B. Geoffroy-Perez

Social inequalities and cancer mortality in France, 1975-1990

Objective: to investigate social inequalities in cancer mortality from 1975 through 1990 among men and women in France.Methods: A sample, that included census data for approximately 1% of the French population, has been followed for mortality from 1975 to 1990. Causes of death were obtained through a record-linkage with the French national cause-of-death file. The analysis was restricted to those aged 35:59 in 1975 and included 61,876 men and 65,291 women. Occupational class, coded according to the social class scheme of Erikson, Goldthorpe and Portecarero in 7 categories, and educational level (in 4 categories) in 1975 have been studied. The analysis has been conducted for 15 cancer sites among men and 13 among women. Analysis used a Cox proportional hazards model.Results: For educational level, inequalities among men were more pronounced for cancers of the pharynx Relative Risk (RR) lowest versus highest educational level=9.2, 95% Confidence Interval (CI) 2.9–29.1, larynx (RR=6.2, CI=3.0:12.6), oral cavity (RR=2.7, CI=1.3–5.3), lung (RR=3.5, CI=2.5–4.8), esophagus (RR=3.1, CI=1.9–5.2), stomach (RR=2.5, CI=1.2–5.3) and rectum (RR=3.4, CI=1.2–9.6). No association between educational level and cancer mortality was observed for cancers of either the colon or lymphatic and hematopoietic tissue. Social inequalities were less pronounced among women but nevertheless observed for cancer of the uterus (RR=1.9, CI=1.0–3.6), stomach (RR=4.1, CI=1.0–17.1) and lung (RR=1.6, CI=0.7–3.7). No associations were found for mortality from breast or ovarian cancers. Results were similar when socioeconomic status was measured by occupational class.Conclusion: The analysis showed substantial inequalities in cancer mortality in France, with large differences according to cancer site.

Confrontation des données du Programme national de surveillance du mésothéliome (PNSM) et du Programme de médicalisation du système d’information (PMSI): Comparison of the French DRG based information system (PMSI) with the National Mesothelioma Surveillance Program database

BACKGROUND One of the main purposes of the French National Mesothelioma Surveillance Program is to estimate and follow the national incidence of pleural mesothelioma. We wanted to study the contribution of the French hospital national database as a valid source of mesothelioma incident cases. METHODS From the 1998 and 1999 hospital national database, medical records with a diagnosis code of mesothelioma or pleural cancer where selected among patients who resided in one of the 17 administrative divisions covered by the National Mesothelioma Surveillance Program in 1998. From these records, 506 patients in 1998 and 474 patients in 1999 where identified and matched with the National Mesothelioma Surveillance Program cases over the same period using indirect criteria of identification (sex, age, place of residence). Medical records of cases unknown by the National Mesothelioma Surveillance Program where consulted in one of the administrative divisions. RESULTS Only two-thirds of the registered cases of the National Mesothelioma Surveillance Program could be matched with a patient identified in the hospital national database with a diagnosis of mesothelioma registered during the same year. Consultation of the medical records showed that 1) certified cases registered in the National Mesothelioma Surveillance Program where often (83%) found in the hospital national database with a code of mesothelioma but 10 to 15% of the patients with a code of mesothelioma in the national hospital databases had a different diagnosis according to their medical records; 2) 65% of the patients with a code of mesothelioma in the national hospital databases that where unknown from the National Mesothelioma Surveillance Program in 1998 and 55% in 1999 where prevalent cases; 3) 3 suspected cases had not been reported to the National Mesothelioma Surveillance Program. CONCLUSION Because of lack of diagnosis certification, mistakes in encoding diagnosis and the fact that incident and prevalent cases cannot be distinguished in the hospital national database make it impossible to estimate the mesothelioma incidence solely from this source of data. However, the hospital claim databases constitute a complementary source of information for the active search of incident cases performed by the National Mesothelioma Surveillance Program.

Personality and the risk of cancer: a 16-year follow-up study of the GAZEL cohort.

Objective Large-scale prospective studies do not support an association between neuroticism and extroversion with cancer incidence. However, research on other personality constructs is inconclusive. This longitudinal study examined the associations between four personality measures, Type 1, “suppressed emotional expression”; Type 5, “rational/antiemotional”; hostility; and Type A with cancer incidence. Methods Personality measures were available for 13,768 members in the GAZEL cohort study (baseline assessment in 1993). Follow-up for diagnoses of primary cancers was obtained from January 1, 1994 to December 31, 2009. Associations between personality and cancer incidence were evaluated using Cox proportional hazards analyses and adjusted for potential confounders. Results During a median follow-up of 16.0 years (range, 9 days–16 years), 1139 participants were diagnosed as having a primary cancer. The mean duration between baseline and cancer diagnosis was 9.3 years. Type 1 personality was associated with a decreased risk of breast cancer (hazard ratio per standard deviation = 0.81, 95% confidence interval = 0.68–0.97, p = .02). Type 5 personality was not associated with prostate, breast, colorectal, or smoking-related cancers, but was associated with other cancers (hazard ratio per standard deviation = 1.17, 95% confidence interval = 1.04–1.31, p = .01). Hostility was associated with an increased risk of smoking-related cancers, which was explained by smoking habits, and Type A was not associated with any of the cancer endpoints. Conclusions Several personality measures were prospectively associated with the incidence of selected cancers. These links may warrant further epidemiological studies and investigations about potential biobehavioral mechanisms.

Socioprofessional trajectories and mortality in France, 1976–2002: a longitudinal follow-up of administrative data

Background Occupying a low socioeconomic position is associated with increased mortality risk. To disentangle this association, previous studies considered various dimensions of socioeconomic trajectories across the life course. However, they used a limited number of stages. We simultaneously examined various dimensions of the whole professional trajectory and its association with mortality. Methods We used a large sample (337 706 men and 275 378 women) of the data obtained by linking individuals’ annual occupation (collected in 1976–2002 from a representative panel of the French salaried population in the semipublic and private sectors) with causes of death obtained from registries. All-cause and cause-specific HRs were estimated using Coxs regression models adjusted for the occupational class at the beginning of the follow-up, the current occupational class, the transition rates between occupational categories and the duration of time spent in occupational categories. Results An increase in the time spent in the clerk class increased men and womens cardiovascular mortality risk compared with that in the upper class (HRs=1.59 (1.14 to 2.20) and 2.65 (1.14 to 6.13) for 10 years increase, respectively, for men and women). Men with a high rate of transitions had about a 1.2-fold increased risk of all-cause and external-cause mortality compared with those without transitions during their professional life. This association was also observed for womens all-cause mortality. Conclusions Strong associations between professional trajectories and mortality from different causes of death were found. Long exposure to lower socioeconomic conditions was associated with increased mortality risk from various causes of death. The results also suggest gradual associations between transition rates and mortality.

A 26-year cohort mortality study of French construction workers aged 20 to 64 years

Objective: The purpose of this report was to study the cause-specific mortality of French workers in the construction industry. Methods: From a cohort of 12,788 male workers, standardized mortality ratios (SMRs) and 95% confidence intervals (CI) were calculated for the years between 1974 and 1999 for workers aged 20 to 64 years. Results: All-cause mortality was significantly increased (SMR = 111, CI = 106–206). Excess mortality was found for cancers (SMR = 125, CI = 117–134), especially for the oral cavity and pharynx (SMR = 134, CI = 108–163), digestive (SMR = 120, CI = 104–137) and respiratory (SMR = 143, CI = 128–159) systems; cerebrovascular disease (SMR = 130, CI = 106–158); diseases of the digestive system (SMR = 130, CI = 113–149), and accidental falls (SMR = 158, CI = 105–125). Excess risks were limited to blue-collar workers. Conclusions: Despite a probable role of lifestyle and potential limitations of the study, elevated mortality was observed for several causes possibly related to occupational factors.

Male gonadal dose of ionizing radiation delivered during X-ray examinations and monthly probability of pregnancy: a population-based retrospective study.

BackgroundMale gonadal exposure to ionizing radiation may disrupt spermatogenesis, but its influence on the fecundity of couples has been rarely studied. We aimed to characterize the influence of male gonadal dose of ionizing radiation delivered during radiodiagnostic on the monthly probability of pregnancy.MethodsWe recruited a random sample of women who retrospectively described 1110 periods of unprotected intercourse beginning between 1985 and 1999 and leading either to a live birth or to no pregnancy; their duration was censored after 13 months. The male partner answered a telephone questionnaire on radiodiagnostic examinations. We assigned a mean gonadal dose to each type of radiodiagnostic examination. We defined male dose for each period of unprotected intercourse as the sum of the gonadal doses of the X-ray examinations experienced between 18 years of age and the date of discontinuation of contraception. Time to pregnancy was analysed using a discrete Cox model with random effect allowing to estimate hazard ratios of pregnancy.ResultsAfter adjustment for female factors likely to influence fecundity, there was no evidence of an association between male dose and the probability of pregnancy (test of homogeneity, p = 0.55). When compared to couples with a male gonadal dose between 0.01 and 0.20 milligrays (n = 321 periods of unprotected intercourse), couples with a gonadal dose above 10 milligrays had a hazard ratio of pregnancy of 1.44 (95% confidence interval, 0.73–2.86, n = 31).ConclusionOur study provides no evidence of a long-term detrimental effect of male gonadal dose of ionizing radiation delivered during radiodiagnostic on the monthly probability of pregnancy during the year following discontinuation of contraceptive use. Classification errors due to the retrospective assessment of male gonadal exposure may have limited the statistical power of our study.

Enquêtes épidémiologiques en milieu de travail : quelques bases pour le médecin du travail

Resume L’epidemiologie a pris une place preponderante dans la recherche en milieu de travail. Le medecin du travail n’a pas toujours toutes les cles pour comprendre les bases des etudes epidemiologiques, y participer, voire les organiser. Nous allons rappeler les principes en donnant les etapes de realisation d’une etude, de la formulation de la question a la publication, en insistant sur la necessite de travailler en equipe avec des specialistes de l’epidemiologie des risques professionnels. Nous allons nous pencher particulierement sur la realisation du protocole d’une etude epidemiologique, qui en planifie toutes les etapes essentielles. Apres une etape bibliographique indispensable, la mise en place d’un protocole complet va permettre de rappeler le contexte de l’etude epidemiologique, d’en definir l’objectif principal et les moyens mis en œuvre pour l’atteindre. Le protocole definit le type d’enquete, la population etudiee et les donnees a analyser. Le protocole donne egalement les differents aspects logistiques de l’etude. Les bases de l’analyse et l’interpretation sont enfin rapidement abordees. Les differentes etapes sont illustrees par un exemple concret.

Psychotropic Drug Use in a Cohort of Workers 4 Years After an Industrial Disaster in France

Two years after the 2001 Toulouse industrial disaster, a longitudinal study was set up to evaluate the impact of the disaster. The current substudy examines the medium-term impact (5 years) the incident had on the mental health of 3,004 participants. As part of the monitoring, data relating to the psychotropic drug use of 2,494 participants were collected from administrative databases 4 years after the disaster. Use of psychotropics was higher among women for anxiolytics (10.4% for men and 15.0% for women), hypnotics (10.5% and 17.0%), and antidepressants (7.6% and 11.2%). Exposure to the disaster, especially proximity to the exposure, was significantly associated with the use of antidepressants in men, OR = 3.22, 95% CI[1.57, 6.61]. This was also the case for other exposure factors (saw dead or injury, injured, home damage, death or injury loved one, psychological disorders, exposure toxic fumes): range of OR 1.75 to 2.52 in men, 1.48 to 1.62 in women. In conclusion, this study highlights the medium-term psychological impact of an industrial disaster on psychotropic drug use and the potential for using medical records data as a means for tracking postdisaster mental health.

Suicide and occupation: first assessments from French available data

Objectives Suicide is a complex and multifactorial phenomenon. The number of work-related suicides is difficult to assess in France. There are nevertheless some data available to document this problem. The aim of this study is to describe suicide mortality and its temporal evolution in employees (men) according to economic sectors in France. Methods The description of suicide mortality comes from the Cosmop programme, conducted by the Department of Occupational Health/InVS. Individual administrative occupational data (DADS-Panel/Insee) have been linked to the medical causes of death from the French National Death Registry (CépiDc/Inserm). Suicide mortality (age-standardised) were calculated in men employees each year from 1976 to 2002 according to economic sector (agriculture sector excluded). Results Over the period from 1976 to 2002, the age-standardised mortality from suicide is estimated at 25.5/100 000. There is no significant temporal trend. However, the mortality differs according to economic sector. The human health and social activities present the highest mortality (34.3/100 000) followed by the public administration (29.8/100 000), the construction (27.3/100 000) and the real estate activities (26.7/100 000). Conclusions This study points out inequalities of mortality by suicide according to economic sectors. However, there is a relative stability over time in the working population between 1976 and 2002 which is overlapping the trend observed in the general population. Despite some limitations (in particular the absence of agricultural workers and a part of civil servants), these results provide a first assessment on suicide mortality according to economic sectors in France.

Mortality from cardiovascular diseases in men according to occupational category and business activity sector in France

Objectives Despite a decrease over last decades, cardiovascular (CV) mortality remains the second cause of death among men in France. The link with occupational factors is poorly documented. A study was conducted to describe the CV mortality according to occupational category (OC) and business activity sector (BAC). Methods Data are issued from the Cosmop program. Individual administrative occupational data from French National Institute for Statistics and Economic Studies (DADS-Panel/Insee) have been linked to the medical causes of death from French National Institute of Health and Medical Research (CépiDc/Inserm). Our study concerns the mortality over the 1976–2002 period among men aged 35–64 years. Age-standardised mortality rates (MR) were calculated for ischemic heart diseases (IHD) and cerebrovascular diseases (CVD) according to OC and BAC. Results MR from IHD and CVD decreased between the 1976–1982 and 1997–2002 periods. On the overall study period, MR from IHD and CVD were higher among people without employed activity (54.3 and 12.7/100 000 respectively) than for active employees (33.7 and 27.1); MR were higher among employees (38.0 and 16.3) and factory workers (37.4 and 15.1) than among executives (22.7 and 7.4 respectively). Among men with employed activity, higher IHD MR concerned the manufacture industry (36.8) the sector of transportation (36.3), whereas sectors showing the highest CVD MR were construction (14.3) and manufacture industry (14.0). Conclusions Our analysis confirms the decrease of premature mortality from CV diseases; nevertheless it shows differences according to occupational category and business activity sector.