The CONSTANCES cohort: an open epidemiological laboratory

<p>Abstract</p> <p>Background</p> <p>Prospective cohorts represent an essential design for epidemiological studies and allow for the study of the combined effects of lifestyle, environment, genetic predisposition, and other risk factors on a large variety of disease endpoints. The CONSTANCES cohort is intended to provide public health information and to serve as an "open epidemiologic laboratory" accessible to the epidemiologic research community. Although designed as a "general-purpose" cohort with very broad coverage, it will particularly focus on occupational and social determinants of health, and on aging.</p> <p>Methods/Design</p> <p>The CONSTANCES cohort is designed as a randomly selected representative sample of French adults aged 18-69 years at inception; 200,000 subjects will be included over a five-year period. At inclusion, the selected subjects will be invited to fill a questionnaire and to attend a Health Screening Center (HSC) for a comprehensive health examination: weight, height, blood pressure, electrocardiogram, vision, auditory, spirometry, and biological parameters; for those aged 45 years and older, a specific work-up of functional, physical, and cognitive capacities will be performed. A biobank will be set up. The follow-up includes a yearly self-administered questionnaire, and a periodic visit to an HSC. Social and work-related events and health data will be collected from the French national retirement, health and death databases. The data that will be collected include social and demographic characteristics, socioeconomic status, life events, behaviors, and occupational factors. The health data will cover a wide spectrum: self-reported health scales, reported prevalent and incident diseases, long-term chronic diseases and hospitalizations, sick-leaves, handicaps, limitations, disabilities and injuries, healthcare utilization and services provided, and causes of death.</p> <p>To take into account non-participation at inclusion and attrition throughout the longitudinal follow-up, a cohort of non-participants will be set up and followed through the same national databases as participants.</p> <p>A field-pilot was performed in 2010 in seven HSCs, which included about 3,500 subjects; it showed a satisfactory structure of the sample and a good validity of the collected data.</p> <p>Discussion</p> <p>The constitution of the full eligible sample is planned during the last trimester of 2010, and the cohort will be launched at the beginning of 2011.</p

LA COHORTE CONSTANCES : UNE INFRASTRUCTURE POUR LA RECHERCHE ET LA SANTÉ PUBLIQUE

International audienceINTRODUCTION – CONSTANCES is a very large “generalist” population-based cohort designed for health research and for providing public health information.MATERIAL-METHODS – The cohort is composed of a representative sample of the French population aged 18-69 years; the expected total size is 200,000 subjects. The inclusion of participants takes place in a health examination center of the insurance scheme, where they receive a medical examination and complete a questionnaire about their health, their lifestyle and occupational history. A biobank (blood and urine) is constituted. The follow-up includes an annual self-administered questionnaire, a medical examination every five years, and the linkage to the SNIIRAM (national inter-scheme health insurance information system), the CNAV (National Old-Age Insurance Fund) and CépiDc (System for Automated Coding of Causes of Death) databases. The data collected from these sources are related to health, socio-professional characteristics, care seeking, biological, physiological, physical and cognitive parameters. Quality control and validation of health events are performed. Consideration of selection effects is based on a random sample of non-participants.ADVANCEMENT – Currently (October 2016), more than 115,000 participants were included in the cohort, and about 3,000 new volunteers are included each month. More than 60 projects on various topics were positively assessed by the cohort International Scientific Council. Public-private partnerships have also been established, as planned in the context of the financing of CONSTANCES by “Investments in the future”.Introduction-Constances est une cohorte « généraliste » de très grande taille en population destinée à la recherche en santé et à fournir des informations à visée de santé publique. Matériel-méthodes-La cohorte est composée d'un échantillon visant à la représentativité de la population française âgée de 18 à 69 ans ; l'effectif total prévu est de 200 000 sujets. L'inclusion des participants a lieu dans les Centres d'examens de santé (CES) de la Sécurité sociale, où ils bénéficient d'un examen médical et complètent un questionnaire concernant leur santé, leurs modes de vie et un historique professionnel. Une biobanque (sang et urine) est constituée. Le suivi se fait par auto-questionnaire annuel, examen médical tous les cinq ans et par appariement aux bases de données du Sniiram (Système national d'information inter-régimes de l'Assurance maladie), de la Cnav (Caisse nationale d'assurance vieillesse) et du CépiDc-Inserm (Centre d'épidémio logie sur les causes médicales de décès). Les données recueillies à ces différentes sources concernent la santé, les caractéristiques socioprofessionnelles, le recours aux soins, des paramètres biologiques, physiologiques, physiques et cognitifs. Un contrôle de qualité et une validation des événements de santé ont été mis en place. La prise en compte des effets de sélection s'appuie sur un échantillon aléatoire de non-participants. État d'avancement-Actuellement (octobre 2016), plus de 115 000 participants ont été inclus dans la cohorte et environ 3 000 nouveaux volontaires sont inclus chaque mois. Plus de 60 projets portant sur des thèmes diversifiés ont été évalués positivement par le Conseil scientifique international de la cohorte. Des partenariats publicprivé ont également été mis en place, comme cela est prévu dans le cadre du financement de Constances par les Investissements d'avenir

LA COHORTE CONSTANCES : UNE INFRASTRUCTURE POUR LA RECHERCHE ET LA SANTÉ PUBLIQUE

International audienceINTRODUCTION – CONSTANCES is a very large “generalist” population-based cohort designed for health research and for providing public health information.MATERIAL-METHODS – The cohort is composed of a representative sample of the French population aged 18-69 years; the expected total size is 200,000 subjects. The inclusion of participants takes place in a health examination center of the insurance scheme, where they receive a medical examination and complete a questionnaire about their health, their lifestyle and occupational history. A biobank (blood and urine) is constituted. The follow-up includes an annual self-administered questionnaire, a medical examination every five years, and the linkage to the SNIIRAM (national inter-scheme health insurance information system), the CNAV (National Old-Age Insurance Fund) and CépiDc (System for Automated Coding of Causes of Death) databases. The data collected from these sources are related to health, socio-professional characteristics, care seeking, biological, physiological, physical and cognitive parameters. Quality control and validation of health events are performed. Consideration of selection effects is based on a random sample of non-participants.ADVANCEMENT – Currently (October 2016), more than 115,000 participants were included in the cohort, and about 3,000 new volunteers are included each month. More than 60 projects on various topics were positively assessed by the cohort International Scientific Council. Public-private partnerships have also been established, as planned in the context of the financing of CONSTANCES by “Investments in the future”.Introduction-Constances est une cohorte « généraliste » de très grande taille en population destinée à la recherche en santé et à fournir des informations à visée de santé publique. Matériel-méthodes-La cohorte est composée d'un échantillon visant à la représentativité de la population française âgée de 18 à 69 ans ; l'effectif total prévu est de 200 000 sujets. L'inclusion des participants a lieu dans les Centres d'examens de santé (CES) de la Sécurité sociale, où ils bénéficient d'un examen médical et complètent un questionnaire concernant leur santé, leurs modes de vie et un historique professionnel. Une biobanque (sang et urine) est constituée. Le suivi se fait par auto-questionnaire annuel, examen médical tous les cinq ans et par appariement aux bases de données du Sniiram (Système national d'information inter-régimes de l'Assurance maladie), de la Cnav (Caisse nationale d'assurance vieillesse) et du CépiDc-Inserm (Centre d'épidémio logie sur les causes médicales de décès). Les données recueillies à ces différentes sources concernent la santé, les caractéristiques socioprofessionnelles, le recours aux soins, des paramètres biologiques, physiologiques, physiques et cognitifs. Un contrôle de qualité et une validation des événements de santé ont été mis en place. La prise en compte des effets de sélection s'appuie sur un échantillon aléatoire de non-participants. État d'avancement-Actuellement (octobre 2016), plus de 115 000 participants ont été inclus dans la cohorte et environ 3 000 nouveaux volontaires sont inclus chaque mois. Plus de 60 projets portant sur des thèmes diversifiés ont été évalués positivement par le Conseil scientifique international de la cohorte. Des partenariats publicprivé ont également été mis en place, comme cela est prévu dans le cadre du financement de Constances par les Investissements d'avenir

Post-retirement surveillance of workers exposed to asbestos or wood dust: first results of the French national SPIRALE Program.

International audienceObjectives: in France, 15 000-20 000 cancers attributable to occupational exposure occur each year. These cancers appear most often after the worker has retired. Since 1995, a system of post-retirement medical surveillance (PRMS) has been set up for former workers, but it remains largely underused. Design: the SPIRALE program is a public health intervention aimed at identifying the former workers having been exposed to asbestos or wood dust during their working life and to propose thema PRMS. Additionally, it is also an epidemiologic research on the longterm effects of occupational exposure.We report the results of first years of the program conducted in 2006-2008, in 13 districts. Setting and participants: a self-administered questionnaire was sent to 50 000 newly retired men, to identify potential past occupational carcinogen exposure. For respondents detected as possibly exposed, exposure was assessed in Health Screening Centres and a PRMS was recommended if necessary. Main outcome measures: participation rate, rate of confirmed exposure, increased rate of PRMS, satisfaction about the program. Results: the participation rate was 24%. From 12 002 questionnaires analysed, 72% of respondents were identified as possibly exposed: 3%to wood dust, 50%to asbestos and 19%to both exposures. Exposure to asbestos was confirmed for 73.4%, and according to the level of exposure, PRMSwas recommended for 47.1%. Wood dust exposurewas confirmed for 56.7%. In these districts, PRMS for asbestos increased by 45% and for wood dust by 600%. Additional surveys showed that participants showed a high degree of satisfaction about the program. Conclusions:The results are positive in terms of detection, information andmedical surveillance of exposed workers

Suivi des retraités exposés à l'amiante ou aux poussières de boions pendant leur vie professionnelle :premier bilan de la phase pilote du projet Spirale

National audienceSummary The estimation of new cancers due to professional exposures each year in France is between 15,000 and 20,000; about 25% of retired males have been professionally exposed to asbestos, and 8% to wood dust. Since 1995, a post-professional medical followup (SPP) exists, but is widely unknown. The Spirale program follows two aims: of public health, identifying eligible persons for SPP and taking them to it, and of epidemiological research on professional exposures long time effects and advantages from SPP. Spirale is leaded by the Inserm/CNAMTS 687 Unit which locates former employees exposed to carcinogens during their professional life course, using a self questionnaire, and the Assurance maladie (National Health Insurance) Health care centers (CES) which evaluate and confirm exposures and help people to obtain SPP. The Spirale pilot period took place in 13 CES in 2006 and 2007, targeting about 50000 new retired males; it identified 1,751 asbestos professional exposures and 684 wood dust ones. It raised asbestos SPP requests by 45% and wood dust ones by 600%. Besides, about 85% of exposed persons have agreed for an epidemiological follow-up. Looking for a whole territory spread order, the Assurance maladie decided to continue Spirale in 2008 in the 13 pilot CES

The CONSTANCES cohort, an epidemiological research infrastructure. Methods and results of the pilot phase

International audienceBackground: prospective cohorts represent an essential design for epidemiological studies and allow for the study of the combined effects of lifestyle, environment, genetic predisposition, and other risk factors on a large variety of disease endpoints. The CONSTANCES cohort is intended to provide public health information and to serve as an epidemiological research infrastructure accessible to the epidemiologic research community. Although designed as a “general-purpose” cohort with very broad coverage, it will particularly focus on occupational and social determinants of health, and on chronic diseases and aging.Methods: the CONSTANCES cohort is designed as a randomly selected representative sample of French adults aged 18-69 years at inception; 200 000 subjects will be included over a five-year period. At inclusion, the selected subjects are invited to fill a questionnaire and to attend a Health Screening Center (HSC) for a comprehensive health examination: weight, height, blood pressure, electrocardiogram, vision, auditory, spirometry, and biological parameters; for those aged 45 years and older, a specific work-up of functional, physical, and cognitive capacities is performed. A biobank will be set up. The follow-up includes a yearly self-administered questionnaire, and a periodic visit to an HSC. Social and work-related events and health data are collected from the French national retirement, health and death databases. The data include social and demographic characteristics, socioeconomic status, life events, behaviors, and occupational factors. The health data cover a wide spectrum: self-reported health scales, reported prevalent and incident diseases, long-term chronic diseases and hospitalizations, sick-leaves, handicaps, limitations, disabilities and injuries, healthcare utilization and services provided, and causes of death. To take into account non-participation at inclusion and attrition throughout the longitudinal follow-up, a cohort of non-participants was set up and will be followed through the same national databases as participants.Results: a field-pilot was performed in 2010 in seven HSCs, which included about 3 500 subjects; it showed a satisfactory structure of the sample and a good validity of the collected data.Conclusions: the constitution of the full eligible sample begun in 2012 and the cohort will be completed by the end of 2017. A public call for ancillary research projects will be launched in 201