Suchergebnisse

Résumé De 1971 à 2003, six vagues de chaleur majeures ont été enregistrées en France métropolitaine, toutes accompagnées d'une forte surmortalité. Les causes médicales directement liées à la chaleur n'expliquent qu'une partie de cette surmortalité, et pratiquement toutes les causes médicales de décès sont en excès. Certaines populations s'avèrent plus particulièrement vulnérables, les personnes âgées et les sujets ayant certaines pathologies spécifiques. La mortalité est également corrélée aux variations quotidiennes « ordinaires » des températures estivales. Un modèle ajusté sur la période 1975-2003 a permis d'identifier des indicateurs de température très prédictifs de la mortalité quotidienne. Ce modèle a ensuite été utilisé pour prédire la mortalité au cours des étés 2004 à 2006 à partir des températures enregistrées pendant cette période ; il montre que si la canicule de juillet 2006 a bien été accompagnée d'une surmortalité importante, elle n'a cependant entraîné que le tiers de la surmortalité que l'on pouvait attendre. Il semble donc que la « vulnérabilité » de la population française à la vague de chaleur de juillet 2006 ait été sensiblement inférieure à ce qu'elle avait été au cours de la période 1975-2003. L'ensemble de ces observations souligne à la fois l'importance des risques de mortalité liés à la chaleur mais aussi la part majeure que peut jouer l'adaptation des populations face à ces risques, comme cela a probablement été le cas après la canicule de 2003.

Les enquêtes téléphoniques en population générale sont indispensables à la description des comportements de santé de la population. Nous avons testé la faisabilité de la demande de deux types de données identifiantes permettant des appariements à des données administratives et médico-administratives dans le Baromètre santé 2014 de Santé publique France : le NIR, numéro d'inscription au répertoire (dit de Sécurité sociale), et les coordonnées de naissance (CDN) comme les nom, prénom, date et lieu de naissance. Chacune était adressée à un sous-échantillon aléatoire de plus de 3000 répondants. L'étude ne portait pas sur la fourniture réelle de ces identifiants mais sur l'intention de le faire. Davantage de personnes accepteraient de communiquer leurs CDN plutôt que leur NIR (51,9 % vs 34,9 %). Les hommes accepteraient plus fréquemment ces propositions et il existe un gradient social au profit des plus diplômés et des cadres (NIR) ou des revenus élevés (NIR et CDN). Les personnes interrogées via un téléphone mobile acceptent moins souvent ces propositions, alors que c'est l'inverse pour celles déclarant des maladies chroniques ou des limitations fonctionnelles, sédentaires, buvant quotidiennement de l'alcool ou s'estimant en mauvaise santé. Les modalités pratiques restent à tester lors d'une prochaine enquête.

BACKGROUND: Monitoring the time course of mortality by cause is a key public health issue. However, several mortality data production changes may affect cause-specific time trends, thus altering the interpretation. This paper proposes a statistical method that detects abrupt changes ("jumps") and estimates correction factors that may be used for further analysis. METHODS: The method was applied to a subset of the AMIEHS (Avoidable Mortality in the European Union, toward better Indicators for the Effectiveness of Health Systems) project mortality database and considered for six European countries and 13 selected causes of deaths. For each country and cause of death, an automated jump detection method called Polydect was applied to the log mortality rate time series. The plausibility of a data production change associated with each detected jump was evaluated through literature search or feedback obtained from the national data producers.For each plausible jump position, the statistical significance of the between-age and between-gender jump amplitude heterogeneity was evaluated by means of a generalized additive regression model, and correction factors were deduced from the results. RESULTS: Forty-nine jumps were detected by the Polydect method from 1970 to 2005. Most of the detected jumps were found to be plausible. The age- and gender-specific amplitudes of the jumps were estimated when they were statistically heterogeneous, and they showed greater by-age heterogeneity than by-gender heterogeneity. CONCLUSION: The method presented in this paper was successfully applied to a large set of causes of death and countries. The method appears to be an alternative to bridge coding methods when the latter are not systematically implemented because they are time- and resource-consuming.

International audience ; Background Monitoring the time course of mortality by cause is a key public health issue. However, several mortality data production changes may affect cause-specific time trends, thus altering the interpretation. This paper proposes a statistical method that detects abrupt changes ("jumps") and estimates correction factors that may be used for further analysis. Methods The method was applied to a subset of the AMIEHS (Avoidable Mortality in the European Union, toward better Indicators for the Effectiveness of Health Systems) project mortality database and considered for six European countries and 13 selected causes of deaths. For each country and cause of death, an automated jump detection method called Polydect was applied to the log mortality rate time series. The plausibility of a data production change associated with each detected jump was evaluated through literature search or feedback obtained from the national data producers. For each plausible jump position, the statistical significance of the between-age and between-gender jump amplitude heterogeneity was evaluated by means of a generalized additive regression model, and correction factors were deduced from the results. Results Forty-nine jumps were detected by the Polydect method from 1970 to 2005. Most of the detected jumps were found to be plausible. The age- and gender-specific amplitudes of the jumps were estimated when they were statistically heterogeneous, and they showed greater by-age heterogeneity than by-gender heterogeneity. Conclusion The method presented in this paper was successfully applied to a large set of causes of death and countries. The method appears to be an alternative to bridge coding methods when the latter are not systematically implemented because they are time- and resource-consuming.

International audience ; Background Monitoring the time course of mortality by cause is a key public health issue. However, several mortality data production changes may affect cause-specific time trends, thus altering the interpretation. This paper proposes a statistical method that detects abrupt changes ("jumps") and estimates correction factors that may be used for further analysis. Methods The method was applied to a subset of the AMIEHS (Avoidable Mortality in the European Union, toward better Indicators for the Effectiveness of Health Systems) project mortality database and considered for six European countries and 13 selected causes of deaths. For each country and cause of death, an automated jump detection method called Polydect was applied to the log mortality rate time series. The plausibility of a data production change associated with each detected jump was evaluated through literature search or feedback obtained from the national data producers. For each plausible jump position, the statistical significance of the between-age and between-gender jump amplitude heterogeneity was evaluated by means of a generalized additive regression model, and correction factors were deduced from the results. Results Forty-nine jumps were detected by the Polydect method from 1970 to 2005. Most of the detected jumps were found to be plausible. The age- and gender-specific amplitudes of the jumps were estimated when they were statistically heterogeneous, and they showed greater by-age heterogeneity than by-gender heterogeneity. Conclusion The method presented in this paper was successfully applied to a large set of causes of death and countries. The method appears to be an alternative to bridge coding methods when the latter are not systematically implemented because they are time- and resource-consuming.

International audience ; Background Monitoring the time course of mortality by cause is a key public health issue. However, several mortality data production changes may affect cause-specific time trends, thus altering the interpretation. This paper proposes a statistical method that detects abrupt changes ("jumps") and estimates correction factors that may be used for further analysis. Methods The method was applied to a subset of the AMIEHS (Avoidable Mortality in the European Union, toward better Indicators for the Effectiveness of Health Systems) project mortality database and considered for six European countries and 13 selected causes of deaths. For each country and cause of death, an automated jump detection method called Polydect was applied to the log mortality rate time series. The plausibility of a data production change associated with each detected jump was evaluated through literature search or feedback obtained from the national data producers. For each plausible jump position, the statistical significance of the between-age and between-gender jump amplitude heterogeneity was evaluated by means of a generalized additive regression model, and correction factors were deduced from the results. Results Forty-nine jumps were detected by the Polydect method from 1970 to 2005. Most of the detected jumps were found to be plausible. The age- and gender-specific amplitudes of the jumps were estimated when they were statistically heterogeneous, and they showed greater by-age heterogeneity than by-gender heterogeneity. Conclusion The method presented in this paper was successfully applied to a large set of causes of death and countries. The method appears to be an alternative to bridge coding methods when the latter are not systematically implemented because they are time- and resource-consuming.

International audience ; Background Monitoring the time course of mortality by cause is a key public health issue. However, several mortality data production changes may affect cause-specific time trends, thus altering the interpretation. This paper proposes a statistical method that detects abrupt changes ("jumps") and estimates correction factors that may be used for further analysis. Methods The method was applied to a subset of the AMIEHS (Avoidable Mortality in the European Union, toward better Indicators for the Effectiveness of Health Systems) project mortality database and considered for six European countries and 13 selected causes of deaths. For each country and cause of death, an automated jump detection method called Polydect was applied to the log mortality rate time series. The plausibility of a data production change associated with each detected jump was evaluated through literature search or feedback obtained from the national data producers. For each plausible jump position, the statistical significance of the between-age and between-gender jump amplitude heterogeneity was evaluated by means of a generalized additive regression model, and correction factors were deduced from the results. Results Forty-nine jumps were detected by the Polydect method from 1970 to 2005. Most of the detected jumps were found to be plausible. The age- and gender-specific amplitudes of the jumps were estimated when they were statistically heterogeneous, and they showed greater by-age heterogeneity than by-gender heterogeneity. Conclusion The method presented in this paper was successfully applied to a large set of causes of death and countries. The method appears to be an alternative to bridge coding methods when the latter are not systematically implemented because they are time- and resource-consuming.

International audience ; Background: Whereas intense physical activity has been associated with deleterious effects on elite athletes' health, in particular due to cardiovascular anomalies, long-term follow-ups have suggested lower mortality rates among elite athletes. Causes of death for French Olympic athletes and female elite athletes have not been studied.Hypothesis/Purpose: We aimed to measure overall and disease-specific mortality of French female and male Olympians comparedwith the French general population. We hypothesize that Olympians, both women and men, have lower mortality rates.Study Design: Cohort study; Level of evidence, 3.Methods: French elite athletes (601 women and 1802 men) participating in summer or winter Olympic Games from 1948 to 2010had their vital status verified by national sources and were followed until 2013. Causes of death were obtained via the NationalDeath registry from 1968 to 2012. Overall and disease-specific mortalities of Olympians were compared with those of the Frenchgeneral population through standardized mortality ratios (SMRs) and 95% CIs. Olympians' observed and expected survivals wereillustrated by Kaplan-Meier curves.Results: At the endpoint of the study, 13 women and 222 men had died. Overall mortality in Olympians compared with that oftheir compatriots was 51% lower (SMR, 0.49; 95% CI, 0.26-0.85) among women and 49% lower (SMR, 0.51; 95% CI, 0.45-0.59) among men. Olympic athletes' survival is significantly superior to that of the French general population (women, P = .03;men, P\.001). According to the total deaths occurring from 1968 to 2012 (12 among women, 202 among men), female Olympiansdied from neoplasm (50.0%), external causes (33.3%), and cardiovascular diseases (16.6%). The main causes of deathamong men were related to neoplasms (36.1%), cardiovascular diseases (24.3%), and external causes (14.4%). Regarding themain causes of mortality among male Olympic athletes, the SMRs were as follows: 0.55 for neoplasms (95% CI, 0.43-0.69),0.55 for cardiovascular ...

International audience ; Background: Whereas intense physical activity has been associated with deleterious effects on elite athletes' health, in particular due to cardiovascular anomalies, long-term follow-ups have suggested lower mortality rates among elite athletes. Causes of death for French Olympic athletes and female elite athletes have not been studied.Hypothesis/Purpose: We aimed to measure overall and disease-specific mortality of French female and male Olympians comparedwith the French general population. We hypothesize that Olympians, both women and men, have lower mortality rates.Study Design: Cohort study; Level of evidence, 3.Methods: French elite athletes (601 women and 1802 men) participating in summer or winter Olympic Games from 1948 to 2010had their vital status verified by national sources and were followed until 2013. Causes of death were obtained via the NationalDeath registry from 1968 to 2012. Overall and disease-specific mortalities of Olympians were compared with those of the Frenchgeneral population through standardized mortality ratios (SMRs) and 95% CIs. Olympians' observed and expected survivals wereillustrated by Kaplan-Meier curves.Results: At the endpoint of the study, 13 women and 222 men had died. Overall mortality in Olympians compared with that oftheir compatriots was 51% lower (SMR, 0.49; 95% CI, 0.26-0.85) among women and 49% lower (SMR, 0.51; 95% CI, 0.45-0.59) among men. Olympic athletes' survival is significantly superior to that of the French general population (women, P = .03;men, P\.001). According to the total deaths occurring from 1968 to 2012 (12 among women, 202 among men), female Olympiansdied from neoplasm (50.0%), external causes (33.3%), and cardiovascular diseases (16.6%). The main causes of deathamong men were related to neoplasms (36.1%), cardiovascular diseases (24.3%), and external causes (14.4%). Regarding themain causes of mortality among male Olympic athletes, the SMRs were as follows: 0.55 for neoplasms (95% CI, 0.43-0.69),0.55 for cardiovascular ...

International audience ; Background: Whereas intense physical activity has been associated with deleterious effects on elite athletes' health, in particular due to cardiovascular anomalies, long-term follow-ups have suggested lower mortality rates among elite athletes. Causes of death for French Olympic athletes and female elite athletes have not been studied.Hypothesis/Purpose: We aimed to measure overall and disease-specific mortality of French female and male Olympians comparedwith the French general population. We hypothesize that Olympians, both women and men, have lower mortality rates.Study Design: Cohort study; Level of evidence, 3.Methods: French elite athletes (601 women and 1802 men) participating in summer or winter Olympic Games from 1948 to 2010had their vital status verified by national sources and were followed until 2013. Causes of death were obtained via the NationalDeath registry from 1968 to 2012. Overall and disease-specific mortalities of Olympians were compared with those of the Frenchgeneral population through standardized mortality ratios (SMRs) and 95% CIs. Olympians' observed and expected survivals wereillustrated by Kaplan-Meier curves.Results: At the endpoint of the study, 13 women and 222 men had died. Overall mortality in Olympians compared with that oftheir compatriots was 51% lower (SMR, 0.49; 95% CI, 0.26-0.85) among women and 49% lower (SMR, 0.51; 95% CI, 0.45-0.59) among men. Olympic athletes' survival is significantly superior to that of the French general population (women, P = .03;men, P\.001). According to the total deaths occurring from 1968 to 2012 (12 among women, 202 among men), female Olympiansdied from neoplasm (50.0%), external causes (33.3%), and cardiovascular diseases (16.6%). The main causes of deathamong men were related to neoplasms (36.1%), cardiovascular diseases (24.3%), and external causes (14.4%). Regarding themain causes of mortality among male Olympic athletes, the SMRs were as follows: 0.55 for neoplasms (95% CI, 0.43-0.69),0.55 for cardiovascular ...

International audience ; Background: Whereas intense physical activity has been associated with deleterious effects on elite athletes' health, in particular due to cardiovascular anomalies, long-term follow-ups have suggested lower mortality rates among elite athletes. Causes of death for French Olympic athletes and female elite athletes have not been studied.Hypothesis/Purpose: We aimed to measure overall and disease-specific mortality of French female and male Olympians comparedwith the French general population. We hypothesize that Olympians, both women and men, have lower mortality rates.Study Design: Cohort study; Level of evidence, 3.Methods: French elite athletes (601 women and 1802 men) participating in summer or winter Olympic Games from 1948 to 2010had their vital status verified by national sources and were followed until 2013. Causes of death were obtained via the NationalDeath registry from 1968 to 2012. Overall and disease-specific mortalities of Olympians were compared with those of the Frenchgeneral population through standardized mortality ratios (SMRs) and 95% CIs. Olympians' observed and expected survivals wereillustrated by Kaplan-Meier curves.Results: At the endpoint of the study, 13 women and 222 men had died. Overall mortality in Olympians compared with that oftheir compatriots was 51% lower (SMR, 0.49; 95% CI, 0.26-0.85) among women and 49% lower (SMR, 0.51; 95% CI, 0.45-0.59) among men. Olympic athletes' survival is significantly superior to that of the French general population (women, P = .03;men, P\.001). According to the total deaths occurring from 1968 to 2012 (12 among women, 202 among men), female Olympiansdied from neoplasm (50.0%), external causes (33.3%), and cardiovascular diseases (16.6%). The main causes of deathamong men were related to neoplasms (36.1%), cardiovascular diseases (24.3%), and external causes (14.4%). Regarding themain causes of mortality among male Olympic athletes, the SMRs were as follows: 0.55 for neoplasms (95% CI, 0.43-0.69),0.55 for cardiovascular diseases (95% CI, 0.41-0.73), and 0.66 for external causes (95% CI, 0.44-0.94).Conclusion: French Olympians live longer than their compatriots: A lower overall mortality of similar magnitude is observedamong male and female athletes compared with the general population. The main causes of death in French Olympians are neoplasms, cardiovascular diseases, and external causes.

International audience ; Background: Whereas intense physical activity has been associated with deleterious effects on elite athletes' health, in particular due to cardiovascular anomalies, long-term follow-ups have suggested lower mortality rates among elite athletes. Causes of death for French Olympic athletes and female elite athletes have not been studied.Hypothesis/Purpose: We aimed to measure overall and disease-specific mortality of French female and male Olympians comparedwith the French general population. We hypothesize that Olympians, both women and men, have lower mortality rates.Study Design: Cohort study; Level of evidence, 3.Methods: French elite athletes (601 women and 1802 men) participating in summer or winter Olympic Games from 1948 to 2010had their vital status verified by national sources and were followed until 2013. Causes of death were obtained via the NationalDeath registry from 1968 to 2012. Overall and disease-specific mortalities of Olympians were compared with those of the Frenchgeneral population through standardized mortality ratios (SMRs) and 95% CIs. Olympians' observed and expected survivals wereillustrated by Kaplan-Meier curves.Results: At the endpoint of the study, 13 women and 222 men had died. Overall mortality in Olympians compared with that oftheir compatriots was 51% lower (SMR, 0.49; 95% CI, 0.26-0.85) among women and 49% lower (SMR, 0.51; 95% CI, 0.45-0.59) among men. Olympic athletes' survival is significantly superior to that of the French general population (women, P = .03;men, P\.001). According to the total deaths occurring from 1968 to 2012 (12 among women, 202 among men), female Olympiansdied from neoplasm (50.0%), external causes (33.3%), and cardiovascular diseases (16.6%). The main causes of deathamong men were related to neoplasms (36.1%), cardiovascular diseases (24.3%), and external causes (14.4%). Regarding themain causes of mortality among male Olympic athletes, the SMRs were as follows: 0.55 for neoplasms (95% CI, 0.43-0.69),0.55 for cardiovascular ...