Proportion of At-Risk Alcohol Consumers According to the New French Guidelines: Cross-Sectional Weighted Analyses From the CONSTANCES Cohort

Objective: To estimate the proportion of the participants of the French national population-based CONSTANCES cohort exceeding the new low-risk drinking guidelines according to sociodemographic and clinical factors.Methods: From 34,470 participants with follow-up data in 2019, among volunteers aged 18–69 years and invited to enroll in the CONSTANCES cohort in 2016 and 2017, weighted prevalence and odds ratios with 95% confidence intervals (CI) exceeding the guidelines using logistic regressions were presented stratified for age, gender, education, occupational grade, employment, income, marital status, pregnancy, work stress, depression, alcohol dependence, binge drinking, cannabis use, smoking status, e-cigarette use, cardiovascular diseases, and cancer.Results: The guidelines were exceeded more by men at 60.2% (95%CI: 59.3%–61.0%) than by women at 36.6% (95%CI: 35.9%–37.4%). Exceeding the guidelines increased with age, socioeconomic status, smoking, vaping, using cannabis, binge drinking, and alcohol dependence. Being depressed was associated with exceeding the guidelines in women. Even though pregnant women were less likely to exceed the guidelines, 7.6% (95%CI: 5.4%–10.6%) were at-risk drinkers.Conclusion: These findings highlight the need to implement effective prevention measures for at-risk alcohol use among the French population

Psychological factors and cardiometabolic risk : moderating effect of occupational inequalities

Un nombre croissant d’études suggèrent que le rôle des facteurs psychologiques dans le risque cardio-métabolique pourrait différer selon la position socio-économique des individus.Les travaux de cette thèse ont utilisé les données du Centre d'Investigations Préventives et Cliniques, de l'Etude Prospective Parisienne 3 et de la cohorte CONSTANCES pour examiner le rôle modérateur de la profession et catégorie socioprofessionnelle (PCS) sur les relations entre stress ou dépression et différents marqueurs du risque cardio-métabolique.Les résultats montrent que la PCS était un facteur modérateur de l'association du stress perçu avec la PA élevée chez les femmes (étude no 1), le diabète (étude no 2) et l'athérosclérose préclinique (étude no 3), de telle sorte que les individus des PCS les moins favorisées étaient les plus à risque. Cela semblait également être le cas pour l'association entre la dépression et le risque de maladie coronarienne à 10 ans chez les hommes (étude no 4).Ces résultats montrent l'importance de prendre systématiquement en compte le rôle modérateur des inégalités socioprofessionnelles dans la relation entre facteurs psychologiques et risque cardio-métabolique, aussi bien dans les études épidémiologiques pour mieux caractériser ce risque, qu’en santé publique et pratique clinique pour mieux le prévenir.A growing body of studies suggests that the association between psychological factors and cardiometabolic risk might depend upon individual's socio-economic status.Data of Centre d'Investigations Préventives et Cliniques, Paris Prospective Study 3 and CONSTANCES cohort were used to examine the moderating role of occupational status (OS) on the associations between stress or depression and cardiometabolic risk markers.OS was a moderating factor of the association between perceived stress and high blood pressure among women (study No. 1), diabetes(study No. 2) and subclinical atherosclerosis (study No. 3), with increased risk for the individuals of lower OS. Similar pattern of results were observed for the association between depression and 10-year coronary heart disease risk among men (study No. 4).These results highlight the importance to systematically take into account the moderating effect of occupational inequalities when examining the association between psychological factors and cardiometabolic risk in epidemiological studies to better characterize this risk but also in public health policies and clinical practice for a better prevention

Facteurs psychologiques et risque cardio-métabolique : rôle modérateur des inégalités socioprofessionnelles

A growing body of studies suggests that the association between psychological factors and cardiometabolic risk might depend upon individual's socio-economic status.Data of Centre d'Investigations Préventives et Cliniques, Paris Prospective Study 3 and CONSTANCES cohort were used to examine the moderating role of occupational status (OS) on the associations between stress or depression and cardiometabolic risk markers.OS was a moderating factor of the association between perceived stress and high blood pressure among women (study No. 1), diabetes(study No. 2) and subclinical atherosclerosis (study No. 3), with increased risk for the individuals of lower OS. Similar pattern of results were observed for the association between depression and 10-year coronary heart disease risk among men (study No. 4).These results highlight the importance to systematically take into account the moderating effect of occupational inequalities when examining the association between psychological factors and cardiometabolic risk in epidemiological studies to better characterize this risk but also in public health policies and clinical practice for a better prevention.Un nombre croissant d’études suggèrent que le rôle des facteurs psychologiques dans le risque cardio-métabolique pourrait différer selon la position socio-économique des individus.Les travaux de cette thèse ont utilisé les données du Centre d'Investigations Préventives et Cliniques, de l'Etude Prospective Parisienne 3 et de la cohorte CONSTANCES pour examiner le rôle modérateur de la profession et catégorie socioprofessionnelle (PCS) sur les relations entre stress ou dépression et différents marqueurs du risque cardio-métabolique.Les résultats montrent que la PCS était un facteur modérateur de l'association du stress perçu avec la PA élevée chez les femmes (étude no 1), le diabète (étude no 2) et l'athérosclérose préclinique (étude no 3), de telle sorte que les individus des PCS les moins favorisées étaient les plus à risque. Cela semblait également être le cas pour l'association entre la dépression et le risque de maladie coronarienne à 10 ans chez les hommes (étude no 4).Ces résultats montrent l'importance de prendre systématiquement en compte le rôle modérateur des inégalités socioprofessionnelles dans la relation entre facteurs psychologiques et risque cardio-métabolique, aussi bien dans les études épidémiologiques pour mieux caractériser ce risque, qu’en santé publique et pratique clinique pour mieux le prévenir

Facteurs psychologiques et risque cardio-métabolique : rôle modérateur des inégalités socioprofessionnelles

A growing body of studies suggests that the association between psychological factors and cardiometabolic risk might depend upon individual's socio-economic status.Data of Centre d'Investigations Préventives et Cliniques, Paris Prospective Study 3 and CONSTANCES cohort were used to examine the moderating role of occupational status (OS) on the associations between stress or depression and cardiometabolic risk markers.OS was a moderating factor of the association between perceived stress and high blood pressure among women (study No. 1), diabetes(study No. 2) and subclinical atherosclerosis (study No. 3), with increased risk for the individuals of lower OS. Similar pattern of results were observed for the association between depression and 10-year coronary heart disease risk among men (study No. 4).These results highlight the importance to systematically take into account the moderating effect of occupational inequalities when examining the association between psychological factors and cardiometabolic risk in epidemiological studies to better characterize this risk but also in public health policies and clinical practice for a better prevention.Un nombre croissant d’études suggèrent que le rôle des facteurs psychologiques dans le risque cardio-métabolique pourrait différer selon la position socio-économique des individus.Les travaux de cette thèse ont utilisé les données du Centre d'Investigations Préventives et Cliniques, de l'Etude Prospective Parisienne 3 et de la cohorte CONSTANCES pour examiner le rôle modérateur de la profession et catégorie socioprofessionnelle (PCS) sur les relations entre stress ou dépression et différents marqueurs du risque cardio-métabolique.Les résultats montrent que la PCS était un facteur modérateur de l'association du stress perçu avec la PA élevée chez les femmes (étude no 1), le diabète (étude no 2) et l'athérosclérose préclinique (étude no 3), de telle sorte que les individus des PCS les moins favorisées étaient les plus à risque. Cela semblait également être le cas pour l'association entre la dépression et le risque de maladie coronarienne à 10 ans chez les hommes (étude no 4).Ces résultats montrent l'importance de prendre systématiquement en compte le rôle modérateur des inégalités socioprofessionnelles dans la relation entre facteurs psychologiques et risque cardio-métabolique, aussi bien dans les études épidémiologiques pour mieux caractériser ce risque, qu’en santé publique et pratique clinique pour mieux le prévenir

How do men and women differ in their depressive symptomatology? A gendered network analysis of depressive symptoms in a French population-based cohort

International audienceBackground: The experience of depressive manifestations and the presentation of symptoms in clinical settings may differ in men and women. Despite the extensive literature, it remains unclear how depressive manifestations interact at symptom levels in men and women. First, we aimed to describe and compare depressive networks by sex. Second, we examined symptom connections to Clinical depression and Functional Limitations as a proxy of self-recognition of a depressive episode.Methods: We estimated networks from the 20 CES-D items in men and women from a large population-based French cohort. We computed centrality measures and ran comparisons. Then, we re-estimated two networks in men and women separately, adding, on the one hand, Clinical Depression and, on the other hand, Limitations due to a depressive episode.Results: Over 200,000 participants were included in this study. Women were twice as likely to have a previous diagnosis of depression. Sex-ratio was less pronounced (1,7:1) for Limitations due to depression. Centrality measures revealed similar symptom patterns. However, network structures differed between men and women. We found some symptom connections to Clinical depression and Limitations to be non-invariant according to sex.Limitations: Cross-sectional data does not capture the direction of the connections between symptoms and an eventual diagnosis. We lacked data about the diagnosis's context and could not account for other factors influencing depressive symptomatology.Conclusions: Network structures differed, suggesting gender-specific mechanisms in activating symptoms and depressive states. Addressing central symptoms evoking depressed moods with tailored interventions may serve to tackle depressive states in men and women

Liens entre le statut tabagique et la situation vis-à-vis de l’emploi : analyse transversale de la cohorte CONSTANCES

International audienceEstimer les prévalences d’usage de tabac en 2017 et en 2019 en population française couverte par le Régime Général d’Assurance Maladie en fonction du statut vis-à-vis de l’emploi. À partir d’un échantillon de 18 008 volontaires inclus en 2017 dans CONSTANCES, une cohorte nationale en population générale française ayant recruté de manière aléatoire des volontaires de 18-69 ans affiliés au Régime Général d’Assurance Maladie, les prévalences d’usage du tabac en fonction de du statut vis-à-vis de l’emploi ont été estimées en 2017 et en 2019 après correction pour les biais de sélection à l’inclusion et de non-réponse au suivi. En 2019, la prévalence du tabagisme était plus élevée chez les actifs inoccupés (29,2 % chez les hommes et 20,7 % chez les femmes) par rapport aux actifs occupés (16,5 % chez les hommes et 13,8 % chez les femmes). La prévalence du tabagisme la plus élevée concernait les personnes sans activité professionnelle pour raisons de santé (38,5 % chez les hommes et 35,8 % chez les femmes). Les fumeurs étaient plus à risque d’être actifs inoccupés comparativement aux non-fumeurs (OR 2,63 [95 % Intervalle de confiance [IC] : 1,79 ; 3,85] chez les hommes et OR 1,55 [95 % IC : 1,08 ; 2,22] chez les femmes). Chez les hommes, la prévalence d’actifs occupés parmi les petits fumeurs (<10 cigarettes/jour) a baissé entre 2017 (87,1 %) et 2019 (74,8 %). Ces analyses soulignent l’importance d’intensifier les campagnes de prévention sur le tabagisme parmi les actifs inoccupés et les inactifs, en particulier pour raisons de santé

Association of depressive symptoms and socioeconomic status in determination of blood pressure levels and hypertension: The CONSTANCES population based study

International audienceBackground: Inconsistent association between depression and hypertension has been highlighted. The association of depression with blood pressure (BP) might depend upon socioeconomic status (SES), but evidence remains weak.Objectives: This study aimed to examine how the associations between depressive symptoms and BP levels and hypertension and then, according to SES variables (education, income, occupational status).Methods: Among 66,478 volunteers of the French CONSTANCES cohort (31,093 men; mean age (standard deviation): 47.8 (12.9) years), depressive symptoms were assessed with the Center of Epidemiologic Studies Depression scale (CES-D). Overall associations between depressive symptoms and BP and hypertension were estimated using regressions and by stratifying on SES.Results: SES were associated with BP in both genders. CES-D score was negatively associated with systolic BP (SBP) in women (b=-0.62 95%CI [-1.03; -0.21] and in men (b=-1.03 95%CI [-1.45; -0.61]) but not with diastolic BP (DBP) in both genders. In women, the decrease in SBP and DBP was more pronounced as educational level increases (p for interaction: 0.012 and 0.013, respectively). In men, few interactions were observed between CES-D score and SES factors for BP levels. The association between CES-D score and hypertension was significant for men, OR=0.86, 95%CI [0.80; 0.93] but not for women, OR=1.03, 95%CI [0.96; 1.10]. No interactions were observed between CES-D score and SES for hypertension.Conclusion: Gender differences were observed for considering depressive symptoms according to SES factors for BP variation and hypertension. In women, educational level was the SES factor which has the main modifying effect on this association

Association between alexithymia and risk of incident cardiovascular diseases in the SUpplémentation en VItamines et Minéraux AntioXydants (SU.VI.MAX) cohort

International audienceObjective Although it has been suggested that alexythymia is associated with cardiovascular diseases, studies are scarce and a causal relationship is questionable. This study explored the prospective association between alexithymia and cardiovascular events in middle-aged participants without cardiovascular history at baseline. Methods The 26-item Toronto Alexithymia Scale (TAS-26) was completed by 5586 participants of the French SUpplementation en VItamines et Mineraux AntioXydants cohort (41.4% of men, M [SD] age = 52.2 [6.3] years) in 1996-1997. Covariates measured at baseline included age, occupational status, depressive symptoms, smoking status, body mass index, hypertension, diabetes, hypercholesterolemia, and hypertriglyceridemia. The follow-up ran from January 1, 1998, to the date of the first cardiovascular event, the date of death or September 1, 2007, whichever occurred first. Cardiovascular events were validated by an independent expert committee. Hazard ratios and 95% confidence intervals were computed with Cox regressions. Results During an average of 8.9 years of follow-up, 171 first cardiovascular events were validated. After adjustment for age, sex, and occupational status, there was no association between baseline alexithymia and cardiovascular events at follow-up (hazard ratio [95% confidence interval] for 15 points of TAS-26 = 1.00 [0.81-1.23], p > .99). Adjusting for all covariates, using binary TAS-26 cut-offs or TAS-26 subscores yielded similar nonsignificant results. Conclusions In this large prospective study, alexithymia and cardiovascular events were not associated among a nonclinical population. This casts some doubt on whether alexithymia could be a meaningful target in the prevention of cardiovascular diseases. Clinical Trial Registration Clinicaltrials.gov (NCT00272428)

Depression, treatable cardiovascular risk factors and incident cardiac events in the Gazel cohort

International audienceBackgroundDepression is an important risk factor of cardiovascular disease (CVD), a leading cause of death worldwide. One of the reasons underlying this association may be that depression modifies the association between treatable cardiovascular risk factors and cardiac events (angina pectoris or myocardial infarction). We tested this hypothesis in a cohort study of middle-aged men and women in France followed for 20 years.Methods10,541 Gazel working men and women free of cardiovascular disease at baseline (1993) were followed-up over 20 years for validated incident cardiac events. Depression was measured at baseline and every three years with the Center for Epidemiological Studies-Depression (CES-D). We used time-dependent Cox regression models to calculate hazard ratios (HR) of cardiac events associated with depression, main treatable cardiovascular risk factors (hypertension, diabetes, and dyslipidemia), and their interactions, adjusting for demographic, lifestyle and clinical characteristics.ResultsOver 20 years of follow-up, 592 incident cases of cardiac events were identified. Depression was significantly associated with incident cardiac events (HR 1.55, P = 0.002), as was hypertension (HR 1.49, P = 0.02), diabetes (HR 2.54, P = 0.001), and dyslipidemia (HR 1.55, P = 0.003). No statistically significant interactions were observed between depression and hypertension, diabetes or dyslipidemia in relation to incident cardiac events (all P ≥ 0.16).ConclusionsThe association between depression and cardiac events is unlikely to be explained by a heightened impact of hypertension, diabetes or dyslipidemia

Lifetime exposure to unemployment and prior working conditions are associated with retiree's health: A retrospective study in a large population-based French cohort

International audienceIt is unclear whether unemployment exposure, as well as working conditions, can have sustained effects on the health of retirees who are no longer exposed. The aim of the present study is to investigate this issue in 29,281 French retirees from the CONSTANCES cohort in whom the prevalence of suboptimal self-rated health, disability for routine tasks, cardiovascular diseases and cancers is assessed according to lifetime exposure to unemployment and prior working conditions. The analyses are performed retrospectively using multivariable logistic regression models with adjustment for potential confounders such as sex, birth year, parental histories of cardiovascular disease and cancer, social position, retirement age and duration. High lifetime exposure to unemployment is associated with an increased prevalence of suboptimal self-rated health (adjusted odds ratio (95% CI), 1.39 (1.23–1.57)), disability for routine tasks (1.41 (1.26–1.57)) and several cardiovascular diseases including stroke (1.66 (1.19–2.31)), myocardial infarction (1.65 (1.18–2.31)) and peripheral arterial disease (2.38 (1.46–3.90)). Bad prior working conditions are associated with an increased prevalence of disability for routine tasks (1.17 (1.04–1.33)) and cancers (1.27 (1.04–1.54)), notably prostate cancer (1.60 (1.01–2.64)). These findings suggest that unemployment and working conditions have long-term health effects that may cumulate over lifetime, emphasizing that risk evaluation and preventive strategies in retirees, as in workers, should take into account the life-course of individuals in addition to traditional risk factors