Deaths associated with acquired haemophilia in France from 2000 to 2009: multiple cause analysis for best care strategies.

Deaths occurring in the context of acquired haemophilia (AH) may be related to inter-connected causes and mechanisms including bleeding, specific or older patient co-morbidities or iatrogenic complications. However, their magnitude remains unknown. This study aimed to determine the respective weight and frequency of the various causes of death in AH. Multiple-cause analysis based on death certificates data is used in this purpose. Over a 10-year period (2000-2009), 121 deaths with AH as a cause were registered in France. All the deaths were of adults (extremes: 47 and 99 years; mean age: 80.7 years). The average number of causes per death certificate was 4.7. AH was the underlying cause of death (UCD) in 69.4% of the cases, and was more frequent in the older subjects. In contrast, before age of 75 years, AH was more often a contributing cause of death. No postpartum or obvious thromboembolism-related deaths were registered. Haemorrhagic shock was the most frequent direct cause of death (DCD), followed by infectious events, cardiac dysfunction, metabolic and nutritional disorders with muscle wasting and decubitus complications, and cancers (52.9%, 26.4%, 7.5%, 5.8% and 4.1%, respectively). However, when AH was not reported as an UCD, infections become the first DCD (32.4%) followed by bleeding events (16.2%). Best prophylactic and curative strategies for infections are particularly required to improve the prognosis in AH. Moreover, as several of its DCD correspond also to steroids side effects, best tolerated immunosuppressant regimen with steroid-sparing agents adjoining are particularly awaited in AH population.

[Knowledge of causes of death in Algeria. Methods and first results]. / Connaissance des causes de décès en Algérie. Etude des décès enregistrés par l'INSP. Méthodes et premiers résultats.

BACKGROUND: This article describes the gradual establishment between 1995 and 2009 of the collection of medical causes of death in Algeria by the National Institute of Public Health (INSP). METHODS: The registration of these causes is based on the WHO certificate's model. The codes and rules of the International Classification of Diseases (ICD10) were used for coding. RESULTS: Initial results for 2007 show that causes of death have been gathered by INSP for 36.5% of the deaths registered by the civil registrar. Among these causes, cardiovascular diseases occupy the first place. Distributions are different by gender and age. CONCLUSION: This study is a first step towards the knowledge of the causes of death in Algeria.

AIDS-related conditions: study of a representative sample of 1203 patients deceased in 1992 in France.

BACKGROUND: Little representative information exists on the frequency of human immunodeficiency virus (HIV)-related diseases among the overall AIDS population. The objective of this research is to assess the nature, frequency and characteristics of these diseases among AIDS patients during their last year of life and to analyse these frequencies according to the mode of transmission and other socio-demographic and medical characteristics. METHODS: To obtain comprehensive data, we conducted an investigation based on retrospective collection of clinical information on a representative sample (1203 deaths) of all AIDS deaths that occurred in France during 1992. RESULTS: The frequency of the diseases was markedly higher than the one described in the AIDS surveillance registers and varied between homosexuals and intravenous drug users (IVDU). After controlling for other variables (age, CD4 counts, survival times) by means of logistic regression, homosexuality remained a significant explaining factor for Kaposi's sarcoma, cytomegalovirus infections, herpes simplex and cryptosporidiosis. In contrast, HIV encephalopathy, hepatitis, mental disorders, invasive candidiasis and cachexia were more frequent in male IVDU. Few differences were observed by sex. CONCLUSIONS: Several factors may explain the differences: variation in exposure to infectious agents, general health status, use of medical care and direct influence of the mode of HIV transmission. These data are of particular value for medical services in planning the magnitude of health care needs among the AIDS population overall, for clinicians and researchers for advancing the understanding of the natural history of AIDS and in the definition of prophylactic strategies against opportunistic infections.

[Gender differences in premature mortality and avoidable deaths]. / Disparités de mortalité "prématurée" selon le sexe et causes de décès "évitables"

OBJECTIVE: This paper aims to describe and to analyse disparities between men and women for "premature" mortality rates (deaths before 65 year-old). The study is particularly focused on "avoidable" causes of death. These types of deaths are greatly related to risk behaviours such as alcohol abuse, tobacco abuse or dangerous driving. Taking account of these indicators ("premature" and "avoidable" mortality) enables to study health status discrepancies by gender and to characterize specific public health issues in France including high rates of "premature" mortality and risk behaviours. METHODS: The analysis is based on exhaustive mortality data from 1980 to 1999 supplied by the Centre for epidemiology of medical causes of death (CepiDc-INSERM). Specific causes of death closely related to risk behaviours are classified as "avoidable": lung and upper airways cancers, cirrhosis, alcoholic psychosis, traffic accidents, aids and suicide. The contribution of these categories in the global male overmortality was assessed according to different demographic and geographic characteristics. RESULTS: Within "premature" mortality, males experience greater burden of "avoidable" mortality (sex-ratio: 4 versus 2). The gender differences are mainly due to injuries and suicides in the younger age groups and to tobacco and alcohol-related cancers (lung and upper airways) in the 45-64 years age group. The recent decline in "premature" mortality sex-ratio is explained by an increase of these two cancers for females. Among european countries, the French male overmortality is especially marked and mainly attributable to "avoidable" causes of death. CONCLUSION: "Avoidable" and "premature" mortality provide useful tools for the follow-up of health status in France particularly because of high risk behaviours and prevention inadequacy. Reducing gender discrepancies will depend mainly on public health policies in terms of primary prevention.

Improvement of the quality and comparability of causes-of-death statistics inside the European Community. EUROSTAT Task Force on "causes of death statistics".

BACKGROUND: Cause-of-death statistics are widely used for comparing health characteristics of European Community (EC) countries. Before attempting to interpret between-country differences, it is essential to assess the biases affecting the comparability of the data. EUROSTAT decided to address globally this problem with the objective to improve the quality and comparability of cause-of-death data within the EC. METHODS: The material is based on a review of results of international comparative cause-of-death studies and on specific inquiries among EC. Both cause-of-death certification and codification practices are analysed. Certification is studied comparing the models of death certificates, the type of information captured, certifiers training and querying practices. The different coding systems are analysed (International classification of diseases (ICD) in use, interpretation of the ICD rules, implementation of automated coding systems). RESULTS: International studies on comparability of certification and coding practices between countries are rare. These studies are based on certification of cases histories and recoding of samples of death certificates. Recent studies on respiratory diseases, cancers and diabetes outline differences that influenced on the reported level of mortality. The specific EUROSTAT investigation (1997) outline general discrepancies: models of death certificates, nature and amount of information entered, way to establish the diagnosis, degree of consistency of the certification process, autopsy practices, certifiers practices, implementation of ICD-10 and implementation of automated coding systems. CONCLUSION: EUROSTAT studies are now focused on causes of death requiring special attention for comparability (e.g. suicide, accidental deaths, drug and alcohol related deaths, unknown and ill-defined causes), on procedures to improve the homogeneity of certifiers training and querying practices, on the effect of the transition to ICD-10. The international model of death certificate recommended by the World Health Organization should be adopted as widely as possible. Uniform complementary information (e.g. surgery, pregnancy, autopsy, place of occurrence of accidental deaths, work accident) should also be adopted. The EUROSTAT investigations must result in definitions of common recommendations and guidelines to EC.

[Quality of suicide mortality data]. / La qualité des données de mortalité sur le suicide.

Prevention of suicide is a public health priority in France. Indicators of suicide mortality have been widely used to describe epidemiological situations or to evaluate public health actions. It is therefore essential to examine the quality of suicide mortality data. The purpose of this work was to identify potential biases affecting the quality of such data and their comparability between different countries as well as to determine how they can affect conclusions. Potential biases were identified by studying the characteristics of the death certificate system and analyzing the international literature on data quality. The impact of biases was assessed by analyzing the causes of "concurrent" death with suicide in the official statistics (trauma and poisoning caused in an undetermined way concerning intention and unknown causes). The proportion of suicides listed as "concurrent" causes of death, estimated from specific surveys was extrapolated to official data. This method was also used to correct the international data. Practices concerning death certificates for violent deaths vary considerably from one country to another: type of certifying physician, frequency of medicolegal investigations, frequency of autopsies, suicide definition criteria, confidentiality regulations, religious and culture context. These practical differences lead to variability in undetermined and unknown causes. The corrections made on the mortality data after taking into account for these potential biases showed that the rate of suicide determined from official data is considerably underestimated, but that sociodemographic and geographic factors of suicide change little after correction. Likewise, the order by country was similar after taking into consideration concurrent causes. A reliable evaluation of the rate of suicide for a given country is of course important. However, it is possible to characterize populations at risk and analyze the determinants of suicidal behavior without necessarily recording all suicides, as long as the declaration bias is stable. Statistical analysis of death by suicide in France shows that, despite under-reporting, the principal sociodemographic and geographic features and trends over time can be considered as valid. A series of recommendations is proposed however to improve data quality and homogeneity for death certificate reporting. Designing operational criteria for deciding when to declare suicide as the cause of death would be helpful to guide physicians who report deaths. Classical autopsies could be completed by "psychological autopsies" with friends and family of the deceased. The death certificate form could be improved to include items for complementary information favoring or not suicide.

Excess mortality related to the August 2003 heat wave in France.

OBJECTIVES: From August 1st to 20th, 2003, the mean maximum temperature in France exceeded the seasonal norm by 11-12 degrees C on nine consecutive days. A major increase in mortality was then observed, which main epidemiological features are described herein. METHODS: The number of deaths observed from August to November 2003 in France was compared to those expected on the basis of the mortality rates observed from 2000 to 2002 and the 2003 population estimates. RESULTS: From August 1st to 20th, 2003, 15,000 excess deaths were observed. From 35 years age, the excess mortality was marked and increased with age. It was 15% higher in women than in men of comparable age as of age 45 years. Excess mortality at home and in retirement institutions was greater than that in hospitals. The mortality of widowed, single and divorced subjects was greater than that of married people. Deaths directly related to heat, heatstroke, hyperthermia and dehydration increased massively. Cardiovascular diseases, ill-defined morbid disorders, respiratory diseases and nervous system diseases also markedly contributed to the excess mortality. The geographic variations in mortality showed a clear age-dependent relationship with the number of very hot days. No harvesting effect was observed. CONCLUSIONS: Heat waves must be considered as a threat to European populations living in climates that are currently temperate. While the elderly and people living alone are particularly vulnerable to heat waves, no segment of the population may be considered protected from the risks associated with heat waves.

Number of deaths among HIV-infected adults in France in 2000, three-source capture-recapture estimation.

We estimated the number of deaths in France for the year 2000 in HIV-infected adults using three sources. The sources were (1) the 'Mortalité 2000' survey (M2000): 964 deaths were documented by 185 hospital wards involved in HIV management; (2) 1288 death certificates with a mention of HIV infection (INSERM-CepiDc) and (3) the French hospital database on HIV infection (FHDH) identified 654 deaths. The capture-recapture method was used with log-linear modelling. Overall 1559 deaths were observed. Estimation of the number of deaths in France was 1699 (95% CI 1671-1727). The completeness of M2000, CepiDc and FHDH were 55%, 76% and 38% respectively. Diversification of diseases and of causes of death in HIV-infected adults may explain: (1) the diversification of physicians involved in their management and incomplete coverage of M2000 and FHDH, and (2) why HIV infection was not mentioned in all death certificates.