[Access to care and prevention for people with disabilities in France: Analysis based on data from the 2008 French health and disabilities households surveys (Handicap-Santé-Ménages)]. / Accès aux soins et à la prévention des personnes en situation de handicap en France: une exploitation de l'enquête Handicap-Santé-Ménages.

BACKGROUND: Using data from the 2008 French health and disabilities households surveys, this study examines the use of three types of routine medical care (dental, ophthalmological and gynecological care) and four preventive services (cervical cancer screening, breast cancer screening, colon cancer screening and vaccination against hepatitis B) both for people with disabilities and for those without. Two definitions of disability were retained: (1) functional limitations (motor, cognitive, visual or hearing limitations) and (2) administrative recognition of disability. METHODS: For each type of care, binary logistic regression was used to test whether access to care is influenced by any of the disability indicators as well as by other explanatory variables. Two set of explanatory variables were included successively: (1) sociodemographic variables such as age, gender as well as a proxy variable representing medical needs and (2) socioeconomic variables such as level of education, household income per consumption unit, supplementary health insurance coverage, co-payment exemption and geographic variables. RESULTS: Persons reporting functional limitations are less likely to access to all types of care, in a proportion that varies between 5 to 27 points, compared to persons without functional limitations, except for eye care for which no gap is observed. The same results are obtained for persons reporting an administrative recognition of disability, and more precisely for those who benefit from the Disability allowance for adults (Allocation adulte handicapé [AAH]). After adding the social variables to the model, problems of access to health care decrease significantly, showing that disabled persons' social situation tends to reduce their access to care. CONCLUSION: This study reveals, for a broad range of care, a negative differential access to care for persons reporting functional limitations compared to those without limitations which is confirmed when identifying disability through administrative recognition. Furthermore, it also discusses factors explaining these differentials. It highlights the role of the social situation of disabled people as an additional barrier to already limited access to healthcare.

New obesity body mass index threshold for self-reported data.

BACKGROUND: Since subjects included in population studies tend to underreport their weight and overestimate their height, obesity prevalence based on these data is often inaccurate. A reduced obesity threshold for self-reported height and weight was proposed and evaluated for its accuracy. METHODS: Self-reported heights and weights were compared with measured heights and weights in a Swiss city adult population representative sample. Participants were asked their height and weight and were invited to undergo a health examination, during which these data were measured. An optimal body mass index (BMI) value was assessed using receiver operating characteristic (ROC) curve analysis and its ability to correctly estimate obesity prevalence was tested on an external French population sample. RESULTS: The Swiss population sample consisted of 13 162 subjects (mean age 51.4). The comparison between self-reported and measured data showed that obesity prevalence calculated from declarations was underestimated: among obese subjects (according to measured BMI), 33.6% of men and 27.5% of women were considered to be non-obese according to their self-report. Considering measures as a reference, a lower BMI cut-off of 29.2 kg/m(2) was identified for both genders for the definition of obesity based on self-report. Respective misclassification was reduced to 17.9% in men and 16.9% in women. The validation procedure on a French population sample (n = 1858) yielded similar results. CONCLUSIONS: The reduced threshold based on self-report allowed a better estimation of obesity prevalence. Its use should be limited to population studies only.

Healthy working life expectancies at age 50 in Europe: a new indicator.

OBJECTIVES: The absence of disease or disability and active involvement in society are considered as essential dimensions of successful ageing. To assess these concepts, we propose a new indicator the Healthy Working Life Expectancy (HWLE) that associates health status and productive engagement, in order to compare various situations in Europe. DESIGN: The study population is drawn from the European Community Household Panel (ECHP) which is the unique source of longitudinal data, providing comparable information between 1995 and 2001 on health and work statuses for a sample of some 60,000 household's representative of the population of: Austria, Belgium, Denmark, Finland, France, Germany, the United Kingdom, Greece, Italy, the Netherlands, Portugal, and Spain. Based on the multi-state life table approach conventionally used for calculating healthy life expectancies, the HWLE corresponds to the number of years spent between the ages of 50 and 70 both in good health and at work. RESULTS: In average, among the 20 years available between age 50 and age 70, the HWLE is 7.5 years for men and 4.8 years for women, ie, one half and one third respectively of the number of years spent in good health (14.1 and 13.5 years). The countries where the healthy working life expectancy of seniors is the highest are also the countries where the levels of employment of seniors are higher. Conversely, health status has only a weak influence on the HWLE indicator. CONCLUSION: These findings suggest the existence of a reservoir of healthy years which can be used to increase the length of the working life expectancy. They underline also the essential role that employment maintenance and retirement policies should have to increase the number of healthy years spent at work, and therefore guarantee a successful ageing for the seniors in Europe.

[Health of the unemployed in France: literature review]. / La santé des chômeurs en France: revue de la littérature.

BACKGROUND: This paper reviews and analyses the main publications concerning health and mortality of the unemployed in France, in order to formulate research orientations for future studies or secondary data analysis. METHODS: The conceptual framework was first set up by assembling the different hypotheses concerning the link between health and unemployment (causality versus selection). A review of the different studies was organized by type: health studies based on data from either cross-sectional health surveys at a national or regional scale, or longitudinal surveys, and mortality studies based on data from follow-up of census samples. RESULTS: Those studies confirm the health disadvantage of the unemployed relative to the employed, in terms of self-perceived health, morbidity, health services utilization and mortality. They provide arguments in favor of both the causality and selection hypotheses. CONCLUSION: The exact nature of the health conditions and causes of death associated with unemployment needs further clarification, as well as the causal pathways.

Trends in antihypertensive drug use among orally treated diabetic patients, in France between 1981 and 1992. Impact of guidelines and new drugs.

OBJECTIVE: To compare antihypertensive drug use between diabetics and non-diabetics and to analyse the change between the two last decennial national surveys on health and medical care in France, in 1981 and 1992. MATERIAL AND METHODS: These surveys included respectively 12,725 and 13,887 adults over 25 years. Use of all antihypertensive drugs marketed in France was compared between orally treated diabetics and non-diabetics who were non-insulin and non-oral anti-diabetic treated population. RESULTS: In 1981, while diuretics were the first treatment in both populations (53% in diabetics vs 60% in non-diabetics, non significant), central inhibitors (31 vs 16% respectively, p<0.001) were the second agent among diabetic patients instead of beta blockers in non-diabetic patients (13 vs 22% respectively, p<0.05). In 1992, beta blockers were also less used in diabetics (21 versus 33%, p=0.001). In contrast, ACE inhibitors were more used (43 versus 35%, p=0.06). In both surveys and populations, other classes (reserpin, vasodilator and alpha blockers) had minor place in the strategy. The frequency of combinations of antihypertensive drugs was similar in both surveys and populations. The preferred combination treatment was in both populations reserpin with diuretics in 1981 (7 vs 9%, non significant) and ACE inhibitors with diuretics in 1992 (18 vs 18%). CONCLUSION: Independently of guidelines, our data suggest that the strategy of hypertension treatment has changed last years and that prescriptions were more targeted for diabetic patients.

Women's health in relation with their family and work roles: France in the early 1990s.

In this paper, the health of women aged 30 to 49 years is analyzed according to the family and work roles which they exercise, based on the 1991-1992 French national health survey. Households are classified based on the amount of their material resources, and a variety of measures of health and of health-related behaviors are considered. Looking at each role separately, the 'healthy married', 'healthy mother' and 'healthy worker' effects are very obvious for almost all health measures, and higher household income per unit of consumption is clearly associated with better health of women. The role patterns of women are not evenly distributed across income levels: housewives and lone mothers are more common at the bottom and middle of the income scale than at the top, while working women without children, married or not, are much more common at the top. In health terms, more heterogeneity is attached to role patterns in the middle of the income scale than at either extreme. In the middle stratum, two groups of women stand out as being clearly disadvantaged in comparison with that of married women with children and a job: (1) lone mothers, particularly in terms of mental health conditions, malaise symptoms and health-related behaviour, and (2) housewives, particularly in terms of physical health conditions. At the bottom of the income scale, no significant disadvantage is found for housewives compared to married working mothers, yet their overall health pattern is somewhat negative. At the top of the income scale, married working women without children, as well as single women do feel more often than married working mothers that they suffer from handicap or discomfort. The findings are discussed in terms of role enhancement and role strain, health selection, the nature of the health disadvantage associated with specific role patterns, and the importance of the structural context in the role framework.

Obesity morbidity and health care costs in France: an analysis of the 1991-1992 Medical Care Household Survey.

OBJECTIVE: To estimate the direct medical costs associated with obesity in France. DESIGN: Analysis of the French 1991-1992 National Household Survey database comprising a representative sample of 14, 670 individuals aged 18 y and over. A subgroup of subjects with a body mass index (BMI)>/=30 kg/m2 was compared with a control group of normal-weight individuals (BMI 18.5-25 kg/m2) matched on age, gender and education level. MEASUREMENTS: Self-reported weight and height used to calculate individual body mass index and health expenditures in a 3 month period, and morbidity as declared by respondents to the national household survey and verified on medical records. RESULTS: The direct cost attributable to obesity (BMI>/=30 kg/m2) was estimated to be in the range 4.2-8.7 billion French Francs (FF) in 1992 value, that is between 0.7 and 1.5% of total health expenditures. CONCLUSION: These results were of the same order of magnitude as similar estimates obtained by a top-down approach for the same year and setting. International Journal of Obesity (2000) 24, 151-155

Trends in the prevalence of obesity in the French adult population between 1980 and 1991.

OBJECTIVE: To determine changes in the prevalences of overweight and obesity between 1980 and 1991 in French adults. DESIGN: Two cross-sectional studies were performed in 1980 and 1991 by the French National Institute of Statistics and Economics Studies in representative samples of the non-institutionalized French population using a similar random sampling of households from the last available national population census. Overweight and obesity were defined, based on reported height and weight, by a body mass index (BMI)> or = 25 kg/m2 and > or = 30 kg/m2, respectively. As age and socio-economic class (SEC) distributions changed between 1980 and 1991, results were compared before and after a direct age class and SEC standardization of the 1991 data, according to the 1980 population distribution. SUBJECTS: 6792 men and 7150 women in 1980, 7250 men and 7856 women in 1991, aged at least 20y, about 1/2500th of the French non-institutionalized adult population. RESULTS: In women, between 1980 and 1991, there were slight increases in the prevalences of obesity (from 6.3% to 7.0%, P<0.08) and of overweight (26.8% and 27.5%, not statistically significant NS). These increases were most pronounced in women aged 20-29y (obesity: 1.4-2.1%, P<0.15; overweight: 8.0-11.5%, P<0.01). In men, the corresponding prevalences were 6.4% and 6.5%, (NS), and 39.4% and 40.8% (NS). After standardization, the increases in the prevalences of obesity and overweight were even higher between 1980 and 1991 in women (the standardized prevalences in 1991 were respectively: 7.8% and 28.9%), but were unchanged in men. CONCLUSIONS: There were slight overall increases in the prevalences of overweight and obesity between 1980 and 1991 in both genders, which were most pronounced among young women. Changes in the age and SEC distribution in the French population have limited the increase in the prevalences of overweight and obesity in women. These results, based on reported data, may underestimate the prevalences of overweight and obesity and their increase. Nevertheless, the prevalences of reported obesity are similar to those of other European countries, such as Sweden and The Netherlands, and lower than in the UK, USA and Canada.

Estimation of the prevalence of orally treated diabetes in France using a pharmacoepidemiologic approach: comparison between 1981 and 1992.

PURPOSE: Non-insulin-dependent diabetes may become a public health problem in the next decade, given the increasing life expectancy of populations and because the baby-boom generation will reach the age at risk. Moreover a modification of the diagnostic criteria may increase the number of diabetic patients. We studied the evolution of diabetes prevalence. METHODS: A non-specific household survey, performed every 10 years was used. Patients who bought an oral antidiabetic drug during these studies were classified as diabetics. RESULTS: In 1980-81 and 1991-92 the crude diabetes prevalences were not significantly different even if there was a trend to increase (1.27% and 1.41%, respectively). When the 1980-81 prevalence was standardized to the age distribution of the 1991-92 sample, the trend disappeared (prevalence 1980-81:1.35%). CONCLUSION: There was no increase in an individual's risk of diabetes. However the crude prevalence tended to increase because of the changing age structure of the population. On-going studies are needed to follow the prevalence of diabetes during the next decade.

Trends in aspirin, paracetamol and non-steroidal anti-inflammatory drug use in children between 1981 and 1992 in France.

OBJECTIVE: Antipyretic/analgesic drugs (AADs) are among the most commonly used drugs in children. Their efficacy and adverse effects have often been debated and new AADs have been introduced over the past few years. The aim of this study was to assess the characteristics of the use of AADs in children in France, and their trends. METHODS: Two surveys on household health care consumption were undertaken in France, in 1981 and in 1992. They included 5060 and 4841 children, respectively. The AADs studied were aspirin, paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs). RESULTS: The proportion of children exposed to AADs increased significantly between 1981 and 1992 (+28% in 11 years). Among them, the percentage of subjects treated with aspirin decreased (-27%). In contrast, the percentage increased for paracetamol (+ 19%) and for NSAIDs (+179%). Aspirin was the AAD most used in 1981 (57.4%) and it was replaced by paracetamol in 1992 (71.6%). Nasopharyngitis was the main reason for AAD prescription under the age of 11 years; for older children it was influenza-like syndrome, irrespective of the study year. A change in AAD choice occurred in nasopharyngitis, acute bronchitis and influenza-like syndrome irrespective of the age group, and in otitis/sinusitis between 4 and 10 years. In all these cases aspirin prescription decreased, in contrast with paracetamol and NSAIDs. Self-medication of AAD was uncommon (8.3% for aspirin and 10.3% for paracetamol in 1992) and decreased (-29% and -33%). It was used principally for nasopharyngitis, influenza-like syndrome and pain. CONCLUSION: The consumption of AADs in children is high and is increasing. Paracetamol and NSAIDs tend to replace aspirin prescription in children and physicians have played the main role in this change.

Trends in antimicrobial drug use in the community--France, 1981-1992.

Trends in the use of antimicrobials in France between 1980-1981 and 1991-1992 were analyzed. Data were obtained from surveys of health and ambulatory care, which were based on national probability samples. In a 3-month period in 1980, 17% of the population of France was treated with an antibiotic, compared with 25% in 1991 (P < .001). The frequency of respiratory tract infections with a presumed viral etiology that were diagnosed and treated with antibiotics increased by 86% for adults and 115% for children in the 11-year period. The proper use of cephalosporins must be encouraged, and vigilance is required in view of the increased improper use of fluoroquinolones, mainly for respiratory tract infections with a presumed viral etiology.