Prise en charge thérapeutique du risque cardiovasculaire des diabètiques de type 2 en France et étude de ses déterminants (étude Entred )

Objectif : Décrire la prise en charge thérapeutique du risque cardiovasculaire chez les diabétiques de type 2 (DT2) en 2001, la comparer aux recommandations de l'Afssaps, et en analyser les déterminants. Patients et méthodes : Pour Entred, 10000 diabétiques traités au dernier trimestre 2001 ont été tirés au sort parmi les bénéficiaires du régime général des travailleurs salariés. Après enquêtes postales, les informations autodéclarées étaient disponibles pour 3324 diabétiques de type 2, dont 1553 pour lesquels un médecin avait fourni les données biologiques et hémodynamiques. Les délivrances de médicaments à visée cardiovasculaire réalisées au dernier trimestre 2001 ont été extraites à partir des fichiers de l'Assurance maladie. Résultats : Parmi les DT2, 67% avaient reçu une délivrance d'antihypertenseurs (IEC/ARA : 44%, diurétiques : 35%, inhibiteurs calciques : 25%, bêtabloquants : 24%). Parmi les personnes traitées ou non traitées par antihypertenseurs, respectivement 5% et 14% avaient une pression artérielle (PA) = 140/90 mmHg. L'utilisation des hypolipémiants (42%) augmentait jusqu'à 70 ans (46%), puis diminuait. Chez 22% des diabétiques à haut risque vasculaire, le taux de LDL était <1g/L, alors que 49 % d'entre eux étaient traités par hypolipémiant. Une macro ou microalbuminurie était rapportée chez 11 % des personnes, mais seulement 59% d'entre elles bénéficiaient d'un IEC/ARA. Parmi les coronariens déclarés, 26% recevaient 3 des 4 classes recommandées (bêtabloquants, statines, IEC/ARA, antiagrégants). En analyse multivariée chez les coronariens, les facteurs associés à une bonne prise en charge étaient : le sexe masculin, un niveau d'études supérieur au bac, être mobile, l'absence de complications microvasculaires, être sous ALD30, avoir été remboursé en 2001 de moins de 3 glycémies, d'un fond d'œil, ou d'une consultation en cardiologie. Conclusion : dans le DT2, l'application des nouvelles recommandations de l'Afssaps en ce qui concerne la prise en charge thérapeutique du risque vasculaire nécessite d'importants efforts, reposant sur les pratiques des médecins généralistes.CHATENAY M.-PARIS 11-BU Pharma. (920192101) / SudocSudocFranceF

Trajectories of Controller Therapy Use Before and After Asthma-Related Hospitalization in Children and Adults: Population-Based Retrospective Cohort Study

BackgroundInappropriate use of inhaled corticosteroids (ICSs) for asthma impairs control and may cause exacerbation, including asthma-related hospitalization (ARH). In prospective studies, ICS use peaked around ARH, but information on routine care use is limited. Since ARH is a major outcome, controller therapy use in routine care before and after ARH should be documented. ObjectiveThis study aimed to distinguish ICS use typologies (trajectories) before and after ARH, and assess their relationships with sociodemographic, disease, and health care characteristics. MethodsA retrospective cohort study was performed using a 1% random sample of the French claims database. All patients hospitalized for asthma between January 01, 2013, and December 31, 2015, were classified as either children (aged 1-10 years) or teens/adults (aged ≥11 years). Health care resource use was assessed between 24 and 12 months before ARH. ICS use was computed with the Continuous Measures of Medication Acquisition-7 (CMA7) for the 4 quarters before and after ARH. Initially, the overall impact of hospitalization on the CMA7 value was studied using a segmented regression analysis in both children and teens/adults. Then, group-based trajectory modeling differentiated the groups with similar ICS use. We tested different models having 2 to 5 distinct trajectory groups before selecting the most appropriate trajectory form. We finally selected the model with the lowest Bayesian Information Criterion, the highest proportion of patients in each group, and the maximum estimated probability of assignment to a specific group. ResultsOverall, 863 patients were included in the final study cohort, of which 447 (51.8%) were children and 416 (48.2%) were teens/adults. In children, the average CMA7 value was 12.6% at the start of the observation period, and there was no significant quarter-to-quarter change in the value (P=.14) before hospitalization. Immediately after hospitalization, the average CMA7 value rose by 34.9% (P=.001), before a significant decrease (P=.01) of 7.0% per quarter. In teens/adults, the average CMA7 value was 31.0% at the start, and there was no significant quarter-to-quarter change in the value (P=.08) before hospitalization. Immediately after hospitalization, the average CMA7 value rose by 26.9% (P=.002), before a significant decrease (P=.01) of 7.0% per quarter. We identified 3 and 5 trajectories before ARH in children and adults, respectively, and 5 after ARH for both groups. Trajectories were related to sociodemographic characteristics (particularly, markers of social deprivation) and to potentially inappropriate health care, such as medical management and choice of therapy. ConclusionsAlthough ARH had an overall positive impact on ICS use trajectories, the effect was often transient, and patient behaviors were heterogeneous. Along with overall trends, distinct trajectories were identified, which were related to specific patients and health care characteristics. Our data reinforce the evidence that inappropriate use of ICS paves the way for ARH

An innovative method to estimate lifetime prevalence of carcinogenic occupational circumstances: the example of painters and workers of the rubber manufacturing industry in France

International audienceBACKGROUND - Existing methods to estimate lifetime exposure to occupational carcinogenic agents could be improved. OBJECTIVE - We propose a new method to estimate the lifetime prevalence of exposure to occupational carcinogens using the example of painters and workers of the rubber industry in France. METHODS - From census, we calculated the proportion of painters and rubber industry workers using predefined occupational codes related to each occupation by sex and 10-year age group in 1982, 1990, 1999, 2007, and 2013. Using a beta-regression model, we obtained the yearly prevalence of exposure by 10-year age group over the period 1967–2007. We estimated the age- and sex-specific lifetime prevalence of exposure of the population in 2017 over 1967–2007, summing up the estimated prevalence of exposure for years 1967, 1977, 1987, 1997, and 2007 combined with a sex- and age-specific turnover factor. Corresponding population-attributable fractions were estimated for lung and bladder cancers in 2017. RESULTS - In 2017, we estimated that 5.6 and 0.2% of men in France had ever worked as a painter or in the rubber industry, respectively, during their working time. The lifetime prevalence of ever having worked as a painter or in the rubber industry was much lower in women: 1.8% and 0.1%, respectively. We estimated that 950 lung cancer and 40 bladder cancer cases were attributable to these occupations in 2017. SIGNIFICANCE - Based on accurate data and taking into account evolution of specific jobs over time, the proposed method provides good estimates of lifetime prevalence of exposure to occupational carcinogens. It could be applied in any other country with similar data

Consommation de soins des patients BPCO en France et au Royaume-Uni entre 2008 et 2017, et coûts associés

International audienc