Inégalités sociales de mortalité au-delà de 65 ans. Le cas de la Belgique

RésuméLes inégalités sociales de mortalité au-delà de 65 ans sont une problématique importante dans le contexte actuel de vieillissement de la population, d’augmentation de l’espérance de vie et de politiques visant à augmenter l’âge légal de départ à la retraite. Cet article pose trois questions : les inégalités sociales face à la mort, très présentes aux âges actifs, se maintiennent-elles durant la vieillesse ? Comment ont-elles évolué au cours de ces dernières décennies ? Quel est le rôle de l’état de santé sur le différentiel social de mortalité aux âges élevés ? Nous utiliserons une base de données appariant les informations du Registre national (1991-2016) avec celles des recensements de la population de 1991, 2001 et 2011. Des tables de mortalité par groupe social et état de santé subjectif ont été calculées et nous aurons aussi recours à des modèles de régression logistique. Les résultats montrent qu’au-delà de 65 ans, les inégalités sociales face à la mort sont importantes et ont même augmenté aux cours des 25 dernières années. En contrôlant l’état de santé, des différences de mortalité subsistent entre les groupes sociaux mais varient en importance en fonction du gradient social. Les plus âgés doivent donc faire l’objet d’une attention particulière, non seulement parce qu’il s’agit d’une population intrinsèquement plus fragile mais aussi parce que leurs effectifs croissent. Il s’agit là d’un défi actuel et futur majeur de santé publique.AbstractSocial inequalities in mortality beyond the age of 65 are an important issue in the current context of population ageing, increased life expectancy and policies aimed at extending the legal retirement age. This article asks three questions: do social inequalities in the face of death, which are very present at working ages, continue in old age? How have they evolved over the last few decades? What is the role of health status on the social differential in mortality at advanced ages? We will use a database matching information from the National Register (1991-2016) with information from the 1991, 2001 and 2011 population censuses. Mortality tables by social group and subjective health status have been calculated. We also use logistic regression models. The results show that social inequalities in the face of death beyond the age of 65 are significant and have even increased over the last 25 years. Controlling for health status, mortality differences remain between social groups but vary in magnitude along the social gradient. The elderly therefore need specialattention, not only because they are an inherently more fragile population, but also because their numbers are increasing. This is a major current and future public health challenge.

Addiction

The primary aim of this study was to evaluate the impact of drug consumption rooms (DCRs) in France on injection equipment-sharing, while the secondary aims focused upon their impact on access to hepatitis C virus (HCV) testing and opioid agonist treatment (OAT). The COhort to identify Structural and INdividual factors associated with drug USe (COSINUS cohort) was a 12-month longitudinal study of 665 people who inject drugs (PWID), conducted in Bordeaux, Marseille, Paris and Strasbourg. We used data from face-to-face interviews at enrolment and at 6-month and 12-month visits. The participants were recruited in harm reduction programmes in Bordeaux and Marseille and in DCRs in Strasbourg and Paris. Participants were aged more than 18 years, French-speaking and had injected substances the month before enrolment. We measured the impact of DCR exposure on injection equipment sharing, HCV testing and the use of medications for opioid use disorder, after adjustment for significant correlates. We used a two-step Heckman mixed-effects probit model, which allowed us to take into account the correlation of repeated measures and to control for potential bias due to non-randomization between the two groups (DCR-exposed versus DCR-unexposed participants). The difference of declared injection equipment sharing between PWID exposed to DCRs versus non-exposed was 10% (1% for those exposed versus 11% for those non-exposed, marginal effect = -0.10; 95% confidence interval = -0.18, -0.03); there was no impact of DCRs on HCV testing and OAT. In the French context, drug consumption rooms appear to have a positive impact on at-risk practices for infectious diseases such as human immunodeficiency virus (HIV) and hepatitis C virus

Rapport sur le vieillissement dans la commune d’Ottignies-Louvain-laNeuve

L'objectif de ce rapport est de dresser le profil de la population âgée de 55 ans et plus résidant à Ottignies-Louvain-la-Neuve; de tracer les grands traits de son évolution future ; de connaître les raisons de ses choix résidentiels et les perspectives d’avenir (vie aux grands âges) sur place, à domicile ou en maison de repos, en distinguant les personnes arrivées à Louvain-la-Neuve dans les années 1970-1980 et qui ont vieilli sur place et les néo-louvanistes qui se sont installés dans la ville au moment de leur retraite. Compte tenu de l’évolution du coût des logements, ces deux populations ne partagent probablement pas les mêmes caractéristiques sociodémographiques et culturelles ; elles sont donc susceptibles d’avoir des positions différentes par rapport à l’évolution de la ville et à leurs besoins futurs. Il s’agira de poser un premier diagnostic de la situation prévalant à Louvain-la-Neuve afin d’identifier les forces et faiblesses de la ville, de mieux connaître la situation des aînés et d’appréhender le plus finement possible le jeu des relations intergénérationnelles qui lie les différentes populations de Louvainla-Neuve. Cette question constitue un enjeu essentiel pour Louvain-la Neuve. En effet, la ville se caractérise par une forte ‘répulsivité’2 migratoire des 30-50 ans entraînant un vide entre les générations fournies des 20-30 ans et celles de plus en plus nombreuses des aînés (Eggerickx et al., 2016). Dans ce contexte de raréfaction de cette « génération tampon », se pose les questions de l’aide informelle et intergénérationnelle de proximité et des sources de tensions potentielles entre ces générations « extrêmes » sur les plans démographique et peut-être culturel et socio-économique. Pour répondre à ces questions et apporter les premiers éléments de diagnostic, deux approches ont été menées. La première consistait à exploiter les données anonymisées du Registre national (1991-2015) couplées à celles des recensements (1991, 2001 et 2011) de manière à dresser un premier portrait de la population ; la seconde consistait à réaliser une enquête auprès de la population âgée de 55 ans et plus à Ottignies-Louvain-la-Neuve. Dans les deux cas, l’analyse a porté sur l’ensemble de la commune d’Ottignies-Louvain-la-Neuve dans la mesure où cela permettait d’avoir un point de comparaison pour situer la population de Louvain-la-Neuve. Ce travail a pu être réalisé grâce au soutien, pour l’étude démographique, de l’INESU et, pour l’enquête, du Legs Pierre De Merre et de la Commune d’Ottignies Louvain-la-Neuve, sous l’égide de la Fondation Louvain

Enquête «Radioscopie des 55 + vivant à Ottignies-Louvain-la-Neuve». Présentation des premiers résultats

Cette communication présente les premiers résultats de l'enquête pilote réalisée dans la communes d'Ottignies-Louvain-la-Neuve auprès de la population âgées de 55 ans et plu

Impact of COVID-19 Pandemic on Men Who Have Sex With Men That Practice Chemsex in France: Results From the National ERAS Web Survey

International audienceChemsex-the use of drugs in a sexual context-has been associated with more at-risk sexual practices and substancerelated complications in men who have sex with men (MSM). To date, no study has focused on the impact of France's first coronavirus disease 2019 (COVID-19)-related lockdown on the mental health and drug/alcohol use of MSM who practice chemsex. We implemented a web-based survey of 9,488 MSM living in France in June 2020 (after the country's first COVID-19 lockdown). Specifically, we first compared the subpopulation of MSM who self-reported practicing chemsex during their most recent sexual intercourse (defined as "chemsexers") with other MSM, using five outcomes: increased 1/tobacco use, 2/alcohol use, and 3/other psychoactive drug use. 4/using psychotropic medication during the lockdown, and finally 5/psychological distress. We then analyzed the outcomes' associations with the main explanatory variable "chemsexer," after adjusting for all relevant variables. Among 7,195 MSM who had sexual intercourse with a man during the previous 6 months, 359 participants (5%) were identified as "chemsexers." Multivariable analyses showed that during the first lockdown period, chemsexers were significantly more likely than non-chemsexers to have increased their use of tobacco, alcohol, and other psychoactive substances. Chemsexers were also more likely to have used psychotropic medication and to have experienced psychological distress during the previous month. Given the ongoing COVID-19 pandemic in France and worldwide, this finding highlights the need to develop psychosocial interventions and harm reduction services for MSM chemsexers, potentially via mobile health

Des pratiques à risque favorisant la survenue d'abcès cutanés chez les personnes qui injectent des substances : résultats de l’étude ANRS-OUTSIDER

International audienceIntroduction: Cutaneous abscesses are a common complication of intravenous substance use. Although these skin and soft tissue infections represent one of the main causes of emergency room visits and hospitalizations in people who inject drugs (PWID), data on their prevalence and causes are scarce. The present study was part of the larger ANRS-OUTSIDER project and aimed to study the factors associated with skin abscesses in PWID, focusing in particular on the different stages of injection.Method: Analyses were based on data of the 164 persons who regularly injected psychoactive substances participating in the French ANRS-OUTSIDER project. A face-to-face questionnaire collected data on sociodemographics, substance use, injection practices, and experience of skin abscesses in the previous six months. Factors associated with skin abscesses were studied using a logistic regression model.Results: Of the 140 participants for whom abscess data were recorded at inclusion, 35% reported having a skin abscess in the previous six months. Factors associated with skin abscesses were: benefiting from universal health coverage (PUMA/CMU/AME) (Odd ratio (OR) = 0.28, confidence interval (CI) à 95%=0.08-0.99), finding the vein to inject by touch (OR=3.44, 95% CI=1.41-8.43) and licking the needle before injection (OR=5.16, 95% CI=1.10-24.30).Conclusion: Our results highlight that skin abscesses were very frequent among the complications observed in our sample of French PWID, and that certain injection practices fostered their occurrence. These data will provide stakeholders with useful information to improve prevention and harm reduction messages for PWID.IntroductionLes abcès cutanés font partie des complications fréquentes liées à la consommation de substances psychoactives par voie intraveineuse. Bien que ces infections de la peau et des tissus mous représentent une des causes principales de passage aux urgences et d'hospitalisation des personnes qui injectent des substances (PQIS), les données concernant la prévalence et les causes de leur survenue sont rares. Cet article s'inscrit dans le cadre du projet ANRS-OUTSIDER et étudie les facteurs associés aux abcès cutanés auprès de PQIS en s'intéressant plus particulièrement aux différentes étapes de l'injection.MéthodesLes analyses ont été réalisées à partir des données d'inclusion de l’étude OUTSIDER menée en France auprès de 164 personnes s'injectant régulièrement des substances psychoactives. Un questionnaire passé par un enquêteur a permis de recueillir des données sociodémographiques, des données de consommation de substances, relatives aux pratiques d'injection et l'expérience d'abcès cutanés au cours des 6 derniers mois. Les facteurs associés à l'expérience d'abcès cutané ont été étudiés à l'aide d'un modèle de régression logistique.RésultatsSur les 140 participants pour lesquels des données sur les abcès étaient renseignées à l'inclusion, 35 % ont rapporté une expérience d'abcès cutané au cours des six derniers mois. Les facteurs associés à l'expérience d'abcès cutanés qui ont été identifiés sont : le fait de bénéficier de la couverture sociale universelle (PUMA/CMU/AME) (Odd ratio (OR) = 0,28, Intervalle de confiance (IC) à 95 %=0,08–0,99), la recherche de la veine à injecter au toucher (OR = 3,44, IC à 95% = 1,41–8,43) et le léchage de l'aiguille avant injection (OR = 5,16, IC à 95 % = 1,10–24,30).ConclusionCes résultats soulignent d'une part une fréquence importante des abcès cutanés parmi les complications observées chez les PQIS, d'autre part certaines pratiques lors de l'injection favorisent leur survenue. Ces données permettront d'apporter des informations pour améliorer les messages de prévention et de réduction des risques destinés au PQIS

Non-disclosure of drug injection practices as a barrier to HCV testing: results from the PrebupIV community-based research study

Abstract Background Hepatitis C virus (HCV) infection prevalence is particularly high in people who inject drugs (PWID), a population that faces many barriers to HCV testing and care. A better understanding of the determinants of access to HCV testing is needed to improve their engagement in the HCV care cascade. We used data from a cross-sectional survey of people who inject drugs, mainly opioids, to identify factors associated with recent HCV testing. Methods Self-reported data on HCV antibody testing were analyzed for 550 of the 557 PWID enrolled in PrebupIV, a French cross-sectional community-based survey which assessed PWID acceptability of injectable buprenorphine as a treatment. Factors associated with recent (i.e., in the previous six months) HCV antibody testing were identified performing multivariable logistic regression. Results Among the study sample, 79% were men and 31% reported recent HCV antibody testing. Multivariable analysis found that PWID who did not disclose their injection practices to anyone (aOR [95% CI] 0.31 [0.12,0.82], p = 0.018), older PWID (aOR [95% CI] 0.97 [0.95,1.00], p = 0.030) and employed respondents (aOR [95% CI] 0.58 [0.37,0.92], p = 0.019) were all less likely to report recent HCV testing. No association was found between opioid agonist therapy and HCV testing. Conclusions Our findings suggest that non-disclosure of injection practices, employment and age were all barriers to HCV antibody testing. Preventing stigma around injection practices, developing the HCV testing offer in primary care and addiction care services, and training healthcare providers in HCV care management could improve HCV testing and therefore, the HCV care cascade in PWID

Exclusive Therapeutic Use of Cannabis in a Large Sample of Daily Cannabis Users in France: A Cross-Sectional Survey

Many cannabis users report therapeutic benefits from cannabis consumption, even when not recommended by a physician. To date, few data on therapeutic users of cannabis in France are available. Using a cross-sectional survey held in 2020, we collected sociodemographic, health and substance use data from 4150 daily cannabis users in France. We used multivariable logistic regression to assess factors associated with exclusive therapeutic use of cannabis. Approximately 10% (n = 453) of the participants reported using cannabis exclusively for therapeutic purposes. Exclusive therapeutic users of cannabis differed from non-exclusive (i.e. recreational and mixed) users, especially regarding age (aOR [95%CI] = 1.01 [1.00-1.02]), employment (aOR = 0.61 [0.47-0.79]), urban area of residence (aOR = 0.75 [0.60-0.94]), physical (aOR = 2.95 [2.34-3.70]) and mental health condition (aOR = 2.63 [1.99-3.49]), mode of cannabis administration (non-smoked, aOR = 1.89 [1.22-2.95); smoked with little tobacco, aOR = 1.39 [1.09-1.76]), frequency of cannabis use (aOR = 1.04 [1.01-1.06]), home cultivation (aOR = 1.56 [1.13-2.15]), at-ridsk alcohol use (aOR = 0.68 [0.54-0.84]), and previous-month opiate use (aOR = 1.67 [1.22-2.30]). A greater understanding of the distinct profiles of regular cannabis users could inform harm reduction strategies and care access for this population. Further studies are needed to better understand the boundaries between therapeutic and recreational use

Changes in cannabis use and associated correlates during France’s first COVID-19 lockdown in daily cannabis users: results from a large community-based online survey

Background: Lockdown measures during the first wave of the COVID-19 pandemic in France led to serious public health concerns over people who use illicit drugs, especially in terms of mental health. We assessed changes in cannabis use during the first lockdown in France among daily cannabis users and associated correlates. Methods: CANNAVID is a French, national, cross-sectional web-based survey, conducted from 17 April to 11 May 2020. Daily cannabis users aged ≥ 18 years and living in France were invited to participate through advertisements. Respondents completed an ad hoc questionnaire on a dedicated online platform. We analyzed changes in cannabis use during the first lockdown (i.e., stopped, decreased, unchanged, or increased) and performed a multinomial logistic regression analysis to evaluate correlates of these changes. Results: Of the 4019 participants, 74.0% were men. Median age was 27 years (interquartile range: 22-37). With regard to cannabis use, 293 (7.3%) persons stopped, 1153 (28.7%) decreased, 1146 (28.5%) did not change, and 1427 (35.5%) increased their use during the lockdown. A multinomial logistic regression model revealed several sociodemographic, behavioral and health-related factors associated with changes in cannabis use. Compared with participants with an unchanged level of cannabis use during the lockdown, those who increased and those who stopped cannabis use were more likely to have increased tobacco and alcohol use and to have experienced depression and sleep disorders intensification. Those who stopped cannabis use were also more likely to have increased benzodiazepine use and to have experienced pain increase during lockdown. Conclusions: France's first COVID-19-related lockdown had a differential impact on daily cannabis users' consumption patterns. Most study respondents reported changes to their cannabis consumption pattern. Those who reported a stable cannabis use were more likely to report fewer negative changes. Specific interventions are needed for this population, as well as research to assess the long-term impacts of these changes