A new reliable index to measure individual deprivation: the EPICES score.

BACKGROUND: Deprivation is associated with inequalities in health care and higher morbidity and mortality. To assess the reliability of a new individual deprivation score, the EPICES score and to analyse the association between the Townsend index, the Carstairs index and the EPICES score and causes of death in one French administrative region. METHODS: Eligible patients were 16 years old or more who had come for consultation in Health Examination Centres of the French administrative region of Nord-Pas-de-Calais. An ecological study was performed between 2002 and 2007 in the 392 districts of this administrative region. The EPICES score was compared with the Townsend and the Carstairs indices. These three measurements of deprivation were compared with social characteristics, indicators of morbidity, health-care use and mortality and specific causes of death. The Pearson correlation coefficients were calculated to assess the reliability of the EPICES score. The association between deprivation and mortality was assessed by comparison of the standardized mortality ratio (SMR) between the most and least deprived districts. RESULTS: The EPICES score was strongly correlated with the Townsend and Carstairs indices and with the health indicators measured. SMR increased with deprivation and the higher the deprivation the higher the SMR for all-cause mortality, premature and avoidable deaths and for most specific causes of death. CONCLUSION: The individual deprivation EPICES score is reliable. Deprivation was related to excess death rate, which clearly indicates that deprivation is a determinant factor that should be considered systematically by health policy makers and health-care providers.

[Social vulnerability is more frequent in victims of interpersonal violence: value of the EPICES score]. / La précarité est plus fréquente chez les victimes de violences volontaires : intérêt du score EPICES.

OBJECTIVES: To evaluate social vulnerability of victims of interpersonal violence having consulted a service of forensic medicine with an individual index of social vulnerability. POPULATION AND METHODS: The population of victims of interpersonal violence was composed of 275 subjects having consulted the service of forensic medicine of the CHU of Saint Etienne. The social data were collected by questionnaire. Social vulnerability was measured by an individual index (EPICES) calculated on the basis of 11 weighted questions related to material and social deprivation. This population was compared with a reference population; the reference population was people, aged more than 16, living in the Rhône-Alpes region and examined in 2005 in one of the Health examination Centres (HECs) of the French General Health Insurance System, that is 7553 men and 6002 women. The comparisons between the two populations were made after redressing the population of the HECs on various socio-demographic data of the Rhône-Alpes region. The relations between violence and the variables studied were measured by odds ratios adjusted on age and sex. RESULTS: The population of the victims of violence is younger than the reference population (p<0.001). It is characterized by a lower level of education (p<0.001, 15% in the higher education level vs 23%) and the categories Employees and Manual workers are more frequent (p<0.001). The situation with respect to employment is also different between the two populations, unemployment rate is higher (OR=2.25) and the retired are fewer (OR=0.41). Subjects in social vulnerability are more frequent in the victims (57% vs 36%). All these differences persist after adjustment on age and sex. The context in which the aggression took place (family, public area or at work) varies significantly according to social vulnerability. On the other hand, the majority of the other medico-legal characteristics are not different according to the level of social vulnerability. CONCLUSION: The population of the victims of interpersonal violence has a socio-economic profile different from the reference population. Social vulnerability is associated with interpersonal violence, in particular with violence in the public and family area.

Socioeconomic deprivation does not influence the severity of Crohn's disease: Results of a prospective multicenter study.

BACKGROUND: Socioeconomic deprivation is associated with poor health. The aims of this study were to evaluate the influence of deprivation in the characteristics and comparisons of deprived and nondeprived Crohn's disease (CD) patients. METHODS: CD patients were prospectively recruited from September 2006 to June 2007 in 6 hospitals in the Paris area. To assess the level of deprivation we used the EPICES score (Evaluation of Precarity and Inequalities in Health Examination Centers; http://www.cetaf.asso.fr), a validated individual index of deprivation developed in France, a score >30 defining deprivation. We defined CD as severe when at least 1 of the conventionally predefined criteria of clinical severity was present. RESULTS: In all, 207 patients (128 women and 79 men, mean age 40 years) were included and had a median score of deprivation of 20.7 (0-100). Seventy-three (35%) were deprived. There were no statistical differences between deprived and nondeprived patients for the following parameters: 1) mean age: 39 +/- 14.6 versus 40.6 +/- 13.5, P = 0.4; 2) sex ratio (female/male): 87/47 (65%) versus 41/32 (56%), P = 0.2; 3) duration of disease (years) 9 +/- 8.8 versus 8.5 +/- 7.2, P = 0.7; 4) delay from onset of symptoms to diagnosis >1 year: 22/115 (19%) versus 13/63 (21%), P = 0.8; and 5) severity of disease 71% versus 70% (P = 0.9). Nondeprived patients had a lower rate of hospitalization (40 versus 56%, P = 0,04) and a higher rate of surgery (44 versus 22%, P = 0,004); the rate of surgery was only identified by logistic regression. CONCLUSIONS: In this study deprivation does not seem to influence the severity of CD. This can be explained by easy access to healthcare in France.

[Psychological support for socially vulnerable people in the context of a periodic health examination]. / Soutien psychologique chez des personnes en fragilité sociale dans le cadre d'un examen périodique de santé.

Social vulnerability often leads to the expression of psychological distress. The Health Examination Center of Côtes d'Armor, in Quimper, experimented with the development and implementation of psychological counseling for a highly socio-economically vulnerable population. As part of a periodic health examination, the center offers psychological counseling to patients with pathological sleep disorders and who lack sufficient psychological support. The Health Examination Center's framework and the context of the periodic health examination have facilitated the establishment of a tailored non-stigmatizing intervention well-embedded within the institutional environment. Marginalized people in situations of psychological distress are offered an opportunity to be listened to, and to receive counseling, appropriate prevention services and access to care.

Update of a meta-analysis on lung cancer and welding.

OBJECTIVES: This study is an update, over the period 1954-2004, of a previous meta-analysis completed in 1994. It was aimed at assessing lung cancer risk among welders, while addressing heterogeneity, publication bias, and confounding issues. METHODS: Combined relative risks (CRR) and their variances were calculated using fixed and random effects models. Heterogeneity was tested using the Q statistic. The publication bias was estimated using funnel plots, and Egger's regression and partially controlled by excluding studies with positive reporting bias. RESULTS: The literature provided 60 studies eligible for the meta-analysis. No heterogeneity was observed. The fixed effect CRR for all of the welders and all of the studies was 1.26 (95% CI 1.20-1.32) after partial control of publication bias. No difference was observed according to welding activities. Smoking did not appear to be a marked confounder in the relationship between lung cancer and welding, but the effect of asbestos could not be assessed. CONCLUSIONS: The meta-analysis showed a 26% excess of lung cancer for welders without any difference according to welding activities.

Association among individual deprivation, glycemic control, and diabetes complications: the EPICES score.

OBJECTIVE: Previous studies have related poor glycemic control and/or some diabetes complications to low socioeconomic status. Some aspects of socioeconomic status have not been assessed in these studies. In the present study, we used an individual index of deprivation, the Evaluation de la Précarité et des Inégalités de santé dans les Centres d'Examens de Santé (Evaluation of Precarity and Inequalities in Health Examination Centers [EPICES]) score, to determine the relationship among glycemic control, diabetes complications, and individual conditions of deprivation. RESEARCH DESIGN AND METHODS: We conducted a cross-sectional prevalence study in 135 consecutive diabetic patients (age 59.41 +/- 13.2 years [mean +/- SD]) admitted in the hospitalization unit of a French endocrine department. Individual deprivation was assessed by the EPICES score, calculated from 11 socioeconomic questions. Glycemic control, lipid levels, blood pressure, retinopathy, neuropathy, and nephropathy were assessed. RESULTS: HbA(1c) level was significantly correlated with the EPICES score (r = 0.366, P < 0.001). The more deprived patients were more likely than the less deprived patients to have poor glycemic control (beta = 1.984 [SE 0.477], P < 0.001), neuropathy (odds ratio 2.39 [95% CI 1.05-5.43], P = 0.037), retinopathy (3.66 [1.39-9.64], P = 0.009), and being less often admitted for 1-day hospitalization (0.32 [0.14-0.74], P = 0.008). No significant relationship was observed with either nephropathy or cardiovascular risk factors. CONCLUSIONS: Deprivation status is associated with poor metabolic control and more frequent microvascular complications, i.e., retinopathy and neuropathy. The medical and economic burden of deprived patients is high.

Cancer mortality among municipal pest-control workers.

OBJECTIVES: This epidemiological study was carried out in order to investigate the hypothesis of a relationship between cancer occurrence and occupational exposure in a population of municipal pest-control workers exposed to a wide range of pesticides and other chemicals. METHODS: The study was designed as a mortality historical cohort study. The cohort comprised all subjects ever employed in a municipal pest-control service between 1979 and 1994. The follow-up period lasted from 1979 to 2000. The mortality rates of pest-control workers were compared with those of a regional population. A job exposure matrix was developed, which took into account four types of chemicals: formaldehyde, ethylene oxide, insecticides and rodenticides. RESULTS: None of the 181 subjects of the cohort, leading to 3,107 person-years, was lost to follow-up. Thirty-nine of them died, and all the causes of deaths were ascertained. The standardized mortality ratios (SMRs) for all causes of deaths and for all cancer causes were significantly greater than unity: 1.61 (1.14-2.20) and 2.24 (1.39-3.43), respectively. Non-significant excesses were observed for most cancer sites, except for lung cancer, which had a low SMR. We obtained significant excesses for cancer in workers with more than 20 years of employment [SMR = 2.42 (1.43-3.82)]. Cancer mortality tended to increase insignificantly with formaldehyde and rodenticides exposures, whereas no clear patterns were observed for ethylene oxide and insecticides. However, significant excesses were observed for the highest exposure levels of formaldehyde, insecticides and rodenticides. CONCLUSIONS: This study showed a statistically significant excess of cancer mortality in a population of municipal pest-control workers exposed to a wide variety of chemicals. These cancer sites might be related to occupational activities, since they tended to be more frequently observed when duration of employment increased.