Caisse nationale dassurance maladie des travailleurs salaries

Le Touquet – Paris-Plage, France

Caisse nationale dassurance maladie des travailleurs salaries

Le Touquet – Paris-Plage, France
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PubMed | Institute lorrain du coeur et des vaisseaux Louis Mathieu and Caisse nationale dassurance maladie des travailleurs salaries
Type: Journal Article | Journal: Archives of cardiovascular diseases | Year: 2016

Cardiovascular diseases (CVDs) constitute the second leading cause of death in France. The Systme national dinformation interrgimes de lassurance maladie (SNIIRAM; national health insurance information system) can be used to estimate the national medical and economic burden of CVDs.To describe the rates, characteristics and expenditure of people reimbursed for CVDs in 2013.Among 57 million general health scheme beneficiaries (86% of the French population), people managed for CVDs were identified using algorithms based on hospital diagnoses either during the current year (acute phase) or over the previous 5 years (chronic phase) and long-term diseases. The reimbursed costs attributable to CVDs were estimated.A total of 3.5 million people (mean age, 71 years; 42% women) were reimbursed by the general health scheme for CVDs (standardized rate, 6.5%; coronary heart disease, 2.7%; arrhythmias/conduction disorders, 2.1%; stroke, 1.1%; heart failure, 1.1%). These frequencies increased with age and social deprivation, and were higher in Northern and Eastern France and Runion Island. The total sum reimbursed by all schemes for CVDs was 15.1 billion (50% for hospital care and 43% for outpatient care [including 15% for drugs and 12% for nurses/physiotherapists]); coronary heart disease accounted for 4 billion, stroke for 3.5 billion and heart failure for 2.5 billion (i.e. 10% of the total expenditure reimbursed by all national health insurance schemes for all conditions).CVDs constitute the leading group in terms of numbers of patients reimbursed and total reimbursed expenditure, despite a probable underestimation of both numbers and expenditure.


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.


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.


Arnaud L.,systemIC | Arnaud L.,Paris-Sorbonne University | Fagot J.-P.,Caisse Nationale dAssurance Maladie des Travailleurs Salaries | Mathian A.,systemIC | And 5 more authors.
Autoimmunity Reviews | Year: 2014

To date, only a small number of studies have examined the epidemiology of systemic lupus erythematosus (SLE) on a nation-wide basis. We used French national administrative databases to analyze the nation-wide prevalence and incidence rates of SLE within the largest French health insurance scheme, which covers 86% of the population (almost 58,200,000 individuals). Patients with SLE were identified if they had full coverage for a chronic disease with a code (ICD-10th M32) in the health insurance information system, or if they had a SLE code in the hospital discharge database as a primary or secondary diagnosis in 2010. We defined incident cases as patients who had a new long-term disease diagnosis of SLE in 2010. Overall, 27,369 individuals were identified as having SLE, of whom 88% were female. The crude 2010 prevalence of identified SLE was 47.0/100,000, and the WHO age-standardized rate was 40.8/100,000. The crude 2010 annual incidence of SLE was 3.32 cases per 100,000 with peaks in females aged 30-39. years old (9.11/100,000) and in males aged 50-59. years old (1.78/100,000). Major differences in regional age-standardized prevalence rates were observed, with the highest rates in the Caribbean oversea areas (up to 126.7/100,000), and the lowest rates in north-western metropolitan territories (down to 29.6/100,000). This is the largest nation-wide population-based study of SLE patients to date, based on more than 58 million beneficiaries of the French health insurance system. These data and subsequent analyses provide guidance to both clinicians and policymakers for improving care of SLE. © 2014 Elsevier B.V.


Tuppin P.,Caisse nationale dassurance maladie des travailleurs salaries | Choukroun S.,Caisse nationale dassurance maladie des travailleurs salaries | Samson S.,Caisse nationale dassurance maladie des travailleurs salaries | Weill A.,Caisse nationale dassurance maladie des travailleurs salaries | And 2 more authors.
Presse Medicale | Year: 2012

Aim: To measure the seasonal influenza vaccination coverage rate (VCR) in France in 2010, one year after the A(H1N1) influenza pandemic, and 2011 by age and target disease and to identify risk factors associated with a lack of vaccination in 2010 for those previously vaccinated in 2009. Methods: At the beginning of each vaccination campaign, the National Health Insurance, covering 86% of the French population, sends free influenza vaccination vouchers to at-risk beneficiaries aged under 65 suffering from diverse target diseases and to all individuals aged 65 and over (around 11.5 million). Results: The global VCR (50.4%), except people with asthma identified by drug refunds, decreased in 2010 compared with the previous three years when it was close to 60% (51.0% in 2011). For people under 65 years old, it fell from 40.3% in 2009 to 31.6% in 2010 (33.1% in 2011) and those aged 65 years and over from 63.3% to 53.8% (54.0% in 2011). The VCR of each target disease also decreased, especially for asthma, but not for HIV infection with campaign modification in 2010. It decreased among those aged 65 years and over with target disease (72.3% in 2009, 60.4% in 2010, 60.7% in 2011). Vaccination lack in 2010 was found to be associated with younger age, low number of drug deliveries and consultations with a general practitioner or a specialist, hospitalisation and the residence in a region of South of France or in overseas regions. Conclusion: An important decline of the VCR was observed in France since 2010 while the recommended VCR is 75%. Efforts must be led to improve the confidence of the insurant, especially towards the most fragile groups. © 2012 Elsevier Masson SAS.


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.


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.


Schnitzler A.,University of Versailles | Woimant F.,Agence Regionale de Sante dIle de France | Nicolau J.,Institute of Veille Sanitaire | Tuppin P.,Caisse Nationale dAssurance Maladie des Travailleurs Salaries | De Peretti C.,Institute of Veille Sanitaire
Neurorehabilitation and Neural Repair | Year: 2014

Background. In France in 2009, patients admitted to Multidisciplinary Inpatient Rehabilitation for stroke were sent to a neurological rehabilitation center (NRC) or a general or geriatric rehabilitation (GRC) service. Objective. To describe the functional outcome of stroke patients admitted for rehabilitation in France in 2009, both globally and as a function of the rehabilitation setting (GRC or NRC). Methods. Data from the French Hospital Discharge Diagnosis databases for 2009 were included. Two logistic regression models were used to analyze factors related to improvement in dependence score and discharge home. Odds ratios (ORs) were also calculated. Results. Among the 83 505 survivors of acute stroke in 2009, 28 201 were admitted for rehabilitation (33.8%). Of these, 19 553 went to GRC (69%) and 8648 to NRC (31%). On average, patients admitted to GRC were older (78.6 years vs 66.4 years), P <.001). At the start of rehabilitation, 50% of NRC patients and 56% of GRC patients were heavily dependent, but level of dependence was similar within each age-group. Rehabilitation in NRC lead to a greater probability of functional improvement (OR = 1.75, P <.001) and home discharge (OR = 1.61, P <.001) after adjustment for gender, age, Charlson's comorbidity index, initial level of dependence, type of stroke, and total length of stay. Conclusion. This study confirms, on a national level, the functional benefit of specialized rehabilitation in NRC. These results should be useful in the improvement of care pathways, organization of rehabilitation, and discharge planning. © 2013 The Author(s).


Schnitzler A.,University of Versailles | Woimant F.,Agence Regionale de Sante dIle de France | Tuppin P.,Caisse Nationale dAssurance Maladie des Travailleurs Salaries | De Peretti C.,Institute of Veille Sanitaire
PLoS ONE | Year: 2014

In France, the prevalence of stroke and the level of disability of stroke survivors are little known. The aim of this study was to evaluate functional limitations in adults at home and in institutions, with and without self-reported stroke. A survey named "the Disability Health survey" was carried out in people's homes (DHH) and in institutions (DHI). Medical history and functional level (activities-of-daily-living, ADL and instrumented-activities-of-daily-living IADL) were collected through interviews. The modified Rankin score (mRS) and the level of dependence and disability were compared between participants with and without stroke. 33896 subjects responded. The overall prevalence of stroke was 1.6% (CI95% [1.4%-1.7%]). The mRS was over 2 for 34.4% of participants with stroke (28.7% of participants at home and 87.8% of participants in institutions) versus respectively 3.9%, 3.1% and 71.6% without stroke. Difficulty washing was the most frequently reported ADL for those with stroke (30.6% versus 3% for those without stroke). Difficulty with ADL and IADL increased with age but the relative risk was higher below the age of 60 (17 to 25) than over 85 years (1.5 to 2.2), depending on the ADL. In the overall population, 22.6% of those confined to bed or chair reported a history of stroke. These results thus demonstrate a high national prevalence of stroke. Older people are highly dependent, irrespective of stroke history and the relative risk of dependence in young subjects with a history of stroke is high compared with those without. © 2014 Schnitzler et al.


PubMed | Caisse nationale dassurance maladie des travailleurs salaries
Type: | Journal: Revue d'epidemiologie et de sante publique | Year: 2017

To describe the state of health, through healthcare consumption and mortality, of people admitted to nursing homes (Ehpad) in France.People over the age of 65years admitted to an Ehpad institution during the first quarter of 2013, beneficiaries of the national health insurance general scheme (69% of the population of this age), were identified from the Resid-Ehpad database and their reimbursed health care was extracted from the SNIIRAM database, identifying 56disease groups by means of algorithms (long-term disease diagnoses and hospitalisations, medicinal products, specific procedures). Disease prevalences were compared to those of other beneficiaries by age- and sex-standardized morbidity/mortality ratios (SMR).A total of 25,534people were admitted (mean age: 86years, 71% women). Before admission, these people presented a marker for cardiovascular or neurovascular disease (48% of cases), dementia (34%), cancer (18%), and psychiatric disorders (14%). Compared to non-residents, new residents more frequently presented dementia (SMR=3-40 according to age and sex), psychiatric disorders (SMR=2.5-12, including psychotic disorders SMR=18-21 in the 65-74 year age-group), neurological disorders (SMR=2-12, including epilepsy SMR=14 in the 65-74 year age-group), and cardiovascular and neurovascular disease (SMR=1.2-3). Overall mortality in 2013 was 22%, with a maximum excess between the ages of 65-74years (males, SMR=8.8, females, SMR=15.9).Medical and administrative data derived from linking the Resid-Ehpad/Sniiram databases reveal a severely impaired state of health, considering healthcare use of institutionalized dependent elderly people, and a high prevalence of diseases responsible for severe dependence and excess mortality, especially among the younger residents.

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