Gestational Age, Socioeconomic Context and Infection-Related Hospital Admissions of Infants Born With Gestational Age Less Than 33 Weeks

Using data from a regional medical follow-up network database of preterm infants born with gestational age (GA) <33 weeks, we found that low GA and deprived socioeconomic neighborhoods increased incidence of infection-related hospitalization during the first year of life. Respiratory tract infections rates were higher in extremely preterm infants.

Défavorisation sociale et facteurs associés au dépistage du SARS-CoV-2 à l'échelle locale dans une région du Sud de la France entre Juillet 2020 et Janvier 2022

Introduction

Les inégalités sociales sont fortement associées aux inégalités de santé, que ce soit pour les maladies chroniques ou infectieuses. Le SARS-CoV-2 ne fait pas exception, l'étude nationale EpiCov ayant montré dès juin 2020 un risque de COVID-19 croissant avec la défavorisation sociale.

Le dépistage demeure un des piliers du contrôle de cette pandémie, tant à l'échelle individuelle pour l'isolement des cas et de leurs contacts à risque, que populationnelle pour identifier et cibler certaines mesures d'accompagnement. L'accès au dépistage ne saurait être considéré comme uniforme, tant l'accès au soin apparaît déficitaire dans certains territoires (zones urbaines défavorisées, rurales). Par ailleurs, le manque de prise en compte des inégalités sociales dans les mesures de suivi des cas a été souligné.

Notre objectif était de prendre en compte le sous-diagnostic du SARS-CoV-2 lié à la défavorisation sociale afin d'améliorer le ciblage des actions de santé publique à l'échelle régionale.

Matériels et méthodes

Le nombre de tests (RT-PCR et antigéniques) et de cas de COVID-19 positifs enregistrés dans la base SI-DEP ont été agrégées à l'échelle spatiale des IRIS (subdivision géographique d'environ 2000 habitants) et temporelle selon des périodes correspondant aux grandes mesures de contrôle de l'épidémie (pré-, pendant, post-confinement, passe sanitaire…). Les taux de dépistage, d'incidence de COVID-19 et de positivité des tests ont été définis par IRIS et par période.

Nous avons caractérisé le profil socio-démographique de chaque IRIS à partir de données de population et d'accès au soin (source INSEE et DREES), et de l'European Deprivation Index (EDI), indicateur spécifique de défavorisation sociale.

Enfin, nous avons analysé le ratio de taux de dépistage (RTD) selon le profil socio-démographique après ajustement sur l'accès au soin, au moyen d'un modèle additif généralisé hiérarchique prenant en compte l'autocorrélation spatiale entre les IRIS voisins.

Résultats

Nous avons distingué 10 périodes entre Juillet 2020 et Janvier 2022, et identifié six profils d'IRIS : un profil rural, un rural/péri-urbain, et quatre profils urbains correspondant respectivement à des IRIS aisés, denses de centre-ville, défavorisées, et denses très défavorisées.

Le taux de dépistage des IRIS urbains très défavorisés était systématiquement inférieur au taux de dépistage des IRIS urbains/péri-urbains aisés (RTD entre 0.85 (IC95 %=0.80-0.91) et 0.64 (0.59-0.69)). Les pics d'incidence de COVID-19 ont été atteints plus tardivement dans les IRIS très défavorisées que dans les IRIS aisés lors de périodes de confinement (novembre 2020) ou de périodes de vaccination massive (juillet 2021).

Conclusion

Cette étude a permis d'identifier une liste limitée d'IRIS caractérisés par un sous-dépistage et un retard d'efficacité des mesures sanitaires de freinage de la COVID-19. Ils ont ainsi pu être priorisés dans les interventions mises en place par les acteurs régionaux et locaux de la réponse à la pandémie.

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The impact of the COVID-19 epidemic on primary care in South-eastern France: implementation of a real-time monitoring system based on regional health insurance system data

BACKGROUND

The spring 2020 COVID-19 epidemic severely impacted France's healthcare system. The associated lockdown (17 March- 11 May 2020) and the risk of exposure to SARS-CoV-2 led patients to change their use of healthcare. This article presents the development and implementation of a real-time system to monitor i) private doctors' activity in South-eastern France, and ii) changes in prescription of drugs for people with diabetes, mental health disorders and for certain vaccines from Mars 2020 to October 2020.

METHODS

Data extracted from the regional healthcare insurance databases for 2019 and 2020 were used to construct indicators of healthcare use. They were calculated on a weekly basis, starting from week 2 2020 and compared for the same period between 2019 and 2020.

RESULTS

Private doctors' activity decreased during the spring 2020 lockdown (by 23 % for general practitioners and 46 % for specialists), followed by an almost complete return to normal after it ended until week 41. Over the same period, a huge increase in teleconsultations was observed, accounting for 30 % of private doctors' consultations at the height of the crisis. The start of the lockdown was marked by a peak in drug prescriptions, while vaccinations declined sharply (by 39 % for the measles, mumps and rubella (MMR) vaccine in children under 5 years old, and by 54 % for human papillomavirus vaccine in girls aged 10-14 years old).

CONCLUSION

The ongoing COVID-19 epidemic may lead to health consequences other than those directly attributable to the disease itself. Specifically, lockdowns and foregoing healthcare could be very harmful at the individual and population levels. The latter issue is a concern for French public authorities, which have implemented actions aimed at encouraging patients to immediately seek treatment. However, the COVID-19 crisis has also created opportunities, such as the roll-out of teleconsultation and tele-expertise. The indicators described here as part of the monitoring system can help public decision-makers to become more responsive and to implement tailored actions to better meet the general population's healthcare needs.

[The impact of the COVID-19 pandemic on first-line primary care in southeastern France: Feedback on the implementation of a real-time monitoring system based on regional health insurance data]

Position du problème

L’épidémie de COVID-19 du printemps 2020 a fortement affecté le système de soins. Le confinement et les risques d’exposition au coronavirus ont incité les patients à modifier leur recours aux soins. L’objectif était de partager un retour d’expérience sur la mise en place d’un dispositif de surveillance en temps réel de l’activité des médecins libéraux de la région Provence-Alpes-Côte d’Azur, et de l’évolution des remboursements de médicaments prescrits aux assurés du régime général pour le diabète, pour des troubles de la santé mentale et pour certains vaccins.

Méthodes

Les données ont été extraites à partir des bases régionales de l’Assurance maladie pour les années 2019 et 2020. Elles ont permis de construire des indicateurs en date de soins pour le régime général stricto sensu, calculés de façon hebdomadaire, à partir de la semaine 2.

Résultats

On constate une chute d’activité des médecins libéraux lors du confinement (−23 % pour les médecins généralistes ; −46 % pour les spécialistes), suivie d’un quasi retour à la normale par la suite. Dans le même temps, les téléconsultations ont connu un véritable essor : elles ont constitué 30 % des actes des médecins libéraux au plus fort de la crise. Le début du confinement a été marqué par un pic d’approvisionnement en médicaments, tandis que la vaccination a fortement diminué (−39 % concernant le vaccin contre la rougeole, les oreillons et la rubéole chez les enfants âgés de moins de 5 ans ; −54 % pour le vaccin contre les papillomavirus humains chez les filles âgées de 10–14 ans).

Conclusion

L’épidémie de COVID-19 risque d’entraîner d’autres conséquences sanitaires que celles directement imputables à la COVID-19 elle-même. Le renoncement aux soins pourrait causer des retards de soins fortement préjudiciables aux individus et à la collectivité. Ces questions inquiètent les autorités publiques, qui mettent en place des actions visant à inciter les patients à se soigner sans tarder. Mais la crise liée à la COVID-19 a aussi créé des opportunités, telles que le déploiement de la téléconsultation et de la télé-expertise. Bien que partiels, les indicateurs mis en œuvre peuvent permettre aux décideurs publics d’être réactifs et de mettre en place certaines actions afin de répondre aux besoins de santé des populations.

Southeastern Regional Health Information System: a mapping tool for public health actors

Issue/problem

Local public health actors often need to identify public health priorities in their territories to guide public health policy and/or action.

Description of the problem

The Southeastern Health Regional Observatory (ORS Paca) has been developing since 2006 a health information system for Southeastern France (SIRSéPACA). The objective of this mapping tool is to give access to regional and local public health actors to public health indicators for various population groups and geographical scales (municipality, districts...) within the region.

Results

Indicators are displayed under the format of maps and tables on the following topics: morbidity, mortality, health social, economic or environmental determinants. Indicators are constructed using national and regional databases (open or accessible through agreements). SIRSéPACA is in free access (www.sirsepaca.org) and regularly updated. A function allows the users to obtain a portrait for a defined geographical area and to obtain in one click a description of various indicators (socio-economic and demographic characteristics, mortality and morbidity causes, health care and prevention, environmental health). Indicators for a given territory can be compared to the regional average (or another area). SIRSéPACA is regularly used to provide a description of the main public health characteristics of territories (“territorial diagnose”), e.g. to help health professionals intending to set up of a multidisciplinary group practice designing their project.

Lessons

Trainings on how to use the tool, interpret the maps produced, and about territorial diagnoses implementation are regularly done. We are also developing a similar tool for all French regions for the Ministry of Health.

Key messages

SIRSéPACA facilitates access to and overview of a lot of indicators and data for local public health actors. This regional experience has been expanded to national level.

Prospective study on chronic diseases and healthcare costs for the south of France region, 2016-2028

Background

In France, Health Regional Agencies (HRA) have to elaborate a Public Health Plan for the 5 coming years. For estimating future population health needs and associated costs to adapt the health services on the regional territory, the HRA in southeastern France requested a prospective analysis, based on demographic and epidemiologic scenarios about major chronic diseases, to evaluate future trends.

Methods

Six chronic diseases were selected: diabetes (1 or 2), cardiovascular diseases, respiratory diseases, cancers, neurological diseases and dementia. We used medico-administrative data from the National health insurance fund, and adapted algorithms to identify people with these diseases. We calculated prevalence rates according to gender and age and used two alternative scenarios (a constant one, and a trend-based one) to estimate the number of people with chronic diseases in 2023 and 2028, starting in 2016. We also estimated future healthcare costs according a constant and a trend-based scenario.

Results

The algorithms detect reasonable rates of disease compared to official rates available for 2016. Due to demographic (ageing) and/or epidemiologic trends, the number of people with chronic diseases will highly increase during the next ten years in the South of France region. For instance, between 2016 and 2028, there will be from 15% to 20% more people with diabetes. Associated costs will also be higher (+33% between 2016 and 2028), especially those granted to nursing care (+40%).

Conclusions

Burden of diseases and health expenditures are going to increase in the future. Projections are needed to help policymakers anticipating the required health services adaptation. Medico-administrative database are an invaluable source of data to do so. The next step of this project will consist in estimating those trends for smaller geographical areas.

Key messages

Data of the French Health Insurance fund can be used to predict future prevalence of chronic diseases and healthcare costs. South of France will face a main increase of people with chronic diseases.

[Relevance of the health insurance databases to study spatial disparities in asthma prevalence: A study in southeastern France]

BACKGROUND

Data on asthma prevalence at a small-area level would be useful to set up and monitor French local public health policies. This study, based on drug reimbursement databases in southeastern France, aimed to (1) compare asthma-like disorders prevalence estimated by using three different indicators; (2) study sociodemographic characteristics associated with these indicators; (3) verify whether these indicators are equivalent to study geographical disparities of the asthma-like disorders prevalence at a small-area level.

METHODS

The study was conducted among the beneficiaries of the National Health Insurance Fund aged 18-44 years residing in southeastern France in 2010 (n=1,371,816). Using data on asthma drugs reimbursements (therapeutic class R03), we built three indicators to assess asthma-like disorders prevalence: at least 1, 2 or 3 purchase(s) in 2010. We analyzed sociodemographic characteristics associated with these indicators, and their geographical disparities at a small-area level using multilevel logistic regression models.

RESULTS

The crude asthma-like disorders prevalence varied between 2.6 % and 8.4 % depending on the indicator. It increased with age, was higher for women than for men, and among low-income people for all three indicators. We measured significant geographical disparities. Areas with high prevalence rates were the same regardless of the indicator.

CONCLUSION

The indicators built in this study can be useful to identify high prevalence areas. They could contribute to launch discussion on environmental health issues at the local level.

Feedback and lessons from the prescription of rimonabant, a drug to be used under strict guidelines, in southeastern France, March 2007 through June 2008

BACKGROUND

To provide feedback on the initial market authorization of rimonabant, a drug to be used under strict guidelines, we conducted a study with information from the National health insurance reimbursements database for southeastern France. The aims of this study were to: (1) describe the characteristics of subjects who have had one rimonabant prescription reimbursed; (2) study the frequency of prescriptions that did not comply with reimbursement criteria; (3) study the frequency of prescriptions for patients simultaneously treated with antidepressants; and (4) analyse the factors associated with both types of prescription (patient and prescriber characteristics).

METHODS

Using the database of drug reimbursements maintained by the southeastern France general health insurance fund, we studied the characteristics of outpatients with at least one reimbursement for rimonabant, compared them to the rest of the population, and analysed compliance with the indications, contraindications, and regulations for rimonabant prescription with multivariate logistic regressions.

RESULTS

A total of 10,510 beneficiaries (0.28%) had at least one rimonabant reimbursement. Among them, 55.7% were treated for diabetes. For at least 62.4% of rimonabant beneficiaries, the reimbursement regulations were not respected: this was significantly more frequent among women less than 57 years old, subjects with no chronic diseases, and when the prescriber was not an endocrinologist; 11.4% of rimonabant beneficiaries also received an antidepressant treatment.

CONCLUSION

Despite the specific status of rimonabant regarding its reimbursement modalities, these results suggest that some prescribers get around reimbursement instructions and that a significant percentage of prescriptions did not respect an important contraindication. Tools to follow up the prescriptions of new drugs with strict guidelines for use should be developed and physicians should be better informed and trained regarding specific prescription regulations.