Frequency of low back pain among men and women aged 30 to 64 years in France. Results of two national surveys.

International audienceINTRODUCTION: In France, most studies of low back pain (LBP) have been carried out among workers or patients. Until very recently, the frequency of LBP in the general population was not known, because National Health Surveys did not include questions on LBP. OBJECTIVE: To estimate the prevalence of LBP in the French population aged 30 to 64 years. MATERIALS AND METHODS: The main data were from the National Health Survey 2002-2003 (n=14,248). LBP was assessed by an accompanying self-administered questionnaire asking details about duration of LBP in the previous 12 months. Weights were used to estimate the prevalence of LBP in the French population, with two definitions of LBP. Additional results dealing with chronic LBP, from another national survey (Handicap, Disability and Dependence), are also briefly presented. RESULTS: More than half of the French population in this age group experienced LBP at least one day in the previous 12 months (LBP1), with 17% experiencing LBP for more than 30 days in the previous 12 months (LBP30); prevalence differed between men and women and that of LBP30 increased with age. DISCUSSION-CONCLUSION: The prevalence of LBP as assessed by the National Health Survey is similar to that found in countries other than France. These estimates can be used as a reference for surveys in specific populations, provided that comparable methodologies are used

Low back pain around retirement age and physical occupational exposure during working life

<p>Abstract</p> <p>Background</p> <p>Physical occupational exposure is a risk factor for low back pain in workers but the long term effects of exposure remain unclear. As several countries consider increasing the retirement age, further information on this topic is relevant. This study aimed to describe the prevalence of low back pain among middle aged and aging individuals in the general French population according to physical occupational exposure and retirement status.</p> <p>Methods</p> <p>The study population originated from the French national survey 'Enquête décennale santé 2002'. Low back pain for more than 30 days within the previous twelve months (LBP) was assessed using a French version of the Nordic questionnaire. Occupational exposure was self assessed. Subjects were classified as "exposed" if they were currently or had previously been exposed to handling of heavy loads and/or to tiring postures. The weighted prevalence of LBP was computed separately for men and women, for active (aged 45-59) and retiree (aged 55-74), according to 5-year age group and past/present occupational exposure.</p> <p>Results</p> <p>For active men, the prevalence of LBP was significantly higher in those currently or previously exposed (n = 1051) compared with those never exposed (n = 1183), respectively over 20% versus less than 11%. Among retired men, the prevalence of LBP tended towards equivalence with increasing age among those previously exposed (n = 748) and those unexposed (n = 599).</p> <p>Patterns were quite similar for women with a higher prevalence in exposed active women (n = 741) compared to unexposed (n = 1260): around 25% versus 15%. Similarly, differences between previously exposed (n = 430) and unexposed (n = 489) retired women tended to reduce with age.</p> <p>Conclusion</p> <p>The prevalence of LBP in active workers was associated with occupational exposure. The link with past exposure among retirees decreased with age. These results should be considered for policies dealing with prevention at the workplace and retirement.</p

Socioeconomic inequalities in cause specific mortality among older people in France

<p>Abstract</p> <p>Background</p> <p>European comparative studies documented a clear North-South divide in socioeconomic inequalities with cancer being the most important contributor to inequalities in total mortality among middle aged men in Latin Europe (France, Spain, Portugal, Italy). The aim of this paper is to investigate educational inequalities in mortality by gender, age and causes of death in France, with a special emphasis on people aged 75 years and more.</p> <p>Methods</p> <p>We used data from a longitudinal population sample that includes 1% of the French population. Risk of death (total and cause specific) in the period 1990-1999 according to education was analysed using Cox regression models by age group (45-59, 60-74, and 75+). Inequalities were quantified using both relative (ratio) and absolute (difference) measures.</p> <p>Results</p> <p>Relative inequalities decreased with age but were still observed in the oldest age group. Absolute inequalities increased with age. This increase was particularly pronounced for cardiovascular diseases. The contribution of different causes of death to absolute inequalities in total mortality differed between age groups. In particular, the contribution of cancer deaths decreased substantially between the age groups 60-74 years and 75 years and more, both in men and in women.</p> <p>Conclusions</p> <p>This study suggests that the large contribution of cancer deaths to the excess mortality among low educated people that was observed among middle aged men in Latin Europe is not observed among French people aged 75 years and more. This should be confirmed among other Latin Europe countries.</p

Should we consider Dupuytren's contracture as work-related? A review and meta-analysis of an old debate

International audienceABSTRACT: BACKGROUND: In view of the conflicting opinions published, a meta-analysis was undertaken on epidemiological studies in order to assess any association between Dupuytren's contracture and work exposure. METHODS: Using the key words: "occupational disease", "work" and "Dupuytren contracture" without limitation on language or year of publication, epidemiological studies were selected from four databases (Pub-Med, Embase, Web of science, BDSP) after two rounds (valid control group, valid work exposure). A quality assessment list was constructed and used to isolate papers with high quality methodological criteria (scores of 13 or above, HQMC). Relevant associations between manual work, vibration exposure (at work) and Dupuytren's contracture were extracted from the articles and a metarisk calculated using the generic variance approach (meta-odds ratios, meta-OR). RESULTS: From 1951 to 2007, 14 epidemiological studies (including 2 cohort studies, 3 case-control studies, and 9 cross-sectional studies/ population surveys) were included. Two different results could be extracted from five studies (based on different types of exposure), leading to 19 results, 12 for manual work (9 studies), and 7 for vibration exposure (5 studies). Six studies met the HQMC, yielding 9 results, 5 for manual work and 4 for vibration exposure. Five studies found a dose-response relationship. The meta-OR for manual work was 2.02[1.57;2.60] (HQMC studies only: 2.01[1.51;2.66]), and the meta-OR for vibration exposure was 2.88 [1.36;6.07] (HQMC studies only: 2.14[1.59;2.88]). CONCLUSION: These results support the hypothesis of an association between high levels of work exposure (manual work and vibration exposure) and Dupuytren's contracture in certain cases

Job strain as a risk factor for clinical depression: systematic review and meta-analysis with additional individual participant data

Background Adverse psychosocial working environments characterized by job strain (the combination of high demands and low control at work) are associated with an increased risk of depressive symptoms among employees, but evidence on clinically diagnosed depression is scarce. We examined job strain as a risk factor for clinical depression. Methods We identified published cohort studies from a systematic literature search in PubMed and PsycNET and obtained 14 cohort studies with unpublished individuallevel data from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) consortium. Summary estimates of the association were obtained using random effects models. Individual-level data analyses were based on a pre-published study protocol (F1000Res 2013;2:233). Results We included 6 published studies with a total of 27 461 individuals and 914 incident cases of clinical depression. From unpublished datasets we included 120 221 individuals and 982 first episodes of hospital-treated clinical depression. Job strain was associated with an increased risk of clinical depression in both published (Relative Risk [RR]= 1.77, 95% confidence interval [CI] 1.47-2.13) and unpublished datasets (RR=1.27, 95% CI 1.04-1.55). Further individual participant analyses showed a similar association across sociodemographic subgroups and after excluding individuals with baseline somatic disease. The association was unchanged when excluding individuals with baseline depressive symptoms (RR=1.25, 95% CI: 0.94-1.65), but attenuated on adjustment for a continuous depressive symptoms score (RR=1.03, 95% CI: 0.81- 1.32). Conclusion Job strain may precipitate clinical depression among employees. Future intervention studies

Psychosocial work factors and first depressive episode: retrospective results from the French national SIP survey

International audienceObjectives : The objective was to explore the associations between psychosocial work factors and first depressive episode. Additional objectives included the study of the frequency and duration of exposure, and the evaluation of the induction period between exposures and outcome and of the reversibility of the effects.Methods : The study was based on a sample of 13,648 men and women from the 2006 national representative French SIP survey. Retrospective evaluation was performed for depressive episode for the whole life history, for psychological demands, skill discretion, social support, tension with the public, reward and work–life imbalance for each job, and within each job before and after each major change, and for time-varying covariates. The outcome was the first depressive episode. Statistical analysis was performed using weighted discrete time logistic regression model.Results : High psychological demands and low social support were risk factors for first depressive episode for both genders. The risk increased with the frequency of exposure to these factors. Associations were found with the frequency of exposure to tension with the public among women and to work–life imbalance among men. The risk increased with the duration of exposure to psychological demands and low social support for both genders, however, these associations become non-significant when recent exposure was taken into account. Past exposure older than 2 years was not associated with the outcome.Conclusion : Associations between psychosocial work factors and first depressive episode were observed, including dose–response associations. However, after removal of the exposure, the risk may be reduced after 2 years

Chronic back problems among persons 30 to 64 years old in France.

STUDY DESIGN: A national population-based survey focusing on disability. OBJECTIVE: To describe the frequency of chronic back conditions among those aged 30 to 64 years, the consequences on their daily lives, their employment status, and source of income. SUMMARY OF BACKGROUND DATA.: Descriptive data from community-based surveys are sparse. METHODS: In the French Handicap, Disability and Dependence survey, 1,289 subjects with chronic back problems were compared with the general population. RESULTS: The estimates for prevalence of chronic back problems were 7.9% for men (95% confidence interval, 7.2-8.5) and 7.5% for women (95% confidence interval, 7.0-8.1). Despite functional limitations, most people in France who had back problems were employed in a ordinary work: 71.5% among men (77.7% in the general population), 53.5% among women (60.2% in the general population). Among them, blue-collar workers were overrepresented. Of the subjects with back conditions, a very small proportion had a source of permanent income related to their health problems. CONCLUSIONS: The results from this national population-based survey emphasize the weight of chronic back problems in the community, in a country where the legislation offers few alternatives to ordinary work for those who suffer from chronic limitations due to low back pain

Changes in major depressive and generalized anxiety disorders in the national French working population between 2006 and 2010

International audienceBackground : This study aimed at assessing the changes in mental disorders in the French working population between 2006 and 2010, using nationally representative prospective data and a structured diagnostic interview for major depressive episode (MDE) and generalized anxiety disorder (GAD), and also at exploring the differential changes in mental disorders according to age, origin, occupation, public/private sector, self-employed/employee status and work contract.Methods : The data came from the prospective national representative Santé et Itinéraire Professionnel (SIP) survey, including a sample of 5600 French workers interviewed in 2006 and 2010. The Mini International Neuropsychiatric Interview (MINI) was used to measure MDE and GAD. Analyses were performed using weighted generalized estimation equations, and were stratified by gender.Results : No changes in MDE and GAD were observed for both genders among the working population. No differential changes were observed, except one: the prevalence of GAD increased among women working in the public sector while there was no change among women in the private sector.Limitations : Two data collections over a 4-year period may not capture the effects of the crisis on mental disorders properly.Conclusion : No changes in mental disorders between 2006 and 2010 were found but the increase in the prevalence of anxiety among women in the public sector may be of particular interest for prevention policies. High levels of social protection in France might contribute to explain these non-significant results

Educational inequalities in major depressive and generalized anxiety disorders: results from the French national SIP study

International audienceObjectives : Social inequalities in mental disorders have been reported; the lower the social position, the higher the prevalence of mental disorders. However, these inequalities have not always been observed and results may vary according to the indicator of social position, mental health outcome and population studied. The objective of this study was to examine the association between social position (educational level) and two mental disorders (major depressive disorder—MDD and general anxiety disorder—GAD), measured using a structured diagnostic interview (MINI), and to evaluate the contribution of work status in the explanation of this association.Methods : The study was based on a national representative sample of the French general population of 11,777 people including 8,072 workers. All analyses were done using weighted data. Bivariate Rao–Scott Chi-square tests were conducted, and multivariate analysis was performed using weighted logistic regression analysis with adjustment for age.Results : The prevalences of MDD/GAD and of less educated people were lower in the working population than in the non-working population. Educational inequalities were observed for MDD and GAD in the general population. Non-working status contributed to explain these inequalities by 23–28 % for MDD and by 23–37 % for GAD when the less educated group was considered. Non-working status was strongly associated with both disorders.Conclusion : These results may improve our knowledge on educational inequalities in mental health and help to understand the discrepancies in the literature. Effort to preserve jobs and facilitate the return to employment may help to reduce social inequalities in mental health

L'absentéisme pour raisons médicales à Electricité et Gaz de France : comparaison selon le sexe

Anne Chevalier, Jean-François Chastang, Claude Blanc: A Comparison of Maie and Female Medically Justified Absenteeism at Electricité et Gaz de France. Sickness absence at the French National Electricity and Gas Company was studied according to the sex of workers. Women are found to be more frequently absent from work than their maie colleagues. The proportion of absentees and the annual mean duration of absence per absent worker are higher among women than among men. Age, family status and salary, although important absence factors, do not explain the female excess of absence. More useful to the understanding of gender differences is the analysis of the medical causes of absence : they are different for men and women, probably because of real differences in disease incidence but also because of differences in attitudes towards health. Professional status and working conditions could be other factors playing a part in gender differences in sickness absence.Anne Chevalier, Jean-François Chasîang, Claude Blanc : L'absentéisme pour raisons médicales à Electricité et Gaz de France : comparaison selon le sexe. La comparaison selon le sexe de l'absentéisme pour raisons médicales des travailleurs d'EGF montre que les femmes interrompent leur travail en plus grand nombre et plus fréquemment que les hommes. La conséquence en est une durée annuelle d'absence plus importante. L'âge, la situation familiale et la catégorie hiérarchique des salariés, bien qu'importants facteurs d'absence, n'expliquent pas le sur-absentéisme féminin. L'analyse des causes médicales d'absence est plus intéressante : des pathologies différentes et une attitude autre vis-à-vis de la santé pourraient être à l'origine de l'excès d'absence des femmes. Leur statut professionnel et leurs conditions de travail viendraient renforcer le phénomène. L'arrêt de travail authentifié par un certificat médical apparaît ici comme un élément de la consommation médicale.Anne Chevalier, Jean-François Chastang, Claude Blanc : El ausentarse por razones médicas en Electricidad y Gas de Francia : comparación según el sexo. Las ausencias por razones médicas de los trabajadores de EDF, comparados los dos sexos, pone de relieve que las mujeres interrumpen su trabajo en número superior y con más frecuencia que los nombres. Como consecuencia, una duración anual de ausencia más importante. La edad, la situación familiar y la categoria jerárquica de las empleadas no explican las excesivas áusencias femeninas. El análisis de las causas médicas de ausencia rsulta más interesante : pudieran hallarse, al origen de las demasiadas ausencias femeninas, patologías diferentes y una actitud también diferente frente a la salud. Reforzarían el fenómeno su estatuto profesional así como sus condiciones de trabajo. Aparece aquí, el paro, hecho auténtico por un certificado médico, como un elemento del consumo médico.Chevalier Anne, Chastang Jean-François, Blanc Claude. L'absentéisme pour raisons médicales à Electricité et Gaz de France : comparaison selon le sexe. In: Sciences sociales et santé. Volume 5, n°3-4, 1987. Recherches en sante dans l'entreprise. L'exemple d'Électricité de France - Gaz de France. pp. 19-40