Change in cardiovascular risk factors in France, 1985–1997

The change in the main cardiovascular risk factors in France was assessed using the MONICA population surveys conducted in the Urban Community of Lille, Bas-Rhin and Haute-Garonne. Trends in obesity, tobacco smoking, hypertension, hypercholesterolaemia and self-reported diabetes were established for the first (1985-1988) and the last (1995-1997) survey. The results indicate that the prevalence of overweight and obesity remained stable in both genders; tobacco smoking decreased in men but increased in women. Prevalence of hypertension decreased, and preventive measures improved in both genders. Prevalence of hypercholesterolaemia remained stable, and preventive measures improved only in men. Prevalence of self-reported diabetes increased solely in women, and preventive measures improved in both genders. However, in 1995-1997 still 40% of the treated hypertensive and 30% of the treated hypercholesterolaemic subjects were not adequately controlled. We conclude that prevalence and prevention of the main cardiovascular risk factors have evolved favourably in France, but the management of hypercholesterolaemia and hypertension can still be improved.     

Diverging Trends in the Incidence of Occupational and Nonoccupational Injury in Ontario, 2004–2011

Objectives. We describe trends in occupational and nonoccupational injury among working-age adults in Ontario.Methods. We conducted an observational study of adults aged 15 to 64 over the period 2004 through 2011, estimating the incidence of occupational and nonoccupational injury from emergency department (ED) records and, separately, from survey responses to 5 waves of a national health interview survey.Results. Over the observation period, the annual percentage change (APC) in the incidence of work-related injury was −5.9% (95% confidence interval [CI] = −7.3, −4.6) in ED records and −7.4% (95% CI = −11.1, −3.5) among survey participants. In contrast, the APC in the incidence of nonoccupational injury was −0.3% (95% CI = −0.4, 0.0) in ED records and 1.0% (95% CI = 0.4, 1.6) among survey participants. Among working-age adults, the percentage of all injuries attributed to work exposures declined from 20.0% in 2004 to 15.2% in 2011 in ED records and from 27.7% in 2001 to 16.9% in 2010 among survey participants.Conclusions. Among working-age adults in Ontario, nearly all of the observed decline in injury incidence over the period 2004 through 2011 is attributed to reductions in occupational injury.Although most developed countries have made progress in improving population health over the past 2 decades, reductions in the burden of mortality, morbidity, and disability attributed to injury have been uneven.1 In the United States, the age-standardized death rate from motor vehicle collisions declined by 30% between 1990 and 2010. By contrast, the age-standardized death rate from falls and poisonings increased by 71% and 128%, respectively, over the period 2000 through 2009.2 A recent surveillance report on injury mortality in Canada found that the share of all-cause mortality attributed to injury increased over the period 2001 through 2007.3 Injury remains the leading cause of death among persons aged younger than 45.4The burden of injury among working-age adults arises from occupational and nonoccupational exposures. Although the reduction in hazardous exposures arising from work has been listed as among the 10 most important public health contributions to the improvement in population health over the past 100 years,5 work exposures continue to cause a large fraction of injury morbidity, responsible for as much as 25% of the burden of injury in working-age adults.6The objective of surveillance in public health and occupational health is the systematic and ongoing assessment of population health status, based on the timely collection, analysis, and dissemination of information on health status and health risks.7 Over the past 2 decades, the population surveillance of injury morbidity has made strengthened use of health interview surveys6,8,9 and administrative records of health care utilization, particularly emergency department (ED) records.10–17 These data sources can be used effectively to identify important trends in injury incidence and, if well-designed, can document occupational and nonoccupational injury causation.We estimated trends in the incidence of occupational and nonoccupational injury in Ontario over the period 2004 through 2011 for adults aged 15 to 64, drawing on a census of ED records and participants in national health interview surveys.     

Incidence of pertussis in subjects aged 50 years and older in France in 2013–2014

Objective

To assess the incidence of pertussis (whooping cough) in subjects aged 50 years and older in France.

Childhood Lymphohematopoietic Cancer Incidence and Hazardous Air Pollutants in Southeast Texas, 1995–2004

Background

Cancer is the second leading cause of death among U.S. children with few known risk factors. There is increasing interest in the role of air pollutants, including benzene and 1,3-butadiene, in the etiology of childhood cancers.

Objective

Our goal was to assess whether census tracts with the highest benzene or 1,3-butadiene ambient air levels have increased childhood lymphohematopoietic cancer incidence.

Methods

Our ecologic analysis included 977 cases of childhood lymphohematopoietic cancer diagnosed from 1995–2004. We obtained the U.S. Environmental Protection Agency’s 1999 modeled estimates of benzene and 1,3-butadiene for 886 census tracts surrounding Houston, Texas. We ran Poisson regression models by pollutant to explore the associations between pollutant levels and census-tract cancer rates. We adjusted models for age, sex, race/ethnicity, and community-level socioeconomic status (cSES).

Results

Census tracts with the highest benzene levels had elevated rates of all leukemia [rate ratio (RR) = 1.37; 95% confidence interval (CI), 1.05, 1.78]. This association was higher for acute myeloid leukemia (AML) (RR = 2.02; 95% CI, 1.03–3.96) than for acute lymphocytic leukemia (ALL) (RR = 1.24; 95% CI, 0.92–1.66). Among census tracts with the highest 1,3-butadiene levels, we observed RRs of 1.40 (95% CI, 1.07–1.81), 1.68 (95% CI, 0.84–3.35), and 1.32 (95% CI, 0.98–1.77) for all leukemia, AML, and ALL, respectively. We detected no associations between benzene or 1,3-butadiene levels and lymphoma incidence. Results that examined joint exposure to benzene and 1,3-butadiene were similar to those that examined each pollutant separately.

Conclusions

Our ecologic analysis suggests an association between childhood leukemia and hazardous air pollution; further research using more sophisticated methodology is warranted.     

Anthropometric indices as predictors of survival in AIDS adults. Aquitaine Cohort,France, 1985–1997

The aim of the study was to assess the performance of weight related nutritional markers [reported involuntary weight loss (WL) greater than 10%, measured WL and body mass index (BMI)] in predicting survival at AIDS stage. The three anthropometric indices were used as time dependant variables in Cox models to predict survival at AIDS stage. The studied sample included 630 HIV1-infected individuals of a prospective cohort of those 421 died (median survival at AIDS stage: 19.9 months). After adjustment for usual prognostic factors of survival, the reported WL greater than 10% was a pejorative predictor of survival (hazard ratio (HR) 2.4; 95% confidence interval (CI): 1.9–3.0). For measured WL <5%, between 5 and 10% and 10% of baseline weight compared with no WL, HR were respectively, 1.9 (CI: 1.4–2.6), 3.3 (CI: 2.4–4.4) and 6.7 (CI: 5.2–8.6). The HR of death were 2.2 (CI: 1.6–3.0) for BMI between 16 and 18.4 kg/m²and 4.4 (CI: 3.1–6.3) for BMI <16 compared to normal BMI (18.5). Even a limited WL measured at a given point in time during follow up increases the risk of death at the AIDS stage. Simple cross-sectional measures of BMI have a good predictive value of survival.     

Fatal heroin-related overdose in San Francisco, 1997–2000: a case for targeted intervention

Heroin-related overdose is the single largest cause of accidental death in San Francisco. We examined demographic, location, nontoxicological, and toxicological characteristics of opiate overdose deaths in San Francisco, California. Medical examiner’s case files for every opioid-positive death from July 1, 1997, to June 30, 2000, were reviewed and classified as overdose deaths or other. Demographic variables were compared to two street-based studies of heroin users and to census data. From 1997 to 2000, of all heroin-related overdoses in San Francisco 47% occurred in low-income residential hotels; 36% occurred in one small central area of the city. In 68% of deaths, the victim was reportedly alone. When others were present between last ingestion of heroin and death, appropriate responses were rare. In three cases, police arrested the person who called emergency services or others present on the scene. We recommend the development of overdose response training targeted at heroin users and those close to them, including the staff of residential hotels.     

An Analysis of All Applications for Sex Reassignment Surgery in Sweden, 1960–2010: Prevalence,Incidence, and Regrets

Incidence and prevalence of applications in Sweden for legal and surgical sex reassignment were examined over a 50-year period (1960–2010), including the legal and surgical reversal applications. A total of 767 people (289 natal females and 478 natal males) applied for legal and surgical sex reassignment. Out of these, 89 % (252 female-to-males [FM] and 429 male-to-females [MF]) received a new legal gender and underwent sex reassignment surgery (SRS). A total of 25 individuals (7 natal females and 18 natal males), equaling 3.3 %, were denied a new legal gender and SRS. The remaining withdrew their application, were on a waiting list for surgery, or were granted partial treatment. The incidence of applications was calculated and stratified over four periods between 1972 and 2010. The incidence increased significantly from 0.16 to 0.42/100,000/year (FM) and from 0.23 to 0.73/100,000/year (MF). The most pronounced increase occurred after 2000. The proportion of FM individuals 30 years or older at the time of application remained stable around 30 %. In contrast, the proportion of MF individuals 30 years or older increased from 37 % in the first decade to 60 % in the latter three decades. The point prevalence at December 2010 for individuals who applied for a new legal gender was for FM 1:13,120 and for MF 1:7,750. The FM:MF sex ratio fluctuated but was 1:1.66 for the whole study period. There were 15 (5 MF and 10 MF) regret applications corresponding to a 2.2 % regret rate for both sexes. There was a significant decline of regrets over the time period.     

Deprivation,Immigration and Tuberculosis Incidence in Naples, 1996–2000

Most of the tuberculosis cases in Campania occur in Naples, the biggest city in the South of Italy with the highest unemployment and immigration rates. However, the occurrence of tuberculosis differs between the different neighbourhoods and it is not known whether these differences are associated with poverty or with immigration. We describe tuberculosis incidence and its association with socio-economic status and immigration in the city of Naples during the period 1996–2000. The basic design was an ecological study, correlating the incidence of tuberculosis which was calculated on the basis of notified tuberculosis cases to census data on immigration and socio-economic deprivation per neighbourhood. Immigrants had a high risk for tuberculosis (RR=34 for Africans) but the incidence of TB varied largely by districts and seemed independent of immigration. All socioeconomic factors increased the incidence of TB significantly. In a multivariate Poisson regression analysis only the rate of unemployment (p=0.02) and the population density (p=0.002) remained independently associated with tuberculosis incidence. In this study we showed that deprivation explained differences in tuberculosis incidence in Naples to a greater extent than immigration.     

Influenza D Virus in Cattle,France, 2011–2014

A new influenza virus, genus D, isolated in US pigs and cattle, has also been circulating in cattle in France. It was first identified there in 2011, and an increase was detected in 2014. The virus genome in France is 94%–99% identical to its US counterpart, which suggests intercontinental spillover.     

The Economic Impact for Farm Injury in Minnesota, 2004–2010

Only 2% of Minnesota’s employed population worked in agriculture between the years 2005 and 2012. However, this small portion of the state’s employed population accounted for 31% of total work-related deaths in the state during that same time period. During a similar time period, 2007–2013, the contribution of agriculture to Minnesota’s gross domestic product increased from approximately 1.5% to about 2.3%. This article describes the economic impact of injuries related to farm work between the years 2004 and 2010. Using hospital discharge data and the Census of Fatal Occupational Injuries (CFOI), estimates of the number of injuries and fatalities related to agricultural work were compiled. A cost of illness model was applied to these injury and fatality estimates to calculate the related indirect and direct costs in 2010 dollars. Estimated total costs, in 2010 dollars, ranged between $21 and $31 million annually over the 7-year study period. The majority of the costs were attributable to indirect costs, such as lost productivity at work and home. Fatal injuries accrued the largest proportion of the estimated costs followed by hospitalized and nonhospitalized injuries. A sensitivity analysis was performed to evaluate the impact each selected data source had upon the cost estimate. The magnitude of the costs associated with these injuries argues for better surveillance of injury related to agriculture to prioritize resources and evaluate intervention and prevention programs.     

Rates of admission for ambulatory care sensitive conditions in France in 2009–2010: trends,geographic variation,costs, and an international comparison

Background

Admissions for ambulatory care sensitive conditions (ACSCs) are considered preventable and indicators of poor access to primary care. We wondered whether per-capita rates of admission for ACSCs in France demonstrated geographic variation, were changing, were related to other independent variables, or were comparable to those in other countries; further, we wanted to quantify the resources such admissions consume.

Methods

We calculated per-capita rates of admission for five categories (chronic, acute, vaccination preventable, alcohol-related, and other) of ACSCs in 94 departments in mainland France in 2009 and 2010, examined measures and causes of geographic variation in those rates, computed the costs of those admissions, and compared rates of admission for ACSCs in France to those in several other countries.

Results

The highest ACSC admission rates generally occurred in the young and the old, but rates varied across French regions. Over the 2-year period, rates of most categories of ACSCs increased; higher ACSC admission rates were associated with lower incomes and a higher supply of hospital beds. We found that the local supply of general practitioners was inversely associated with rates of chronic and total ACSC admission rates, but that this relationship disappeared if we accounted for patients’ use of general practitioners in neighboring departments. ACSC admissions cost 4.755 billion euros in 2009 and 5.066 billion euros in 2010; they consumed 7.86 and 8.74 million bed days of care, respectively. France had higher rates of ACSC admissions than most other countries examined.

Conclusions

Because admissions for ACSCs are generally considered a failure of outpatient care, cost French taxpayers substantial monetary and hospital resources, and appear to occur more frequently in France than in other countries, policymakers should prioritize targeted efforts to reduce them.

     

Temporal Trends in Incidence and Mortality Rates for Colorectal Cancer by Tumor Location: 1975–2007

Objectives. We evaluated changes in colorectal cancer (CRC) incidence and mortality by anatomic site to assess the possible impact of CRC screening.Methods. Using data from 9 Surveillance, Epidemiology, and End Results cancer registries, we estimated trends in 1975–2007 CRC incidence and 1985–2007 incidence-based mortality. We evaluated trends separately for proximal and distal CRC, overall and by stage, tumor site, and race.Results. Between 1975 and 2007, 323 237 adults in the study area were diagnosed with CRC. For most tumor and population subgroups, incidence rates increased between 1975 and 1985 and subsequently declined markedly. Declines were most rapid between 1999 and 2007 and were greater for distal than proximal CRC. Declines in incidence were greater for White than Black adults and greatest for regional-stage disease. There was little difference in trends across subsites within the proximal and distal colorectum. Declines in incidence-based mortality mirrored those for incidence.Conclusions. Recent declines in CRC incidence and mortality are greater for distal than proximal CRC. Differing trends across populations may reflect variations in screening prevalence; distinct trends by tumor characteristics likely reflect differences in screening efficacy.Colorectal cancer (CRC) is the third most commonly diagnosed cancer and the second leading cause of cancer-related mortality in the United States.1 Recent reports indicate a decline in the burden associated with CRC in the United States on the basis of changes in incidence2–6 and mortality2–4 rates over time. However, such patterns of decline have been shown to differ across population groups and according to tumor characteristics.6–8 In particular, unequal declines in CRC mortality rates by race have resulted in increased racial disparities in CRC mortality,7 and observed declines in incidence rates have been more pronounced with respect to distant stage than local stage disease.6,8 The utilization of screening for CRC is likely a key contributing factor for these observed trends as well as for differences in trends across populations.4,9–17 However, the benefits of certain CRC screening modalities have been reported to differ for tumors arising in different sites in the colon and rectum.9–15,18,19 In particular, the sensitivity of fecal occult blood testing (FOBT) is higher for distal and rectal CRC than for CRC arising in the proximal colon,19 sigmoidoscopy does not allow visualization of the proximal colon, and there is some suggestion that colonoscopy of the entire large bowel is more strongly associated with a reduction in risk of incidence and mortality for distal than for proximal CRC.11,12,14 Thus, to the extent that screening is responsible for observed declines in CRC incidence and mortality, temporal trends in CRC may be expected to differ across populations and tumor subgroups.We have characterized temporal patterns of CRC incidence and incidence-based mortality (IBM) across anatomic locations and tumor stage and according to population characteristics, with the underlying goal of characterizing the impact that screening may have had on these rates.     

Trends in HIV Risk,Testing, and Treatment among MSM in Chicago 2004–2014: Implications for HIV Elimination Planning

Men who have sex with men (MSM) in the USA continue to have high rates of HIV infection. Increasingly, in addition to behavioral factors, biomedical interventions have been found to play important roles in HIV prevention. In this analysis, we used four waves of cross-sectional data (2004, 2008, 2011, and 2014) from the National HIV Behavioral Surveillance System (NHBS) to examine trends in key behaviors and biomedical interventions among MSM in Chicago (N = 3298). Logistic regression was used to determine changes in behaviors and use of biomedical interventions. Condomless sex increased significantly in waves 3 and 4, compared to wave 1: wave 3 (AOR = 2.07; 95% CI 1.53, 2.78) and wave 4 (AOR = 2.19; 95% CI 1.62, 2.96). Compared to those aged 18–24, older participants were significantly less likely to be routinely tested for HIV: 30–39 (AOR = 0.63; 95% CI 0.48, 0.83), 40–49 (AOR = 0.40; 95% CI 0.29, 0.55), and >50 (AOR = 0.28; 95% CI 0.18, 0.43). Awareness of both post-exposure prophylaxis (PEP)(?AOR = 3.13; 95% CI 1.22, 8.03) and pre-exposure prophylaxis (PrEP)(?AOR = 10.02; 95% CI 2.95, 34.01) increased significantly in wave 4, compared to wave 3. These results suggest a potential increase in HIV rates among men with main and casual partners and should be monitored closely as PrEP becomes more widespread among MSM of all races and ethnicities in Chicago. This study also suggests that further analyses of the barriers to PEP and PreP uptake among high-risk populations are necessary.     

Mortality trends in systemic sclerosis in France and USA, 1980–1998: an age-period-cohort analysis

We compared trends of Systemic Sclerosis (SS) mortality in France and the USA over the period 1980–1998 and used an Age-Period-Cohort (APC) model to adjust on the age at death of SS patients. All deaths coded with SS as an underlying primary or secondary cause in the national French and US mortality databases from 1980 to 1998 were included in the analysis. SS age-standardized mortality rates increased from 7.2 to 10.3/million in US women (+43%), and from 3 to 3.9/million in French women (+22%). Most of the increase occurred in senior women. In contrast, SS age-standardized death rates remained stable among US men (around 3/million) and French men (around 2/million). In US women, the APC analysis shows a growing cohort effect between 1900 and 1940, tending to stabilize for following cohorts. Similar findings were obtained to a lesser extent in French women. In conclusion, SS mortality rates increased by more than 40% between 1980 and 1998 in the USA, mostly in women born between 1900 and 1940. Whether these trends reflect rising incidence of SS need to be documented. The observed dissimilarity between genders and countries underline that environmental exposure and gender-related factors likely play a major etiological role. Stabilization in the following birth cohorts suggests that the increase of mortality observed since 1980 may slow down in the near future.     

Westward Spread of Echinococcus multilocularis in Foxes,France, 2005–2010

During 2005–2010, we investigated Echinococcus multilocularis infection within fox populations in a large area in France. The parasite is much more widely distributed than hitherto thought, spreading west, with a much higher prevalence than previously reported. The parasite also is present in the large conurbation of Paris.     

Changing mortality for motor neuron disease in France (1968–2007): an age-period-cohort analysis

The incidence and mortality of motor neuron disease (MND) increase with age and appear to have increased with time. The examination of period and cohort effects using age-period-cohort (APC) models can help characterize temporal trends. Our objective was to describe mortality from MND in France (1968–2007), and to examine the role of age, period of death, and birth-cohort on changes in mortality. The number of people who died from MND and population statistics (1968–2007) were extracted from French national records. Annual standardized (age/sex) mortality ratios (SMRs) were computed. Using Poisson regression, APC models examined the relationship between mortality rates and age, period of death, and birth-cohort in subjects aged 40–89 years. Deviance/degrees-of-freedom ratios evaluated model fit; ratios close to one indicated adequate fit. Between 1968 and 2007, 38,863 individuals died from MND (mortality rate = 1.74/100,000); 37,624 were aged 40–89 years. SMRs increased from 54 (95% CI = 49–59) in 1968 to 126 (120–132) in 2007. Male-to-female ratios declined from 1.80 in 1968 to 1.45 in 2007. Changing mortality rates were best explained by cohort effects (deviance/degrees-of-freedom = 1.09). The relative risk of dying from MND increased markedly for persons born between 1880 and 1920, and more slowly after 1920. In conclusion, mortality rates for MND increased between 1968 and 2007, and more rapidly in women than men. This increase was better explained by the birth-cohort of individuals than by period effects. Changing environmental exposures may be a possible explanation and these findings warrant the continued search for environmental risk factors for MND.