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Age-based comparison of patients with heart failure treated with sacubitril-valsartan in France: a real-world evaluation
No full textSession: The pandemic of ageing in heart failure: age, frailty, and cognitionInternational audienceBackground: Sacubitril-Valsartan (S/V) was approved in Europe in 2015, for treatment of adults with symptomatic chronic heart failure with reduced left ventricular ejection fraction (HFrEF). In France, S/V had benefited from an early access program (2015-2018) and became available in community pharmacy since October 2018.Purpose: Our study aimed to describe characteristics of patients who received S/V in France and to assess real-life mortality in this population regarding age.Methods: This non-interventional retrospective study utilized existing claims data from the French National Healthcare Data System (SNDS) allowing long-term follow-up of patients who benefited from at least one reimbursement of S/V. Patient data between April 2012 and December 2020 were extracted from the database. Prespecified subgroup analyses were conducted for subjects aged <75 and ≥75 y to describe characteristics of patients at first reimbursement of S/V. Cardiovascular mortality and all-cause mortality were estimated using Kaplan-Meier method.Results: Between 2015 and 2020, 104,910 patients initiated S/V and were followed for an average of 20 months; 42.6% (44,743 patients) were ≥75 y. Mean (SD) age difference between the 2 subgroups was 20.3 years [62.2 (9.6) vs 82.5 (5.2) in patients <75 and ≥75 y respectively]. Patients ≥75 y had a higher prevalence of atrial fibrillation (50.6% vs 31.2%) and chronic renal failure (20.9% vs 10.1%) and were less co-treated with mineralocorticoid-receptor antagonists (21.8% vs 40.5%) and ß-Blockers (64.0% vs 73.8%) compared to those <75 y. Three months after first dispensation, 48.3%, 35.3%, and 16.4% of patients aged ≥75 y received S/V dosages of 24/26mg, 49/51mg, and 97/103mg respectively, compared to 31.4%, 38.2%, and 30.4% for patients aged <75 y. The mean (SD) exposure period was 14.7 (13.6) months in patients ≥75 y vs 19.0 (15.5) months in <75 y patients. As expected, given the age difference, patients ≥75 y had a higher probability of all-cause mortality at 12-month 16.5% vs 6.2% in patients <75 y. Furthermore, 12-month cardiovascular mortality – evaluated during the early access program period (2015-2017) – in patients ≥75 y was 11.0% vs 4.8% in patients <75 y. Figures 1 and 2 show survival curves for cardiovascular mortality and all-cause mortality of these 2 subgroups. Of interest, cardiovascular mortality rate at 12 months was 7% in this study, compared to 6% in PARADIGM-HF, and all-cause mortality at 12-month was higher (10,6% vs 7%), likely due to the profile of the patients, who were older and have more comorbidities in real life. Finally, very few patients were hospitalized for reasons related to angioedema, 16/44,743 in ≥75 y patients and 26/60,167 in those <75 y.Conclusion: This is the first French real-world study providing exhaustive nationwide data on S/V mortality over a period of almost 6 years in a very large population of elderly with a mean age of 70.9 y vs 63.8 y in PARADIGM-HF
Prioritisation of infectious diseases from a public health perspective: a multi-criteria decision analysis study, France, 2024
No full textInternational audienceWithin the International Health Regulations framework, the French High Council for Public Health was mandated in 2022 by health authorities to establish a list of priority infectious diseases for public health, surveillance and research in mainland and overseas France. Aim Our objective was to establish this list. Methods A multi-criteria decision analysis was used, as recommended by the European Centre for Disease Prevention and Control. A list of 95 entities (infectious diseases or groups of these, including the World Health Organization (WHO)-labelled ‘Disease X’) was established by 17 infectious disease experts. Ten criteria were defined to score entities: incidence rate, case fatality rate, potential for emergence and spread, impact on the individual, on society, on socially vulnerable groups, on the healthcare system, and need for new preventive tools, new curative therapies, and surveillance. Each criterion was assigned a relative weight by 77 multidisciplinary experts. For each entity, 98 physicians from various specialties rated each criterion against the entity, using a four-class Likert-type scale; the ratings were converted into numeric values with a nonlinear scale and respectively weighted to calculate the entity score. Results Fifteen entities were ranked as high-priorities, including Disease X and 14 known pathologies (e.g. haemorrhagic fevers, various respiratory viral infections, arboviral infections, multidrug-resistant bacterial infections, invasive meningococcal and pneumococcal diseases, prion diseases, rabies, and tuberculosis). Conclusion The priority entities agreed with those of the WHO in 2023; almost all were currently covered by the French surveillance and alert system. Repeating this analysis periodically would keep the list updated
Les enjeux du partage de connaissances pour intégrer la santé dans les politiques d’aménagement et d’urbanisme
No full textInternational audienceMalgré l’existence de données probantes de l’impact sanitaire des politiques d’aménagement et d’urbanisme, la santé ne constitue pas un critère décisionnel majeur de leur élaboration. Pourtant, la communauté scientifique reconnait que le partage de connaissances entre scientifiques et décideurs favorise une prise de décision éclairée par les données probantes..
Mise au point sur les travaux de recherche en France sur la santé des soignants : soutenir l’émergence de l’usage des bases de données (ministère de la Santé et de la Prévention, Paris 19 mars 2024)
No full textInternational audienceThis article provides a synthesis of recent research in France on the health of healthcare professionals, stemming from the 2023 call for projects by the MNH Foundation and the DREES. Utilizing data from the National Health Data System and the Permanent Demographic Sample, the projects WOCAPREG, TRAILSS, CAPESSA, and SOIGNANCES provide an overview of knowledge on maternal health, mental health, occupational cancers, and the exposome of healthcare workers. The article also highlights the efforts of national organizations such as DREES and HAS to improve working conditions for healthcare professionals, emphasizing the need for a coordinated response.Cet article propose une synthèse des recherches récentes en France sur la santé des professionnels de santé, issues de l’appel à manifestation d’intérêt de 2023 par la Fondation MNH et la DREES. Utilisant des données du Système national des données de santé (SNDS) et de l’échantillon démographique permanent, les projets WOCAPREG, TRAILSS, Capessa, et Soignances font état des connaissances sur la santé maternelle, la santé mentale, les cancers professionnels, et l’exposome des soignants. L’article met également en avant les efforts d’organisations nationales comme la DREES et la HAS pour améliorer les conditions de travail des soignants, soulignant l’importance d’une réponse coordonnée
Intimidation against advocates and researchers in the tobacco, alcohol and ultra-processed food spaces: a review
No full textInternational audienceUnhealthy commodity industries (UCIs) engage in corporate political activity, using diverse practices, including intimidatory tactics, to thwart, delay and dilute regulations that threaten their businesses. While examples of such intimidation exist across multiple sectors, no attempt has been made to synthesize these. Furthermore, much of the literature focuses on intimidation of policy-makers. Less is known about the types of intimidation experienced by advocates and researchers and their responses to this intimidation. This scoping review explores the literature across the tobacco, alcohol and ultra-processed food spaces for instances of intimidation and categorizes them inductively and deductively based on a framework of intimidation types. Similarly, responses to intimidation were mapped onto a pre-existing framework. We found intimidatory tactics towards advocates and researchers in every sector. Public discreditation, followed by legal threats and action, complaints and freedom of information requests were most frequently mentioned and often attributed to UCIs or their third parties. Surveillance, threats of violence, violence, burglary and bribery were less prevalent in the literature and their perpetrators were unknown. Those intimidated reported carrying on as normal, defensive action (changing/adapting work, taking security precautions) or, as was most reported, offensive action (exposing intimidation, correcting misinformation, taking legal action). The similarity of intimidation across sectors suggests that UCIs engage in similar intimidatory tactics regardless of sector. Understanding more about the scale of intimidation and how it impacts the work and wellbeing of those affected is essential, as is learning more about the ways researchers and advocates can effectively pre-empt and respond
The effect of residential greenness on cardiovascular mortality from a large cohort in South China: An in-depth analysis of effect modification by multiple demographic and lifestyle characteristics
No full textInternational audienceBackground: The potential for residential greenness to improve cardiovascular health through both physical and psychological mechanisms is well recognized. However, evidence from rapidly urbanizing developing countries and cohort-based causal inference approaches, remains limited. We aim to examine the effect of residential greenness and time to cardiovascular mortality in South China.Methods: We utilized data from a community-based population survey involving 748,209 participants at baseline from 2009 to 2015, followed up until 2020. Residential greenness exposure was assessed by the annual Normalized Difference Vegetation Index (NDVI) in the 500 m radius of each participant's residence. We used time-varying proportional hazard Cox models coupled with inverse probability weighting to fit marginal structural models and obtain hazard ratios (HRs) for cardiovascular disease (CVD) mortality after adjusting for confounders. Multiple effect modifiers on both additive and multiplicative scales were further explored.Results: A total of 15,139 CVD-related deaths were identified during a median of 7.9 years of follow-up. A protective effect was found between higher greenness exposure and reduced CVD mortality, with a 9.3 % lower rate of total CVD mortality (HR 0.907, 95 % CI 0.859-0.957) based on a 0.1 increase in annual average NDVI. Demographic (age, marital status) and lifestyle factors (smoking, drinking status) were found to modify the association between residential greenness and CVD mortality (all P interaction values < 0.05 or 95 %CI for RERI excluded the value 0). Notably, this effect was more pronounced among older adults, married, and individuals having healthier lifestyles, indicating a greater benefit from greenness for these subgroups.Conclusions: Our findings support a causal link between increased residential greenness exposure and a reduced risk of CVD mortality in South China with marked heterogenous effects, which has public health implications for cultivating greener urban environments to mitigate the impact of CVD within the context of rapid urbanization
Excess Mortality and its Determinants During the COVID-19 Pandemic in 21 Countries: An Ecological Study from the C-MOR Project, 2020 and 2021
No full textInternational audienceIntroduction: The COVID-19 pandemic overwhelmed health systems, resulting in a surge in excess deaths. This study clustered countries based on excess mortality to understand their response to the pandemic and the influence of various factors on excess mortality within each cluster.Materials and Methods:his ecological study is part of the COVID-19 MORtality (C-MOR) Consortium. Mortality data were gathered from 21 countries and were previously used to calculate weekly all-cause excess mortality. Thirty exposure variables were considered in five categories as factors potentially associated with excess mortality: population factors, health care resources, socioeconomic factors, air pollution, and COVID-19 policy. Estimation of Latent Class Linear Mixed Model (LCMM) was used to cluster countries based on response trajectory and Generalized Linear Mixture Model (GLMM) for each cluster was run separately.Results: Using LCMM, two clusters were reached. Among 21 countries, Brazil, the USA, Georgia, and Poland were assigned to a separate cluster, with the mean of excess mortality z-score in 2020 and 2021 around 4.4, compared to 1.5 for all other countries assigned to the second cluster. In both clusters the population incidence of COVID-19 had the greatest positive relationship with excess mortality while interactions between the incidence of COVID-19, fully vaccinated people, and stringency index were negatively associated with excess mortality. Moreover, governmental variables (government revenue and government effectiveness) were the most protective against excess mortality.Conclusion: This study highlighted that clustering countries based on excess mortality can provide insights to gain a broader understanding of countries' responses to the pandemic and their effectiveness
Changes in Healthcare Utilization After the 2022 Seoul Metropolitan Flood: Applying a Generalized Synthetic Control Approach
No full textInternational audienceFloods can have adverse health effects and impose a burden on healthcare systems. However, the potential consequences of floods on specific medical causes in densely populated metropolitan cities has not been characterized yet. Therefore, we evaluate the changes in healthcare utilization patterns after the 2022 Seoul flood using nationwide health insurance data. Based on the flood inundation map, districts within the flooded municipalities of Seoul were classified as severe‐(n = 12), mild‐(n = 22), or non‐(n = 38) flood‐affected districts. Capitalizing on the timing of the flood as a natural experiment, a generalized synthetic control method was applied to estimate changes in the number of disease‐specific hospital visits in flood‐affected districts during 2 weeks after the flood. We found excess hospital visits for external injuries (20.2 visits, 95% CI: −6.0, 45.2) and fewer visits for pregnancy and puerperium (−3.0 visits, 95% CI: −5.1, −0.5) in residents of flooded districts. When comparing severe‐ and non‐flood districts, the increase in hospital visits for external injuries (56.2 visits, 95% CI: 17.2, 93.2) and a decrease in hospital visits related to pregnancy and puerperium (−5.3 visits, 95% CI: −8.4, −1.6) were prominent in residents living in severe‐flood affected districts. Disease specific analysis showed an increase in hospital visits for injuries to the elbow and forearm, ankle and foot injuries, and chronic lower respiratory diseases in severe‐flood‐affected districts. However, these impacts were not observed when comparing the mild‐ and non‐flood‐affected districts. Our study suggests an immediate and substantial change in medical demand following flood exposure, highlighting the importance of public health responses after flood events
Simulating the impact of greenspace exposure on metabolic biomarkers in a diverse population living in San Diego, California: A g-computation application
No full textInternational audienceIntroduction: Growing evidence exists that greenspace exposure can reduce metabolic syndrome risk, a growing public health concern with well-documented inequities across population subgroups. We capitalize on the use of g-computation to simulate the influence of multiple possible interventions on residential greenspace on nine metabolic biomarkers and metabolic syndrome in adults (N = 555) from the 2014-2017 Community of Mine Study living in San Diego County, California.Methods: Normalized difference vegetation index (NDVI) exposure from 2017 was averaged across a 400-m buffer around the participants' residential addresses. Participants' fasting plasma glucose, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglyceride concentrations, systolic and diastolic blood pressure, hemoglobin A1c (%), waist circumference, and metabolic syndrome were assessed as outcomes of interest. Using parametric g-computation, we calculated risk differences for participants being exposed to each decile of the participant NDVI distribution compared to minimum NDVI. Differential health impacts from NDVI exposure by sex, ethnicity, income, and age were examined.Results: We found that a hypothetical increase in NDVI exposure led to a decrease in hemoglobin A1c (%), glucose, and high-density lipoprotein cholesterol concentrations, an increase in fasting total cholesterol, low-density lipoprotein cholesterol, and triglyceride concentrations, and minimal changes to systolic and diastolic blood pressure, waist circumference, and metabolic syndrome. The impact of NDVI changes was greater in women, Hispanic individuals, and those under 65 years old.Conclusions: G-computation helps to simulate the potential health benefits of differential NDVI exposure and identifies which subpopulations can benefit most from targeted interventions aimed at minimizing health disparities
On classes of consistent tests for the Type I Pareto distribution based on a characterization involving order statistics
No full textInternational audienceWe propose new classes of goodness-of-fit tests for the Pareto Type I distribution. These tests are based on a characterization of the Pareto distribution involving order statistics. We derive the limiting null distribution of the tests and also show that the tests are consistent against fixed alternatives. The finite-sample performance of the newly proposed tests are evaluated and compared to some of the existing tests, where it is found that the new tests are competitive in terms of powers. The paper concludes with an application to a real world data set, namely the earnings of the 22 highest paid participants in the inaugural season of LIV golf