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Resume Position du probleme Le developpement et l’utilisation des bases de donnees en sante accentuent le besoin d’outils, notamment d’algorithmes reconnus et valides de selection de sejours ou de patients atteints de cancer. Dans le cadre du developpement du reseau REDSIAM (Reseau de donnees Sniiram, Systeme national d’information inter-regimes de l’assurance maladie), le groupe « Tumeurs » avait pour objectif de dresser un etat des lieux des algorithmes publies dans les etudes en cancerologie, francaises ou etrangeres, afin de permettre au lecteur en recherche d’algorithme de cibler ceux susceptibles de l’interesser. Methode Une recherche non systematique de la litterature a ete effectuee pour diverses localisations. Les resultats sont presentes pour le poumon, sein, colon et rectum. Les publications jusqu’en aout 2016 ont ete recherchees dans les bases de donnees Medline, Scopus, Base de donnee en sante publique, Google Scholar et dans les sommaires des principales revues francaises en cancerologie et sante publique. Une grille d’extraction adaptee a la cancerologie a ete construite et utilisee lors du processus d’extraction. Resultats Au total, 18 publications ont ete retenues pour le cancer du poumon, 18 pour le cancer du sein et 12 pour le cancer colorectal. Les performances et le choix des algorithmes utilises s’averent dependant du contexte, de l’objectif et de la localisation etudiee. La grille de description construite par le groupe « Tumeurs » est plus detaillee compare au socle bibliographique commun aux autres groupes de REDSIAM, mais son remplissage reste simple. Conclusions Cette etude montre la complexite de la detection des cas de cancers a partir des bases de donnees en sante et l’insuffisance d’algorithmes valides. Il est necessaire de promouvoir et de developper les travaux visant a normaliser et faciliter la validation de ces algorithmes.

International audience; BACKGROUND:Immigrant women often have lower cervical cancer screening (CCS) rates, tend to have a higher body mass index (BMI) and may be more vulnerable to BMI-related stigmatization. Our aim was to assess the role of BMI in differences in CCS rates by migration history.METHODS:Analyses were based on the 2012-2015 inclusion data (n = 27,226) for the population-based CONSTANCES cohort, including detailed, self-reported information on demographics and socioeconomic characteristics, migration history, health behaviours, health, and health care use. Measured BMI (underweight (30)) was collected. Poisson regression models with robust variance were conducted to assess the contribution of BMI to differences in CCS rates by migration history, and analyses stratified by BMI were done. Multiple imputations were performed.RESULTS:The CCS rates ranged from 87% among French-born women with two French parents to 86% among French-born women with at least one parent of foreign origin, 82% among naturalized immigrants and 74% among non-naturalized immigrants. After adjusting for covariates, non-naturalized immigrants showed an 11% (95% CI: 8%-14%) lower CCS rate than French-born women with two French parents. Adjusting for BMI did not change the estimates. When stratifying by BMI category, non-naturalized immigrants showed an 11% (7%-14%) lower CCS rate then French-born with two French parents when normal weight, a 9% (2%-16%) lower CCS rate when overweight, and an 18% (5%-30%) lower CCS rate when obese.CONCLUSION:Migration history and BMI jointly impact CCS rates. They were lower among all non-naturalized immigrants, particularly those who were obese.

Background Socioeconomic inequalities are observed in breast cancer screening (BCS) and cervical cancer screening (CCS) in France. A large range of determinants is associated with BCS and CCS. Most of these determinants are socially stratified and are likely to contribute to socioeconomic inequalities in BCS and CCS. Various factors associated with BCS and CCS non-adherence have been identified in many studies. However, limited evidence exists on their contributions to socioeconomic inequalities. This study quantified the contributions of these determinants to BCS and CCS income inequalities in France. Methods The study utilised the 2012–2014 baseline data in the CONSTANCES survey conducted in France (10,260 women for BCS and 18,761 for CCS). Screening non-adherence was defined by having last BCS for more than 2 years and last CCS for more than 3 years. The standard concentration index (Ch) was computed to measure the income inequalities in BCS and CCS non-adherence. Decomposition analyses quantified the contributions of the determinants to the income inequalities. We used the method proposed by Wagstaff. A large range of determinants were accounted for: sociodemographic (age, partner, children, migration status, area of residence), socioeconomic (education, employment status, unmet healthcare need for financial reasons), healthcare access (health insurance for low-income individuals, potential spatial accessibility to gynecologists and general practitioners), health status (measured BMI, taking anti-diabetic treatment, taking antihypertensive treatment, self-reported physical limitations, self-reported cognitive limitation, personal history of cancer, family history of cancer, perceived health status, self-reported smoking status) and healthcare use (last visit to a gynaecologist from inclusion, number of GP visits during the inclusion year; and last glucose test from inclusion). Results BCS non-adherence was concentrated towards the lower income groups [Ch = −0.0756 (95% CI: −0.1000 to −0.0512)], these inequalities were explained mainly by less frequent visit to gynaecologist (50.0%), more unmet healthcare needs (13.9%) and higher BMI status (8.4%) in lower income groups. CCS non-adherence was concentrated towards the poorer groups [Ch = −0.1264 (CI: −0.1422 to −0.1106)], these inequalities were mostly explained by less frequent visit to gynaecologist (54.6%), having a partner (8.2%), and more unmet healthcare needs (7.0%) in lower income groups. Regular visits to general practitioner contributed negatively to both inequalities in BCS and CCS non-adherence (−10.2% and −4.8%, respectively): they were associated with lower BCS and CCS non-adherence and they were more common in poorer women. Conclusion Awareness of healthcare professionals should be raised regarding different factors contributing to the socioeconomic inequalities in BCS and CCS non-adherence as they are in the front-line of giving health advice adapted to women's characteristics.

Contexte Des inegalites sociales sont observees pour la pratique du depistage du cancer du sein (CS) et du col de l’uterus (CCU). De nombreux facteurs sont associes au recours au depistage. La plupart sont socialement stratifies et sont donc susceptibles de contribuer aux inegalites sociales de depistage observees. Toutefois, peu d’etudes ont porte sur ce sujet. L’objectif est de quantifier la contribution de nombreux determinants du recours au depistage aux inegalites sociales de non-recours au depistage. Methode Nous avons utilise les donnees d’inclusion dans la cohorte Constances (10 260 femmes pour le depistage du CS et 18 761 pour le depistage du CCU). Le fait de ne pas etre a jour pour ces depistages a ete defini comme ne pas avoir eu de frottis au cours des trois dernieres annees et ne pas avoir eu de mammographie au cours des deux dernieres annees. Les inegalites sociales ont ete quantifiees a l’aide de l’indice de concentration calcule en fonction du revenu. Nous avons utilise la methode proposee par Wagstaff pour estimer la contribution de differents facteurs (sociodemographiques, socioeconomiques, acces aux soins, etat de sante, suivi medical) aux inegalites sociales de non-recours au depistage. Resultats Ne pas etre a jour pour le depistage du CS etait plus frequent parmi les femmes ayant un faible revenu (Indice de concentration C = −0,0756 (IC 95 % : −0,1000 a −0,0512)). Ces inegalites etaient expliquees principalement par un moindre suivi par un gynecologue (50,0 %), des renoncements aux soins plus frequents (13,9 %) et un IMC plus eleve (8,4 %) chez les femmes ayant un faible revenu. Ne pas etre a jour pour le depistage du CCU etait plus frequent parmi les femmes ayant un faible revenu (C = −0,1264 (IC 95 % : −0,1422 a −0,1106)). Ces inegalites etaient expliquees principalement par un moindre suivi par un gynecologue (54,6 %), l’absence de partenaire (8,2 %) et des renoncements aux soins plus frequents (7,0 %) chez les femmes ayant un faible revenu. Un suivi regulier par un medecin generaliste contribuait de facon negative aux inegalites pour le depistage du CS (−10,2 %) et du CCU (−4,8 %) : ce facteur est associe avec un meilleur recours au depistage et est plus frequent parmi les femmes ayant un faible revenu. Conclusion Il est important de former et de sensibiliser les professionnels de sante aux facteurs contribuant aux inegalites sociales de recours au depistage pour le CS et le CCU car ils sont en premiere ligne pour suivre les pratiques de depistage des femmes.

Background and Objective To assess the influence of medical conditions on road traffic accidents among a cohort of middle-aged workers and pensioners. Study Design and Setting A longitudinal study of 13,548 participants from a cohort study of French workers. Follow-up data covered the 1989–2000 period. Adjusted hazards ratios (HR adj ) for serious accidents were computed by Cox's proportional hazards regression with time-dependent covariates adjusted for age, occupation, annual mileage in 2001, alcohol consumption, and number of reported health problems. Results Men who reported treated dental or gingival problems (HR adj =8.57, 95% confidence interval CI=2.70–27.2) and women who reported treated renal colic or kidney stones (HR adj =9.71, 95% CI=2.40–39.3) were much more likely to have a serious traffic accident. Treated glaucoma, hiatal hernia or gastric ulcers, and diabetes among women and treated cataract among men were also found to be associated with the risk of serious traffic accidents. Conclusions This study raises the hypothesis that pain and pain treatment (singly or in combination) could increase the risk of road traffic accident and confirms that medical conditions traditionally found to be associated with traffic accident involvement of older drivers are also risk factors for middle-aged drivers.

Depression has long been hypothesized to be associated with cancer incidence. However, there is evidence for a positive publication bias in this field. In the present study, we examined the association between various measures of depression and cancer incidence at several sites. A total of 14,203 members of the French GAZEL (Gaz et Electricite) cohort (10,506 men, 3,697 women) were followed up for diagnoses of primary cancers from January 1, 1994, to December 31, 2009. All medically certified sickness absences for depression recorded between January 1, 1990, and December 31, 1993, were compiled. Depressive symptoms were self-reported in 1993, 1996, and 1999 with the Center for Epidemiologic Studies Depression Scale. During a mean follow-up period of 15.2 years, 1,119 participants received a cancer diagnosis, excluding nonmelanoma skin cancer and in situ neoplasms. Considering 6 cancer sites (prostate, breast, colorectal, smoking-related, lymphoid and hematopoietic tissues, other sites) and 4 measures of depression, we found 1 positive association and 1 negative association. Overall, there was no compelling evidence for an association between depression and cancer incidence. Such null results should be considered when addressing concerns of cancer patients and their relatives about the role of depression in cancer onset.

International audience; 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.

BACKGROUND:: Personal responses to stressful life events are suspected of increasing the risk of serious traffic accidents. METHODS:: We analyzed data from a French cohort study (the GAZEL cohort), including a retrospective driving behavior questionnaire, from 13,915 participants (10,542 men age 52-62 years and 3373 women age 47-62 years in 2001). Follow-up data covered 1993-2000. Hazard ratios for serious accidents (n = 713) were computed by Cox's proportional hazard regression with time-dependent covariates. Separate analyses were also performed to consider only at-fault accidents. RESULTS:: Marital separation or divorce was associated with an increased risk of a serious accident (all serious accidents: hazard ratio 2.9, 95% confidence interval = 1.7-5.0; at-fault accidents: 4.4, 2.3-8.3). The impact of separation and divorce did not differ according to alcohol consumption levels. Other life events associated with increased risk of serious accident were a child leaving home (all accidents: 1.2, 0.97-1.6; at-fault accidents: 1.5, 1.1-2.1), an important purchase (all accidents: 1.4, 1.1-1.7; at-fault accidents: 1.6, 1.2-2.1), and hospitalization of the partner (all accidents: 1.4, 1.1-2.0). CONCLUSION:: This study suggests that recent separation and divorce are associated with an increase in serious traffic accidents.

Background 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. Methods/Design 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. 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. 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. Discussion 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.