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Pugnet G.,University Paul Sabatier | Sailler L.,University Paul Sabatier | Bourrel R.,Caisse nationale dassurance maladie des travailleurs salaries | Montastruc J.-L.,University Paul Sabatier | Lapeyre-Mestre M.,University Paul Sabatier
Journal of Rheumatology | Year: 2015

Objective. To investigate the potential association between statin use and giant cell arteritis (GCA) course. Methods. Using the French National Health Insurance system, we included patients with incident GCA from the Midi-Pyrenees region, southern France, from January 2005 to December 2008 and randomly selected 6 controls matched by age, sex, and date of diagnosis. Statin exposure was compared between patients with GCA and their controls before GCA occurrence with a logistic regression. Influence of statin exposure on prednisone requirements during GCA course was explored with a Cox model, considering statin exposure as a time-varying variable. Results. The cohort included 103 patients (80 women, mean age 74.8 ± 9 yrs, mean followup 48.9 ± 14.8 mos), compared to 606 controls. Statin exposure (27.2% of patients with GCA and 23.4% of controls) was not associated with GCA occurrence (adjusted OR 1.2, 95% CI 0.76-1.96; p = 0.41). Diabetes mellitus was significantly associated to GCA occurrence (adjusted OR 0.38, 95% CI 0.11-0.72; p = 0.008). After diagnosis, exposure to statins up to 20 months was associated with maintenance while taking low prednisone doses (p = 0.01). Conclusion. Statin exposure was not associated with GCA occurrence in the general population. However, exposure to statins up to 20 months may favor a quicker corticosteroid tapering. Based on those results, statin effect on GCA course should not be definitively ruled out. © 2015. All rights reserved.

de Peretti C.,Institute of Veille Sanitaire | Nicolau J.,Institute of Veille Sanitaire | Tuppin P.,Caisse nationale dassurance maladie des travailleurs salaries | Schnitzler A.,Hopital Raymond Poincare | Woimant F.,Agence regionale de sante dile de France
Presse Medicale | Year: 2012

Objectives: The objectives of this study were to assess the main characteristics of acute and post-acute care for transient ischemic attack (TIA) and stroke, based on the French national hospitalization databases and their evolutions from 2007 through 2009. Methods: Hospitalizations with a main diagnosis of stroke were first selected in the 2007, 2008 and 2009 French hospital discharge databases (PMSI-MCO). They were then linked in the corresponding national databases of post-acute hospitalization records (PA), through the common anonymous patient number used in every hospitalization database. Results: In France, 138,601 acute hospitalizations were registered in 2009, 31,674 TIA and 106,927 strokes, of which 91% were in public hospitals. The mean length of stay was 6.4 days for TIA and 12.7 days for stroke. Stroke hospitalization in stroke unit increased from 9.7% in 2007 to 25.9% in 2009 and acute care in hospital having a stroke unit, from 22.9% to 47.4%. A third of stroke patients hospitalized in acute care in 2009 (and not deceased), were linked in the post-acute-care database: 10.4% were in rehabilitations facilities (RF) and 23.4%, in post-acute nursing facilities (PAN), versus respectively 7.5% and 24% in 2007. Discussion: French national hospitalization databases are exhaustive (acute care) or quasi-exhaustive (post-acute care) and can be linked with a good reliability. However, their validity depends on coding accuracy. In this respect, stroke unit hospitalization might be underreported. Conclusion: The French national hospital databases showed consistent improvements in stroke care in recent years. At the acute phase, there was an increase in stroke care in both stroke unit and hospital with stroke unit, due to the development of stroke care in France. Furthermore, the proportion of stroke patient discharged in rehabilitation facilities increased from 7.5% to 10.4%. © 2012 Elsevier Masson SAS.

Romon I.,Institute of Veille Sanitaire | Rey G.,French Institute of Health and Medical Research | Mandereau-Bruno L.,Institute of Veille Sanitaire | Weill A.,Caisse nationale dassurance maladie des travailleurs salaries | And 6 more authors.
Diabetic Medicine | Year: 2014

Aims: To compare the 5-year mortality (overall and cause-specific) of a cohort of adults pharmacologically treated for diabetes with that of the rest of the French adult population. Methods: In 2001, 10 000 adults treated for diabetes were randomly selected from the major French National Health Insurance System database. Vital status and causes of death were successfully extracted from the national registry for 9101 persons. We computed standardized mortality ratios. Results: Over 5 years, 1388 adults pharmacologically treated for diabetes died (15% of the cohort, 32.4/1000 person-years). An excess mortality, which decreased with age, was found for both genders [standardized mortality ratio 1.45 (1.37-1.52)]. Excess mortality was related to: hypertensive disease [2.90 (2.50-3.33)], ischaemic heart disease [2.19 (1.93-2.48)], cerebrovascular disease [1.76 (1.52-2.03)], renal failure [2.14 (1.77-2.56)], hepatic failure [2.17 (1.52-3.00)] in both genders and septicaemia among men [1.56 (1.15-2.09)]. An association was also found with cancer-related mortality: liver cancer in men [3.00 (2.10-4.15)]; pancreatic cancer in women [3.22 (1.94-5.03)]; colon/rectum cancer in both genders [1.66 (1.28-2.12)]. Excess mortality was not observed for breast, lung or stomach cancers. Conclusions: Adults pharmacologically treated for diabetes had a 45% increased risk of mortality at 5 years, mostly related to cardiovascular complications, emphasizing the need for further prevention. The increased risk of mortality from cancer raises questions about the relationship between cancer and diabetes and prompts the need for improved cancer screening in people with diabetes. What's new?: In this first mortality study of a French 5-year cohort of adults pharmacologically treated for diabetes, the 45% excess mortality related to diabetes is mostly attributable to cardiovascular complications and, to a lesser extent, renal failure. While the cardiovascular risk profile of people with diabetes has improved, further prevention is required. This study raises questions about the relationship between diabetes and cancer and highlights the need for screening for cancer in people with diabetes. © 2014 Diabetes UK.

Annequin M.,French Institute of Health and Medical Research | Annequin M.,Paris-Sorbonne University | Weill A.,Caisse nationale dassurance maladie des travailleurs salaries | Thomas F.,Center dInvestigations Preventives et Cliniques | And 2 more authors.
Annals of Epidemiology | Year: 2015

Purpose: Few studies examined the relationship between neighborhood characteristics and both depressive disorders and the corresponding mental health care use. The aim of our study was to investigate neighborhood effects on depressive symptomatology, antidepressant consumption, and the consultation of psychiatrists. Methods: Data from the French Residential Environment and Coronary heart Disease Study (n = 7290, 2007-2008, 30-79 years of age) were analyzed. Depressive symptomatology was cross-sectionally assessed. Health care reimbursement data allowed us to assess antidepressant consumption and psychiatric consultation prospectively more than 18 months. Multilevel logistic regression models were estimated. Results: The risk of depressive symptoms increased with decreasing personal educational level and unemployment and slightly with decreasing neighborhood income. In a sample comprising participants with and without depressive symptoms, high individual and parental educational levels were both associated with the consultation of psychiatrists. In this sample, a low personal educational level increased the odds of consumption of antidepressants. No heterogeneity between neighborhoods was found for antidepressant consumption. However, the odds of consulting psychiatrists increased with median neighborhood income and with the density of psychiatrists, after adjustment for individual characteristics. Among depressive participants only, a particularly strong gradient in the consultation of psychiatrists was documented according to individual socioeconomic status. Conclusions: Future research on the relationships between the environments and depression should take into account health care use related to depression and consider the spatial accessibility to mental health services among other environmental factors. © 2015 Elsevier Inc.

Brondeel R.,French Institute of Health and Medical Research | Brondeel R.,Paris-Sorbonne University | Weill A.,Caisse nationale dassurance maladie des travailleurs salaries | Thomas F.,Center dInvestigations Preventives et Cliniques | And 2 more authors.
Health and Place | Year: 2014

This study investigated the effect of spatial accessibility to healthcare services (HS) in residential and workplace neighbourhoods on the use of HS. Questionnaire data from the RECORD Study (2007-2008) were merged with administrative healthcare and geographic data. A novel method was developed to assess clustering of visits to HS around the residence/workplace. We found clustered use of HS around the workplace for few participants (11%). Commuting from suburbs to Paris and commuting distance were associated with a higher use of HS around the workplace. No associations were found between the spatial accessibility to and the use of HS. © 2014 Elsevier Ltd.

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