Intérêt de l’analyse des causes multiples dans l’étude de la mortalité aux grands âges : l’exemple français

En France, la plus grande part des décès se produit aux âges élevés et même très élevés. Le décès est alors souvent l’aboutissement d’un processus complexe qui met en jeu plusieurs affections. Or, la plupart des études traitant des profils ou des tendances de la mortalité par cause reposent uniquement sur la cause initiale du décès. L’objectif de cet article est d’étudier l’impact de la prise en compte des causes multiples (cause initiale, cause directe et causes associées) sur la caractérisation de la mortalité en France à 60 ans ou plus. Les trois causes de décès les plus fréquentes à ces âges (maladies cardio-vasculaires, tumeurs et maladies de l’appareil respiratoire) sont inchangées mais la méthode fait ressortir le poids d’autres pathologies, en particulier le diabète et les troubles mentaux. L’interprétation des associations constatées entre différentes causes est complexe car la multiplicité des combinaisons théoriquement possibles nous oblige à effectuer des regroupements. L’article propose une analyse approfondie pour les deux groupes de causes de décès les plus fréquentes : les maladies de l’appareil circulatoire et les tumeurs.In France, most deaths occur among the elderly and very elderly. Death is often the end result of a complex process involving a number of ailments. However, most studies dealing with cause-specific mortality profiles or trends are only based on the underlying cause of death. The aim of this article is to study the impact of considering multiple causes (the underlying cause, direct cause and contributing causes) on the characterization of mortality in France at age 60 and over. The three most frequent causes of death at these ages (cardiovascular illness, tumours and respiratory illness) remain unchanged, but the method brings out the importance of other disorders, particularly diabetes and mental illness. Interpretation of the associations observed between various causes is a complex process since we need to set up groupings in view of the multiple theoretically possible combinations. The article offers an in-depth analysis of two groups of the most frequent causes of death: circulatory system illness and tumours

Beneficial effect of adjusted sentences on recidivism in France: investigating the hidden role of the judge

Adjusted sentences may be considered as detrimental or favorable to former offenders' re-entry. According to the "labelling theory", alternative-to-incarceration sentences reduce recidivism because they are less stigmatizing than prison. The defenders of the "deterrence theory" consider that they are too soft to prevent people from reoffending. Results from the most recent study conducted in France, show that, after controlling for several characteristics of the former inmates, recidivism is significantly higher among those who had fully served a prison sentence than among those who benefited from an adjusted sentence. However, this does not prove a direct effect of these measures. Beneficiaries may be selected among offenders with lower risks of recidivism. Judges in charge of sentences execution also take into account the socioeconomic environment the inmates will find upon release. In this study, we use a cohort built by the French Ministry of Justice (6,869 inmates followed over 5 years after release) to further investigate this issue. The database includes the information on the court in charge of the inmate's execution of sentence. We use the inter-court disparity in granting adjusted sentences to capture part of the unobserved heterogeneity between inmates and examine how it impacts on the link with recidivism.Les aménagements de peine sont tantôt considérés comme favorables ou défavorables à la réinsertion. Selon la « théorie de l'étiquetage », les peines alternatives à la prison réduisent le risque de récidive parce qu'elles sont moins stigmatisantes. Les défenseurs de la « théorie de la dissuasion » estiment en revanche qu'elles ne sont pas assez dures pour dissuader de commettre une nouvelle infraction. L'étude la plus récente menée en France sur le sujet montre qu'une fois contrôlées plusieurs caractéristiques des anciens détenus, la récidive est significativement plus élevée chez ceux ayant effectué l'intégralité de leur peine en prison que chez ceux ayant bénéficié d'aménagements de peine. Ceci ne fait toutefois pas la preuve d'un effet direct de ces mesures. Ceux qui en bénéficient sont potentiellement sélectionnés parmi ceux ayant les meilleures chances de réinsertion. Les juges en charge de l'exécution des peines prennent aussi en compte l'environnement socio-économique que le détenu trouvera à sa sortie. Nous utilisons les données d'une cohorte constituée par le Ministère de la justice français (6 869 détenus suivis dans les 5 ans suivant leur libération) pour approfondir ces questions. Nous nous appuyons sur la disparité entre tribunaux de grande instance en termes de nombre d'aménagements de peine octroyés pour capter une partie de l'hétérogénéité non-observée entre individus et examiner comment cela modifie le lien avec la récidive

Revisiting the mortality of France and Italy with the multiple-cause-of-death approach

International audience; In this paper we revisit the mortality profiles of France and Italy in 2003 using the multiple-cause-of-death approach. The method leads to a substantial upward reassessment of the role played by certain conditions - e.g. diseases of the blood and diseases of the skin - in overall mortality. Regarding the associations of causes, we distinguish three patterns of pairwise joint occurrence of causes that are common to both countries. The numerous similarities that emerge from the comparison of the two countries are a positive signal of the reliability of the multiple-cause-of-death data

Frailty at death: An examination of multiple causes of death in four low mortality countries in 2017

Background: The increasing prevalence of frailty in ageing populations represents a major social and public health challenge which warrants a better understanding of the contribution of frailty to the morbid process. Objective: To examine frailty-related mortality as reported on death certificates in France, Italy, Spain, and the United States in 2017. Methods: We identify frailty at death for the population aged 50 years and over in France, Italy, Spain, and the United States. We estimate the proportions of deaths by sex, age group, and country using specific frailty-related ICD-codes on the death certificate, (1) as the underlying cause of death (UC), (2) elsewhere in Part I (sequence of diseases or conditions or events leading directly to death), and (3) anywhere in Part II (conditions that do not belong in Part I but whose presence contributed to death). Results: The age-standardized proportion of deaths with frailty at ages 50 and over is highest in Italy (25.0Š) followed by France (24.1Š) and Spain (17.3Š), and lowest in the United States (14.0Š). Cross-country differences are smaller when frailty-related codes are either the underlying cause of the death or reported in Part II. Frailty-related mortality increases with age and is higher among females than males. Dementia is the most frequently reported frailty-related code. Conclusions: Notable cross-country differences were found in the prevalence and type of frailty-related symptoms at death, even after adjusting for differential age distributions. Contribution: Strong similarities between countries were found that warrant monitoring frailty at death in low-mortality countries to complement information on frailty prevalence in the living population

Self-rated health of French prison inmates : does time spent behind bars matter?

In this paper, our aim is to evaluate the effect of imprisonment on the inmates’ self-rated health. Data are taken from the most recent nationally representative survey on disabilities in French prisons. We first compare the inmates’ self-rating with results obtained in the general population. Then, we examine the extent to which it varies according to time spent behind bars. We find that the prevalence of less-than-good self-rated health is more than twice higher among French inmates (36%) than in the general population of similar age, sex, and level of education. Both very short and long periods of imprisonment are associated with poorer self-rated health. So damaging effects of imprisonment on health seems to outweigh potential beneficial effects. Better living conditions in prisons would certainly contribute positively to improve inmates’ health. Our results also suggest that special attention should be paid to incoming prisoners

Le handicap en prison

Contribution aux actes du colloque du 20 janvier 2005 organisé à la Maison des sciences économiques

La prise en charge de la dépendance des personnes âgées en France

fait partie de "Politique sociales en France et en Russie", Dossiers et Recherches n°9