Estimated prevalence, incidence and healthcare costs of Sjögren's syndrome in France: a national claims-based study.

OBJECTIVES: To estimate prevalence, incidence and mortality rates, and annual healthcare costs of primary Sjögren's syndrome (pSS) and SS associated with other autoimmune disorders (SS+AID) in France. METHODS: French national healthcare claims-based study within the prospective Système National des Données de Santé database that includes the majority of the French population. An algorithm was developed to identify patients with SS and SS-related healthcare claims were analysed between 2011 and 2018. RESULTS: Overall, 23 848 patients with pSS and 14 809 with SS+AID were identified. From 2011 to 2018, the prevalence rate increased slightly for pSS (23-32 per 100000) and SS+AID (16-20 per 100 000), with females comprising 90%-91% and 92%-93% of cases, respectively. The incidence rate of SS per 100 000 persons decreased from 2012 (pSS: 4.3; SS+AID: 2.0) to 2017 (pSS: 0.7; SS+AID: 0.3). Mortality rates per 100 000 persons increased from 2012 to 2018 in patients with pSS (0.2-0.8) or SS+AID (0.1-0.5); mean age of death also increased. Artificial tears and hydroxychloroquine were the most common drug reimbursements. Less than half of patients received annual specialist care from a dentist or ophthalmologist. Healthcare costs associated with SS increased from 2011 to 2018 and exceeded the national estimate of expected costs for chronic diseases. CONCLUSION: In this large French population database study, the low prevalence of pSS confirms that it is an orphan disease. SS is clinically and economically burdensome; these findings may help clinicians better understand routine healthcare received by patients.

Evaluation of Elastic Venous Compression Device dispensation in pregnant and post-partum women using the French National Health Insurance Claims Database: The ProFIL retrospective cohort study.

OBJECTIVES: To describe the real-world use of Elastic Venous Compression Devices (EVCDs) during pregnancy and post-partum using data from a representative subset of the French National Health Insurance Claims Database (the Echantillon Généraliste des Bénéficiaires, EGB). STUDY DESIGN: Women aged 15-49 who were pregnant between 1st July 2017 and 15th June 2018 were identified in the EGB using pregnancy-specific acts (certain prenatal examinations or deliveries). Subgroups were defined by age, presence of Venous Thrombo-Embolism (VTE) risk factors, history of VTE, delivery type and time period. EVCD dispensations (format, prescriber, and date) were identified among those for "standard orthotics" using their unique reimbursement tariffs. Dispensation rates were computed for all subgroups, overall and by format and were compared. RESULTS: 15,528 pregnant women were included: 7,252 [46.7 %] deliveries (5,796 vaginal [79.9 %], 482 planned cesarean sections (C-sections) [6.7 %] and 974 unplanned C-Sections [13.4 %]), 2,734 (17.6 %) terminations and 5,542 (35.7 %) unknown outcomes. Overall, 4,919 (31.7 %) women were dispensed at least one EVCD. Ante-partum dispensation occurred in 43.1 % (n = 3,122) of women whose pregnancy led to a delivery. Dispensation rates were 17.3 % (n = 1,005), 46.7 % (n = 225) and 44.1 % (n = 430) after vaginal delivery, planned C-sections or unplanned C-sections, respectively. Overall, dispensation rates significantly increased with age, the presence of VTE risk factors, and a history of VTE (p < 0.01). EVCD dispensation was most frequent (17.0 %) during the 5th month of pregnancy. Among pregnant women who were dispensed at least one EVCD during ante- or post-partum, 69.0 % had one or two units of compression (27.1 % [one unit], 41.9 % [two units]). Stockings (48.6 %, n = 6,038) were dispensed significantly more frequently than socks (36.9 %, n = 4,586) and tights (14.5 %, n = 1,806) (p < 0.01). The main contributors to mechanical VTE prophylaxis were gynecologists (26.3 % of dispensations, n = 2,280), general practitioners (20.2 %, n = 1,749) and midwives (15.1 %, n = 1,314). CONCLUSIONS: Low observed dispensation rates highlight a discrepancy between the French National Authority for Health (Haute Autorité de Santé, HAS), recommending EVCDs use during pregnancy and after delivery, and the real-life use of EVCD. Prescription sensitization combined with targeted information campaigns for pregnant women would be beneficial to contribute to the prevention of VTE, a health problem for pregnant women.

[Sport-related injuries and conditions among French military personnel]. / Les affections en service liées aux sports chez les militaires français.

INTRODUCTION: Physical and military training is an essential component of training in the armed forces. Although there is considerable evidence for the health benefits of training, the negative impacts cannot be ignored. A study was conducted to determine the frequency of sport-related injuries and conditions in the French armed forces in 2011. MATERIALS AND METHOD: To cover the cost of treating injuries and conditions related to military service, medical officers report all accidents to the Caisse Nationale Militaire de Sécurité Sociale. Based on this evidence, the following information was collected: type of sport, age, sex, length of service, service branch and type of lesion. RESULTS: 8,157 injuries and conditions were reported in the first six months of 2011, giving an incidence rate of 4.472 per 100,000 person-years. An army soldier was found to be 2.1 times more likely to suffer an injury than a member of the navy. The study also found that men were more likely to be injured, except during the first four months of service. Running was the most common cause of exercise-related injury (21.5%). Traumas accounted for 92% of all conditions, diseases for 3%, and overuse injuries for 3%. Lower limb injuries were the most common problem (63%), with a majority of ankle lesions, followed by knee lesions. The frequency of musculoskeletal lesions was 75%. DISCUSSION: A new approach to exercise has been developed to reduce the frequency of sport-related injuries and conditions.

[Incidence of thirty chronic diseases in the French armed forces between 2005 and 2011]. / Incidence des ALD 30 chez les militaires d'active entre 2005 et 2011.

OBJECTIVE: To determine the incidence of chronic diseases (ALD30) in the French armed forces between 2005 and 2011. METHODS: Descriptive study on active soldiers covered by the French military healthcare system (CNMSS) between 01/01/2005 and 31/12/2011. Data were standardized due to over-representation of young men. The incidence of ALD30 was analyzed from medical records by consulting physicians using the Hippocrate database. RESULTS: The mean annual population comprised 331,000 persons. During the study, 10,107 of the 11,581 soldiers to whom an ALD diagnosis was attributed were granted exemption of co-payment. The mean age was 43.2 years, 87.9% of patients were male. The most common chronic diseases were cardiovascular diseases, representing 29.8% of the group, followed by malignant tumours (24.3%), diabetes (14.8%) and severe psychiatric disorders (8.6%). The age-matched standard incidence rate of was higher for women than for men (501 vs 462 per 100,000). The Army had the highest standard incidence rate of ALD and the Navy had the lowest incidence rate (1,139 vs 768 per 100,000). In comparison with the age- and gender-adjusted incidence rates in the general population, the armed forces almost always presented a much lower risk of ALD, which could be explained by medical selection, the type of activity and the short-term affiliation of the users of CNMSS. CONCLUSION: Data extracted from ALD databases are useful for epidemiological studies and for the evaluation of health and prevention programmes.

Increased mortality in patients with RA-associated interstitial lung disease: data from a French administrative healthcare database.

OBJECTIVES: Interstitial lung disease (ILD) is a severe extra-articular manifestation of rheumatoid arthritis (RA). The objectives of this study were to estimate mortality rate in patients with RA-ILD and identify factors affecting mortality. METHODS: Data from a French national claims database (Système National des Données de Santé) from 2013 to 2018 were analysed. Adults with an RA diagnosis (International Classification of Diseases (ICD)-10 codes M05, M06.0, M06.8 and M06.9) were included. ILD diagnosis was defined with ICD-10 code J84. Mortality rates were compared between patients with RA with and without ILD, using Cox proportional hazards regression, after matching 1:1 for age, sex, age at RA-ILD onset and RA duration. RESULTS: Among 173 132 patients with RA, 4330 (3%) also had ILD (RA-ILD). After matching, RA-ILD was associated with an increased mortality rate (HR 3.4, 95% CI 3.1 to 3.9). The HR for mortality was greater for: patients aged <75 years (HR 4.8, 95% CI 3.9 to 5.9) versus ≥75 years (HR 3.0, 95% CI 2.6 to 3.5); patients with ILD onset occurring before RA onset (HR 8.4, 95% CI 5.5 to 13.0) versus ILD onset occurring after RA onset (HR 2.9, 95% CI 2.6 to 3.3); and men (HR 5.2, 95% CI 4.4 to 6.2) versus women (HR 3.6, 95% CI 3.0 to 4.2). CONCLUSION: In this nationwide cohort study, RA-ILD was associated with increased mortality rate (vs in patients with RA without ILD), notably for those aged <75 years, those whose ILD preceded RA onset and men.

Management of bone fragility in patients with rheumatoid arthritis in France: An analysis of a national health insurance claims database.

OBJECTIVES: Rheumatoid arthritis (RA) is considered a major risk factor for fragility fractures. We examined the quality of management of bone fragility in RA patients in a real-life setting. METHODS: We performed a longitudinal case-control retrospective study in a 1/97th random sample of French health care claims database from 2014 to 2016 to determine the extent of bone fragility management in patients with RA compared with non-RA matched controls. RESULTS: Compared to their non-RA controls (n=4652), RA patients (n=1008; mean age: 61.1years; methotrexate: 69.7%; other conventional disease-modifying antirheumatic drugs (cDMARDs): 26.8%; biologic: 26.0%; corticosteroids: 36.9%) had more reimbursements for bone mineral density (BMD) measurements (21.6 vs. 9.2%; OR=2.7 [2.3; 3.3]; P<0.01) and for bisphosphonates (7.1 vs. 3.6%, OR=2.0 [1.5; 2.7]; P<0.05). In patients exposed to corticosteroids, RA patients underwent more BMD assessments than non-RA controls (28.0 vs. 18.8%; OR=1.7 [1.3; 2.2]; P<0.05). RA patients exposed to corticosteroids were more likely to sustain fracture than non-exposed RA patients (5.7 vs. 2.4%, P<0.01). In addition, only when comparing patients exposed to corticosteroids, was there statistical evidence of an association between RA and an increased fracture rate (6.2 vs. 3.5%, P<0.05). CONCLUSION: Patients with RA exposed to corticosteroids are at high risk of fracture. Patients with RA had more bone fragility management than controls.

Assessment of the French National Health Insurance Information System as a tool for epidemiological surveillance of malaria.

OBJECTIVE: Epidemiological surveillance of malaria in France is based on a hospital laboratory sentinel surveillance network. There is no comprehensive population surveillance. The objective of this study was to assess the ability of the French National Health Insurance Information System to support nationwide malaria surveillance in continental France. MATERIALS AND METHODS: A case identification algorithm was built in a 2-step process. First, inclusion rules giving priority to sensitivity were defined. Then, based on data description, exclusion rules to increase specificity were applied. To validate our results, we compared them to data from the French National Reference Center for Malaria on case counts, distribution within subgroups, and disease onset date trends. RESULTS: We built a reusable automatized tool. From July 1, 2013, to June 30, 2014, we identified 4077 incident malaria cases that occurred in continental France. Our algorithm provided data for hospitalized patients, patients treated by private physicians, and outpatients for the entire population. Our results were similar to those of the National Reference Center for Malaria for each of the outcome criteria. DISCUSSION: We provided a reliable algorithm for implementing epidemiological surveillance of malaria based on the French National Health Insurance Information System. Our method allowed us to work on the entire population living in continental France, including subpopulations poorly covered by existing surveillance methods. CONCLUSION: Traditional epidemiological surveillance and the approach presented in this paper are complementary, but a formal validation framework for case identification algorithms is necessary.

Cost-benefit analysis of vaccination against tick-borne encephalitis among French troops.

BACKGROUND: French troops are exposed to tick-borne encephalitis (TBE) during their tours of duty in the Balkans. This disease, potentially serious because of its lethality and morbidity, has an effective vaccination. The epidemiological characteristics of TBE in the Balkans are not well known. OBJECTIVE: In order to provide the French Department of Defence with arguments on the utility of vaccinating troops on missions in this area of Europe, we conducted a cost-benefit study. DESIGN AND SETTING: Through a decision analysis, we estimated the net benefit of a three-injection vaccination programme for all French military personnel in the Balkans versus no vaccination during a period from 2004 to 2014. We used a review of the literature to estimate the parameters necessary for the present study: the disease's morbidity and death incidence rate; the disease's sequelae; and the adverse effects of the vaccination. The initial hypothesis of the seroconversion rate of TBE in the Balkans was 834 per 100,000 person-years. Human life was valued in Euro (year 2004 values) by calculating the amounts paid by the French Department of Defence to military personnel in case of disabling sequelae and to their heirs in case of death. MAIN RESULTS: The net benefit was negative: -5.68 million Euro. The vaccination programme's cost was 10.05 million Euro. 121 cases of TBE could be prevented by this vaccination; however, the sensitivity analysis showed that the results are closely related to the incidence of the disease. CONCLUSION: Very high incidence rates of TBE were initially hypothesised compared with what has actually been reported. As a result, the vaccination programme against TBE for French military personnel should not be implemented unless the objective of the armed forces is to prevent all cases of TBE and they are willing to assume the cost of doing so.

3D contrast-enhanced MR angiography of the abdominal aorta and its distal branches: Interobserver agreement of radiologists in a routine examination.

RATIONALE AND OBJECTIVES: To evaluate the quality of images of the aorta and visceral arteries made at a high level of spatial resolution with thin slices and an optimized acquisition time by three-dimensional contrast-enhanced magnetic resonance angiography (3D CE-MRA). MATERIALS AND METHODS: 3D CE-MRA with a 1.4-mm slice thickness and 512-pixel base matrix was done on 62 consecutive patients with a 1.5-T magnetic resonance imaging MRI unit. A bolus test with a power injector was used to calculate the optimal scan delay time. For quantitative evaluation, the signal-to-noise ratio (SNR) was measured in 3 regions of interest. Qualitative image analysis was evaluated independently by two radiologists and graded on a scale of 0-3. Separate analyses were done for the aorta and distal visceral arterial branches. RESULTS: The means SNR values were respectively 56.2 +/- 15.2 (mean +/- SD) for the aorta, 59.2 +/- 15.1 for the celiac trunk, and 57 +/- 15.2 for the superior mesenteric artery, with a homogeneous distribution (P = .99). Consistent enhancement was confirmed by the lack of statistically significant differences between the SNR values. The average score for vessel visualization on source images ranged from good to excellent for different segments. After post-processing of images, the average score for distal arterial segments was significantly improved. The overall agreement between the 2 reviewers in the visualization of definite artery segments was excellent (k = .91). CONCLUSION: 3D CE-MRA with a 512-pixel base matrix and thin slices can be applied in a reproducible way with excellent depiction and delineation of small vessels. Such a protocol could be used routinely.

[Double reading in breast-cancer screening: what women know about it]. / Connaissance de la double lecture dans le dépistage du cancer du sein.

OBJECTIVE: An officially-sponsored and free breast cancer screening in France was extended to all regions in 2004. These mammography procedures include double reading, which reduces the number of false negatives. Together with this official program, administered by associations in each district, voluntary individual screening is still available. The aim of this study is to ascertain what women think about breast cancer screening, why they choose one method of screening or the other, and what they know about "double reading". METHODS: A postal survey inquiring about the kind of screening chosen and the reasons for this choice was sent to women aged 50 to 74 years covered by the national military health insurance fund. After descriptive analysis of the results, we compared the respondents' knowledge of double reading according to residence (two departments, one rural one and one urban), age, and educational level. RESULTS: 541 of the 994 eligible women responded (54%). More than 94% of them had had a mammography within the past two years, 62.1% through the official program. Women who had participated in the official screening knew more about "double reading" than the others (71.6% versus 50%, p<0.05 in the rural district and 67.4% versus 63.9% in the urban district). In the latter, familiarity with double reading increased as age decreased. Individual mammography depended on prior habits and gynecologists' prescriptions. DISCUSSION: Women must shift from individual mammography to the official program to receive a standardized, double-read, and quality-controlled mammography. Prescribing physicians should serve as an additional entryway into the organized program.

Suicide in the French armed forces.

Several states, of whom France, have been alarmed about suicide in the military. An observational longitudinal cohort study was conducted to check whether the suicide risk in the French army was higher than in the general population and to find out the more prone to self-harm destruction personnel categories. From 1997 to 2000 inclusive, 230 suicides occurred among 315,934 person.years; i.e., the overall annual crude suicide rate was 18.2 per 100,000 active-duty personnel. With the National data for 1999 as reference, army men had a lower suicide risk than men in the overall population of similar age categories (standardised mortality ratio = 67). A Poisson regression model showed that the incidence rate in the Gendarmerie was twice as high as in the Land Forces (incidence rate ratio = 2.15), that the incidence relative risk increased threefold over 4 years, and that the incidence rate ratio amongst under 25 and from 40 to 44-year-old personnel was almost twice as high as in the 25-29-year-old category. The main suicide methods were use of a firearm (51%) and hanging (28%). Despite a global lower risk than in the general population, certain army categories, i.e., Gendarmerie personnel and young men, deserve specific surveillance and preventive measures.