Aspects épidémiologiques des anomalies du métabolisme glucidique et du diabète de type 2 en Guadeloupe

Le diabète de type 2 est désormais qualifié d'épidémie mondiale par l'Organisation Mondiale de la Santé (OMS) et son association aux co-morbidités que sont l'hypertension artérielle et les dyslipidémies en font une cible prioritaire des actions de prévention des prochaines décennies. La Guadeloupe, archipel caribéen de plus de 422000 habitants, a une population multiethnique, composée d'individus afro-caribéens, indo-caribéens et caucasiens. La prévalence du diabète de type 2 y est de 6,6 % en population générale et de 22,5 % parmi les indo-caribéens soit respectivement 2 et 7 fois supérieure aux chiffres métropolitains. Les sujets diabétiques représentent par ailleurs près de 30 % des sujets dyalisés avec une mortalité 3 fois plus élevée que celle des sujets non diabétiques. Nos travaux sur le diabète sont présentés dans 4 études précédées chacune d'une revue de la littérature. L'association des paramètres anthropométriques (seuils définis par l'OMS) au diabète de type 2 a été étudiée afin de déterminer leur intérêt en pratique clinique dans une population d'âge moyen supérieur à 50 ans. La distribution du syndrome métabolique, impliqué dans la survenue du diabète de type 2 et des complications cardiovasculaires, a été abordée en comparant des sujets indo-caribéens à des sujets issus de la population générale. Dans une troisième étude, nous rapportons l'association de la pression artérielle pulsée, facteur de risque non traditionnel, aux complications cardiovasculaires chez les patients diabétiques en dialyse. Enfin, la place des anomalies glucidiques et lipidiques ainsi que le rôle des cytokines de l'inflammation (adiponectine et leptine) comme facteurs de risque de survenue d'une insulino-résistance ont été étudiés au sein d'une cohorte de patients infectés par le VIH.Type 2 diabetes is now qualified as a worldwide epidemic by the World Health Organization (WHO). The links of type 2 diabetes with co morbidities such as hypertension and dyslipidemia, focuse on the need of primary health care in the next decades. Guadeloupe is a French Carobbean archipelago with more than 422 000 inhabitants including people of Indian and African descents and Caucasians. Prevalence of type 2 diabetes reaches 6,6 % in general population compared to 22,5 % in subjects of Indian descents which are respectively 2 and 7 fold higher than in mainland France. Diabetic subjects represent about 30 % of patients on hemodialysis with a mortality rate 3 fold higher than non diabetic subjects. Our works are presented in four studies preceded by a review of the literature. The association between anthropometric parameters (WHO criteria) and type 2 diabetes was studied for potential use in clinical practice in a population with a mean age over 50 years old. The distribution of metabolic syndrome, involved in type 2 diabetes and cardiovascular complications, was studied by comparing subjects of Indian descents with subjects of the general population. We report in a third study, the association of arterial pulse pressure, a non-traditional risk factor, with cardiovascular complications in type 2 diabetic patients undergoing haemodialysis. We finally study, glucose metabolism abnormalities, dyslipidemia and proinflammatory cytokines (adiponectin and leptin), as risk factors for insulin resistance in an HIV infected cohort of patients.BORDEAUX2-BU Santé (330632101) / SudocSudocFranceF

Lymphomes malins non hodgkiniens et myélomes en Guadeloupe (répartition géographique, caractéristiques cliniques et survie des patients. Analyse des données du registre des cancers sur la période 2008-2010)

rLes lymphomes malins non Hodgkiniens (LMNH) et les myélomes multiples (MM) ont une incidence croissante dans le monde depuis 1975. Leur survenue est liée à des facteurs sociodémographiques, génétiques, cliniques et environnementaux. En Guadeloupe, ces hémopathies malignes sont au 4ème rang des cancers. Nous avons analysé les cas de MM et LMNH du registre des cancers de Guadeloupe sur la période 2008-2010. L étude a été rétrospective, observationnelle et pronostique de survie. Elle a porté sur la répartition géographique, la profession exercée, certaines caractéristiques clinico-biologiques et la survie des patients à 1 et 3 ans.Nous avons étudié 185 patients : 97 hommes et 88 femmes. La moyenne d âge était de 65 ans dans les deux sexes. L incidence, standardisée sur la population mondiale pour 100 000 personnes-année, était respectivement chez les hommes et les femmes, de 4,3 et 4,1 pour les MM et 7,2 et 6,2 pour les LMNH. Ces incidences sont moindres qu en France métropolitaine et aux Etats-Unis. La répartition des cas sur le territoire n était pas homogène, certaines zones étaient surreprésentées. La profession, renseignée pour 50% des cas, était représentée pour moitié par des agriculteurs et des ouvriers. Le type histologique de LMNH le plus fréquent était le lymphome à grandes cellules (36,5%). La médiane de survie, de 33,5 mois pour le MM et 20 mois pour les LMNH était globalement plus faible en Guadeloupe qu en Europe et aux Etats-Unis.Cette étude préliminaire doit être complétée d études étiologiques pour étayer l hypothèse d une distribution géographique de ces hémopathies en Guadeloupe.Non-Hodgkin's lymphoma (NHL) and multiple myeloma (MM) have an increasing incidence in the world since 1975. Their occurrence is related to socio-demographic, genetic, clinical and environmental factors. In Guadeloupe, these malignancies are the fourth most common cancer. We analyzed the cases of MM and NHL cancer registry of Guadeloupe during the 2008-2010 period. The study is retrospective, observational and prognostic of survival. It focuses on the geographic distribution, occupation, clinical and biological characteristics and patient 1 and 3 years survival. We studied 185 patients : 97 men and 88 women. The average age is 65 years for both sexes. The incidence, standardized to the world population for 100 000 person-years, was respectively in men and women, 4.3 and 4.1 for MM and 7.2 and 6.2 for the NHL. These incidences were smaller than France and United States. The distribution of cases in the territory was not uniform, some areas were overrepresented. Profession, entered for 50% of cases, was represented by half of farmers and workers. The histological type of NHL the most common was large cell lymphoma (36.5%). Survival median of 33.5 months for MM and 20 months for the NHL was generally lower in Guadeloupe than in Europe and United States. This preliminary study must be completed by etiological studies to support the hypothesis of a geographical distribution of these malignancies in Guadeloupe.ABYMES-CHRUPPA-BU (971202102) / SudocSudocFranceF

Geographical variations of cancer incidence in Guadeloupe, French West Indies

International audienceBACKGROUND: Geographical disparities in cancer incidence are observed at different scales and may highlight areas of high risk that need special attention to improve health policies. In Guadeloupe, a French archipelago in the Caribbean, environmental and socioeconomic factors are potential factors associated with cancer incidence. Our objective was to describe geographical variations of cancer incidence in Guadeloupe at a small-area level, in order to identify potential clusters.METHODS: We conducted spatial analyses for the 18 most frequent cancer sites, using data collected by the population-based cancer registry of Guadeloupe over the period 2008-2017. For each cancer sites, we used the Besag, York and Mollié model to estimate smoothed standardized incidence ratios (SIRs) at a sub-municipality level. In addition, we performed ascendant hierarchical clustering of these smoothed SIRs to describe the relationship between the different cancer sites and to identify geographical clusters.RESULTS: We observed geographical disparities with a spatial pattern that varied across cancer sites. Clustering of the smoothed SIRs showed aggregations between breast cancer and multiple myeloma, thyroid and stomach cancer, cervical and head and neck cancers, lung and rectal cancers, ovarian and endometrial cancers. Cluster analysis also identified six geographical clusters. Features of these clusters suggest alcohol consumption, exposure to pesticides, pollution generated by open landfills, and ethnicity as possible explanatory factors.DISCUSSION/CONCLUSION: Our study provided for the first time an extensive description of geographical disparities in cancer incidence in Guadeloupe, in a region where socioeconomic and environmental issues are major concerns. Although the identification of underlying factors was out of the scope of the present study, we highlighted areas of special interest and put forward some hypotheses that warrant to be further investigated in more in-depth analyses

Characteristics of invasive breast cancer and overall survival of patients eligible for mass breast cancer screening in Guadeloupe compared to those of the preceding age group

International audienceBackground: Mass breast cancer screening is offered to French women between the ages of 50 and 74. In the French overseas department of Guadeloupe, where the population is of mostly African ancestry, a low age at diagnosis of breast cancer has been reported, as for African-Americans. This raises the question of whether breast cancer is more aggressive in the age group preceding that eligible for mass screening (4049) in Guadeloupe. Methods: We compared the tumor-related prognostic factors, first line therapy and overall survival rates of breast cancer cases diagnosed between the 40-49 and 50-74 age groups, based on reports of the cancer registry of Guadeloupe for the period 2008-2013. Results: The characteristics studied, risk of death after breast cancer (HR 0.84 [95% CI: 0.58-1.22] and overall survival, did not differ significantly between the two groups, except for higher tumor size (28.8 vs 24.0; p = 0.004) in the younger group. Conclusion: These results do not show a pattern of more aggressive breast cancer in the age group preceding that eligible for mass screening in Guadeloupe. (C) 2017 Elsevier Ltd. All rights reserved

Characterization of potentially avoidable cases in a 1-year series of consecutive cesarean sections in the tertiary maternity unit of Guadeloupe (French West Indies)

International audienceAim The global increase in the rate of cesarean sections (CS) is currently an issue. We aimed to assess the rate of CS locally and to identify cases in which this procedure may have been avoidable. Methods In this prospective consecutive series, we analyzed the 478 CS carried out in our unit in 2009. We analyzed the characteristics of each case, and classified each as potentially avoidable or unavoidable. Results The total rate of CS was 24.0%, including 1.7% that was scored as potentially avoidable. Parity, gestational age at birth, birthweight, cases requiring cervical ripening, cases of labor induction, and CS during labor were all significantly higher or more frequent among potentially avoidable CS. Multivariate analysis indicated that the risk of potentially avoidable CS was positively associated with gestational age and tended to be negatively associated with parity. The main indications for potentially avoidable CS were cervical dystocia and abnormal fetal heart rate, and for unavoidable CS they were abnormal fetal heart rate and history of previous CS. Conclusion Labor, especially when induced, seems to be the key period for the prevention of ‘avoidable’ CS. This is particularly important given that potentially avoidable CS are more frequently associated with uncomplicated pregnancies than are unavoidable CS. A woman's first CS increases the likelihood of CS for subsequent deliveries, so the prevention of the first CS is a key aim for reducing the overall rate of C

Lung Cancer in the French West Indies: Role of Sugarcane Work and Other Occupational Exposures

International audienceOBJECTIVE: Our aim was to study the role of occupational exposures in lung cancer risk in the French West Indies, with special attention to some specific activities, such as sugarcane work, that can only be studied in a limited number of populations.METHODS: We used data from a population-based case-control study that included 147 incident lung cancer cases and 405 controls. Smoking histories and detailed occupational histories with descriptions of tasks and substances were collected by questionnaire during face-to-face interviews. Odds ratios (OR) adjusted for sex, age, region, smoking status, and cigarette pack-years and 95% confidence intervals (95% CI) were estimated by unconditional logistic regression.RESULTS: Significantly increased risks of lung cancer were found in sugarcane farm workers (OR = 2.7; 95% CI 1.1-6.6) and more generally in the sugarcane-growing sector (OR = 2.5; 95% CI 1.0-6.3) and to a lesser extent in rum production. Elevated risks of lung cancer were also observed among other agricultural workers, painters, warehouse porters, labourers, and maintenance and motor vehicle repair workers. Exposure to herbicides in sugarcane cultivation was associated with an increased risk of lung cancer (OR = 2.6; 95% CI 0.9-7.6).CONCLUSION: These results show that occupational exposures contributed to lung cancer risk in the French West Indies, and highlighted the role of exposures related to sugarcane work

Facteurs de risque professionnels et environnementaux des cancers du poumon aux Antilles françaises

National audienc