moreover, the cost of clotting factor concentrates may restrain the maintenance of sufficient stocks in hospital pharmacies. The aim of this study was to investigate the accessibility of clotting factor concentrates to persons with hemophilia in the context of long-term prophylaxis and emergency treatment in the Rhone-Alpes region of France. METHODS: A geographic information system was used for evaluating accessibility of clotting factor concentrates. Persons with hemophilia and hospital pharmacies were geolocalized with the use of postal data, and the evaluation of accessibility was based on the road network. RESULTS: Approximately 72% of the study area was accessible in less than 30 minutes to a hospital pharmacy. Eighty-five percent of persons with hemophilia had access to clotting factor concentrates for prophylactic treatment in less than 20 minutes. Most of them were patients with severe or moderate hemophilia. Regarding emergency doses, factor VIII was accessible in less than 30 minutes in 45.6% of the study area, and factor IX in 30.5%. CONCLUSION: This study highlights that spatial access to clotting factor concentrates by persons with hemophilia in the Rhône-Alpes region is good for prophylactic treatment but is more uneven for emergency doses.