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Immigrants in Western countries have been particularly affected by the COVID-19 crisis.We analysed excess mortality rates among the foreign-born population and changes in their distinctive mortality profiles ("migrant mortality advantage") during the first pandemic wave in France.Deaths from all causes in metropolitan France from March 18 to May 19, 2020 were used, with information on sex, age, region of residence and country of birth. Similar data from 2016 through 2019 were used for comparisons.During the pre-pandemic period (2016-2019), immigrant populations (except those from Central and Eastern Europe) had lower standardized mortality rates than the native-born population, with a particularly large advantage for immigrants from sub-Saharan Africa. In the regions most affected by COVID-19 (Grand-Est and Île-de-France), the differences in excess mortality by country of birth were large, especially in the working-age groups (40-69 years), with rates 8 to 9 times higher for immigrants from sub-Saharan Africa, and about 3 to 4 times higher for immigrants from North Africa, from the Americas and from Asia and Oceania relative to the native-born population. The relative overall mortality risk for men born in sub-Saharan Africa compared to native-born men, which was 0.8 before the pandemic, shifted to 1.8 during the first wave (0.9 to 1.5 for women). It also shifted from 0.8 to 1.1 for men from North Africa (0.9 to 1.1 for women), 0.7 to 1.0 for men from the Americas (0.9 to 1.3 for women), and 0.7 to 1.2 for men from Asia and Oceania (0.9 to 1.3 for women).Our findings shed light on the disproportionate impact of the first wave of the pandemic on the mortality of populations born outside Europe, with a specific burden of excess mortality within the working-age range, and a complete reversal of their mortality advantage.

This study aims to describe the socio-demographic profile of so-called “key workers” during the first lockdown in France and to assess their potential occupational exposure to SARS-CoV-2 under routine, pre-pandemic working conditions. We used the French list of essential jobs that was issued during the first lockdown to identify three subgroups of key workers (hospital healthcare, non-hospital healthcare, non-healthcare). Based on the population-based “Conditions de travail-2019” survey, we described the socio-demographic composition of key workers and their potential work-related exposures (to “infectious agents,” “face-to-face contact with the public,” and “working with colleagues”) using modified Poisson regression. In general, women, clerical and manual workers, workers on temporary contracts, those with lower education and income, and non-European immigrants were more likely to be key workers, who accounted for 22% of the active population. Non-healthcare essential workers (57%) were the most socially disadvantaged, while non-hospital healthcare workers (19%) were polarized at both extremes of the social scale; hospital healthcare workers (24%) were intermediate. Compared to non-key workers, all subgroups had greater exposure to infectious agents and more physical contact with the public. This study provides evidence of accumulated disadvantages among key workers concerning their social background, geographical origin, and potential SARS-CoV-2 exposure.

Introduction Immigrants in the United States are less likely to smoke than those born in the United States, but studies have not fully described the diversity of their smoking patterns. We investigate smoking by world region of birth and duration of residence in the United States, with a comprehensive approach covering current prevalence levels, education gradients, and male-to-female ratios. Methods The data originate from the National Health Interview Surveys, 2000–2015, and the sample of 365 404 includes both US-born and foreign-born respondents aged 25–70 years. World region of birth and duration of residence in the United States measure immigrant characteristics. Current cigarette smoking was analyzed using logistic regression. Results Immigrant groups were protected from smoking and had weaker education gradients in smoking and larger male-to-female smoking ratios than the US-born population. However, large differences emerged among the immigrant groups for region of birth but less so for duration of residence in the United States. For example, immigrants from sub-Saharan Africa and the Indian subcontinent have low prevalence, weak education gradients, and high male-to-female ratios. Immigrants from Europe have the opposite pattern, and immigrants from Latin America fall between those two extremes. Conclusion The stage of the cigarette epidemic in the region of birth helps explain the diverse group profiles. Duration of residence in the United States does less to account for the differences in smoking than region of birth. The findings illustrate the heterogeneity of immigrant populations originating from diverse regions across the world and limited convergence with the host population after immigration. Implications The study identifies immigrant groups that, because of high smoking prevalence related to levels in the host country, should be targeted for cessation efforts. It also identifies immigrant groups with low prevalence for which anti-smoking programs should encourage maintenance of healthy habits. Many immigrant groups show strong education disparities in smoking, further suggesting that smokers with lower levels of education be targeted by public health programs.

Background: to date, little attention has been given to gender differences in the health of migrants relative to native-born. In this study, we examine the health profile of the largest immigrant groups in metropolitan France, considering several health indicators and with a special interest in the gendered patterns. Methods: The data originate from the 2017 Health Barometer survey representative of metropolitan France. A subsample of 19,857 individuals aged 18&ndash, 70 years was analysed using modified Poisson regression, and risk ratio estimates (RR) were provided for the different migrant groups regarding alcohol use, current smoking, obesity and less-than-good self-reported health, adjusting for age and educational level. Results: None of the groups of male migrants differs from the native-born in terms of self-reported health, and they have healthier behaviours for alcohol (men from sub-Saharan Africa: 0.42 (0.29&ndash, 0.61)) and from the Maghreb: 0.30 (0.1&ndash, 0.54)) and smoking (men from sub-Saharan Africa: 0.64 (0.4&ndash, 0.84)), with less frequent obesity (men from the Maghreb: 0.61 (0.3&ndash, 0.95)). The latter, however, more frequently report current smoking (1.21 (1.0&ndash, 1.46)). For women, less-than-good health is more frequently reported by the groups from sub-Saharan Africa (1.42 (1.1&ndash, 1.75)) and from the Maghreb (1.55 (1.3&ndash, 1.84)). Healthier behaviours were found for alcohol (women from overseas d&eacute, partements: 0.38 (0.1&ndash, 0.85)) and from the Maghreb: (0.18 (0.0&ndash, 0.57)) and current smoking (women from southern Europe: 0.68 (0.4&ndash, 0.97), from sub-Saharan Africa: 0.23 (0.1&ndash, 0.38) and from the Maghreb: 0.42 (0.2&ndash, 0.61)). Conversely, some were more frequently obese (women from overseas d&eacute, partements: 1.79 (1.2&ndash, 2.56) and from sub-Saharan Africa: 1.67 (1.2&ndash, 2.23)). In the latter two groups from Africa, there is a larger relative male excess for tobacco than in the native-born (male-to-female ratios of respectively 2.87 (1.6&ndash, 5.09) and 3.1 (2.0&ndash, 4.65) vs 1.13 (1.0&ndash, 1.20)) and there is a female excess for obesity (0.51 (0.2&ndash, 0.89) and 0.41 (0.2&ndash, 0.67)) in contrast with the native-born (1.07 (0.9&ndash, 1.16)). The female disadvantage in terms of less-than-good self-reported health is more pronounced among migrants from the Maghreb than among the natives (0.56(0.4&ndash, 0.46) vs. 0.86 (0.8&ndash, 0.91)). Conclusion: Considering a set of four health indicators, we provide evidence for distinctive gender patterns among immigrants in France. Male immigrants have a healthy behavioural profile in comparison with the natives and no health disadvantage. Female immigrants have a more mixed profile, with a health disadvantage for the non-Western groups from Africa. The contribution to this discordance of socioeconomic factors and gender relations needs to be investigated

Background France has one of the highest levels in Europe for early use of legal and illegal psychoactive substances. We investigate in this country disparities in adolescent problematic substance use by family living arrangement and parental socioeconomic group. Methods The data used were from the 2017 nationally-representative ESCAPAD survey, conducted among 17-year-olds in metropolitan France (N = 39,115 with 97% response rate). Prevalence ratios (PR) were estimated using modified Poisson regression. Results Adolescents living in non-intact families (44%) reported daily smoking, binge drinking and regular cannabis use (respectively ≥3 episodes and ≥ 10 uses in the last 30 days) much more frequently than those living in intact families (for example, the PR estimates for father single parent families were respectively 1.69 (1.55–1.84), 1.29 (1.14–1.45) and 2.31 (1.95–2.74)). Socioeconomic differences across types of families did little to explain the differential use. Distinctive socioeconomic patterns were found: a classical gradient for smoking (PR = 1.34 (1.22–1.47) for the most disadvantaged group relative to the most privileged); an inverse association for binge drinking (PR = 0.72 (0.64–0.81) for the most disadvantaged relative to the most privileged), and no significant variation for cannabis use. Conclusion Our findings shed light on the consistency of the excess use of adolescents from non-intact families and on the substance-specific nature of the association with parental socioeconomic group. Preventive approaches at the population level should be complemented by more targeted strategies.

International audience; Background : Migrants make up a growing share of European populations, and very little is known about the impact of migration on their smoking patterns. We develop a longitudinal analysis of smoking prevalence among native-born and immigrants in France based on retrospective data collected in the 2010 national Baromètre santé health survey. Methods : Analyses concerned 19 578 individuals aged 18–70 years and born in metropolitan France, in the Maghreb or in sub-Saharan Africa. Person-years with and without smoking were reconstructed using migration and smoking histories and analyzed with discrete-time regression models. Results : Prior to migration, immigrants from both the Maghreb and sub-Saharan Africa had lower smoking prevalence than the native-born of similar birth cohort, age and education. After migration, the prevalence increased over time among Maghrebin men up to levels beyond those of the native-born (odds ratio: 1.54 [1.09–2.17] for 10 years of residence or more), while it remained much lower throughout among men from sub-Saharan Africa (odds ratio: 0.36 [0.19–0.68] for 10 years of residence or more). Starting at extremely low levels, the prevalence in both groups of women rose considerably after migration. Women from sub-Saharan Africa nearly caught up to the native-born (odds ratio: 0.70 [0.37–1.32] for 10 years of residence or more), but this was not the case for those from the Maghreb (odds ratio: 0.52 [0.33–0.81] for 10 years of residence or more). Conclusion : The findings uncover the low pre-migration prevalence and the diversity of post-migration trajectories. Tobacco control programs targeting recently arrived migrants would contribute to prevent unhealthy assimilation.

Background The migrant mortality advantage is generally interpreted as reflecting the selection of atypically healthy individuals from the country of origin followed by the wearing off of selection effects over time, a process theorised to be accelerated by progressive and negative acculturation in the host country. However, studies examining how migrant mortality evolves over duration of stay, which could provide insight into these two processes, are relatively scarce. Additionally, they have paid little attention to gender-specific patterns and the confounding effect of age. In this study, we analyze all-cause mortality according to duration of stay among male and female migrants in France, with a particular focus on the role of age in explaining duration of stay effects. Methods We use the Échantillon Démographique Permanent (Permanent Demographic Sample; EDP), France’s largest socio-demographic panel and a representative 1% sample of its population. Mortality was followed-up from 2004 to 2014, and parametric survival models were fitted for males and females to study variation in all-cause mortality among migrants over duration of stay. Estimates were adjusted for age, duration of stay, year, education level and marital status. Duration of stay patterns were examined for both open-ended and fixed age groups. Results We observe a migrant mortality advantage, which is most pronounced among recent arrivals and converges towards the mortality level of natives with duration of stay. We show this pattern to be robust to the confounding effect of age and find the pattern to be consistent among males and females. Conclusions Our novel findings show an intrinsic pattern of convergence of migrant mortality towards native-born mortality over time spent in France, independent from the ages at which mortality is measured. The consistent pattern in both genders suggests that males and females experience the same processes associated with generating the migrant mortality advantage. These patterns adhere to the selection-acculturation hypothesis and raise serious concerns about the erosion of migrant health capital with increasing exposure to conditions in France. Electronic supplementary material The online version of this article (10.1186/s12889-019-6652-1) contains supplementary material, which is available to authorized users.

The study of changes in smoking behaviors over the life course is a promising line of research. This paper aims to analyze the temporal relation between family transitions (partnership formation, first childbirth, separation) and changes in smoking initiation and cessation. We propose a discrete-time logistic model to explore the timing of changes in terms of leads and lags effects up to three years around the event in order to measure both anticipation and adaptation mechanisms. Retrospective biographical data from the Santé et Itinéraires Professionnels (SIP) survey conducted in France in 2006 are used. Partnership formation was followed for both genders by a fall in smoking initiation and an immediate rise in smoking cessation. Childbirth was associated with increased smoking cessation immediately around childbirth, and additionally, females showed an anticipatory increase in smoking cessation up to two years before childbirth. Couple separation was accompanied by an anticipatory increase in smoking initiation for females up to two years prior to the separation, but this effect only occurred in males during separation. Our findings highlight opportunities for more targeted interventions over the life course to reduce smoking, and therefore have relevance for general practitioners and public policy elaboration.

International audience; BACKGROUND:Although the French population comprises large and diverse immigrant groups, there is little research on smoking disparities by geographical origin. The aim of this study is to investigate in this country smoking among immigrants born in either north Africa, sub-Saharan Africa or French overseas départements.METHODS:The data originate from the 2010 Health Barometer survey representative of metropolitan France. The subsample of 20,211 individuals aged 18-70 years (born either in metropolitan France or in the above-mentioned geographical regions) was analysed using logistic regression.RESULTS:Both immigrants from sub-Saharan Africa and immigrants from overseas départements were protected from smoking compared to the reference population, and the former had a distinctive strongly reversed educational gradient in both genders. Returned former settlers from the French colonies in North Africa (repatriates) had the highest smoking levels. Natives from the Maghreb (Maghrebins) showed considerable gender discordance, with men having both a higher prevalence (borderline significance) and a reversed gradient and women having lower prevalence than the reference population.CONCLUSION:Immigrants from regions of the world in stage 1 of the cigarette epidemic had relatively low smoking levels and those from regions in stage 2 had relatively high smoking levels. Some groups had a profile characteristic of late phases of the cigarette epidemic, and others, some of which long-standing residents, seemed to be positioned at its early stages. The situation for Maghrebins reflected the enduring influence of gendered norms post-migration. Based on their educational gradients, immigrants from overseas départements (particularly men) and Maghrebin women may be at risk of losing their particularly low prevalence. Immigrants from sub-Saharan Africa could retain it. In-depth analysis of smoking profiles of immigrants' groups is essential for a better targeting of smoking prevention and cessation programs.

This paper investigates age variations in foreign-born vs. native-born mortality ratios in an international comparative perspective, with the purpose of gaining insight into the mechanisms underlying the so-called migrant mortality advantage. We examine the four main explanations that have been proposed in the literature for the migrant mortality advantage (i.e., in-migration selection effects, out-migration selection effects, cultural effects, and data artifacts), and formulate expectations as to whether they should generate an increase, a decrease, or no change in relative mortality over the life course. Using data from France, the US and the UK for periods around 2010, we then examine typical age patterns of foreign-born vs. native-born mortality ratios in light of this theoretical framework. We find that these mortality ratios vary greatly by age, with important similarities across migrant groups and host countries. The most systematic age pattern we find is a U-shape pattern: at the aggregate level, migrants often experience excess mortality at young ages, then exhibit a large advantage at adult ages (with the largest advantage around age 45), and finally experience mortality convergence with natives at older ages. The explanation most consistent with this pattern is the "in-migration selection effects" explanation. By contrast, the "out-migration selection effects" explanation is poorly supported by the observed patterns. Our age disaggregation also shows that migrants at mid-adult ages experience mortality advantages that are often far greater than typically documented in this literature. Overall, these results reinforce the notion that migrants are a highly-selected population exhibiting mortality patterns that poorly reflect their living conditions in host countries.

The study investigates the life cycle patterns of educational inequalities in smoking according to gender over three successive generations. Based on retrospective smoking histories collected by the nationwide French Health Barometer survey 2010, we explored educational inequalities in smoking at each age, using the relative index of inequality. Educational inequalities in smoking increase across cohorts for men and women, corresponding to a decline in smoking among the highly educated alongside progression among the lower educated. The analysis also shows a life cycle evolution: for all cohorts and for men and women, inequalities are considerable during adolescence, then start declining from 18 years until the age of peak prevalence (around 25), after which they remain stable throughout the life cycle, even tending to rise for the most recent cohort. This analysis contributes to the description of the “smoking epidemic” and highlights adolescence and late adulthood as life cycle stages with greater inequalities.

The original four-stage model of the cigarette epidemic has been extended with diffusion of innovations theory to reflect socio-economic differences in cigarette use. Recently, two revisions of the model have been proposed: (1) separate analysis of the epidemic stages for men and women, in order to improve generalization to developing countries, and; (2) addition of a fifth stage to the smoking epidemic, in order to account for the persistence of smoking in disadvantaged social groups. By developing a cohort perspective spanning a 35-year time period in France and the USA, we uncover distinctive features which challenge the currently held vision on the evolution of smoking inequalities within the framework of the cigarette epidemic. We argue that the reason for which the model may not be fit to the lower educated is that the imitation mechanism underlying the diffusion of innovations works well with regard to adoption of the habit, but is much less relevant with regard to its rejection. Based on those observations, we support the idea that the nature and timing of the epidemic differs enough to treat the stages separately for high and low education groups, and discuss policy implications.

International audience; Financial transfers from parents to their adult children are a growing trend in contemporary societies, and this study investigates the relation of those transfers to their beneficiaries' health in France. In the 2005 nationally representative Gender and Generation Survey, nearly 6% of the subjects aged 25–49 years reported having received financial transfers during the last 12 months. Subjects who had achieved intergenerational upward mobility as well as those who had remained in the upper class were more likely to receive transfers, suggesting that parents rewarded those of their children who achieved most social success. After adjusting for a wide range of socio-demographic factors, subjects who had been given large transfers were much more likely to report very good health than subjects who had not been given anything. Findings were interpreted within the framework of sociological research on intergenerational transfers and that of lifecourse epidemiology.

Background Depressive mood has been associated with all-cause mortality in both men and women. This study aimed at exploring gender differences in the association between depressive mood and specific causes of mortality as well as factors that may account for it, including education, marital status, social support, health behaviors, and chronic diseases. Methods A population-based survey including 6043 subjects (2892 men and 3151 women) was conducted in 1996 in the north-east of France with a questionnaire covering education, marital status, social support, health behaviors (smoking status, alcohol consumption, body mass index), and chronic diseases. Depressive mood was measured using the Duke Health Profile questionnaire. Cox regression models were used to examine its association with subsequent natural all-cause mortality, and cardiovascular and cancer mortality. Results During a follow-up of 12.5 years, 406 men and 303 women died from a natural cause. Adjusting for all covariates, depressive mood predicted natural mortality in both men [Hazard Ratio (HR) = 1.30; 95% confidence interval (CI): 1.00–1.69] and women (HR = 1.37; 95% CI: 1.06–1.77). However, this association was significant for cardiovascular mortality in men (HR = 1.63; 95% CI: 1.00–2.65) whereas it was significant for cancer mortality in women (HR = 1.71; 95% CI: 1.11–2.64). Limitations Baseline data were self-reported and the response rate was low. Discussion Preventive strategies aiming at reducing the increased mortality associated with depressive mood should take gender into account. Depressed men may warrant a better screening for cardiovascular risk factors and diseases, whereas depressed women may benefit from better cancer prevention measures.

International audience; This study investigates the relation between early life conditions and adult obesity in France, using a rich data set collected through the 2003 nationally representative Life History Survey. No salient factor emerged in men, while in women, after controlling for current socio-demographic characteristics, a relation was found between obesity and the following factors: father's occupation (OR=3.2 for women whose father was a clerical worker, versus those whose father was in a higher-level occupation); experience of economic hardship in childhood (OR=2.0), and; high parity (OR=2.1 for parities of more than 3 versus parity of 1). Neither early family history nor mother's working status surfaced as significant factors. Those findings highlight a definite gender pattern, with a strong association between early disadvantage and obesity in women, but not in men. Potential mechanisms are discussed, particularly the "habitus", the "thrifty phenotype" and the "feast-famine" hypotheses, and possible interactions with childbearing and motherhood. An integration of social and biological perspectives is needed to reach a better understanding of the processes involved, and to achieve progress in primary and secondary prevention.

International audience; Using contributions from the fields of interactionist sociology and narrative studies and the results of an empirical study, in this article we examine the subject's mediation between life events and state of health. Examining narratives focusing on significant life events from 26 men and women aged between 51 and 73 from the administrative region of Ile de France, we suggest that dimensions of meaning and coherence of self need not be taken as internal dispositions, but rather as the product of sociocognitive work on self-narration. The characterisation of the types of causal relationships that the narrators establish between significant events and other events, situations or periods in their lives, opens up avenues for the development of a methodological tool to replace traditional ways of measuring sense of coherence and meaning/purpose in life using psychometric methods. This alternative perspective based on a conception of the self as narrative might provide a remedy for certain conceptual and methodological difficulties that are found within the field of coping research.

The diffusion of cannabis initiation has been accompanied by a reversal in the educational gradient: contrary to older generations, the less educated in recent generations are more likely to initiate than the more educated. We tested whether the educational gradient for the transition from initiation to daily use evolved in the same way.A French telephone random survey conducted in 2010 (21 818 respondents aged 15-64 years), asking interviewees about their ages at initiation to daily use, if any.A total of 6824 cannabis initiators aged 18-64 years at data collection. Three birth cohort groups (generations) were compared: 1946-60 (n = 767), 1961-75 (n = 2632) and 1976-92 (n = 3425) with, respectively, 47, 42 and 45% of women.Risks of transition to daily use from ages 11-34 were compared through time-discrete logistic regressions and educational gradients were quantified through a relative index of inequality (RII). Control variables include age and time-varying variables (ages at tobacco daily use, at first drunkenness and at first other use of an illicit drug in a list of 13 products).Twenty-four per cent of the initiators reported daily use before age 35, the proportions tripling from the oldest to the youngest generation (from 11.7 to 38.6% in men, from 7.7 to 22.2% in women). Whatever the generation, the less educated initiators more often shifted to daily use than the most educated: from the oldest to the youngest generation, RII = 2.13, 95% confidence interval (CI) = [0.65, 7.02]; 2.19 95% CI = [1.33, 3.63]; and 2.24, 95% CI = [1.60, 3.15] in men; RII = 3.31, 95% CI = [0.75, 14.68]; 3.17, 95% CI = [1.49, 6.76]; and 3.56, 95% CI = [2.07, 6.14] in women, respectively.In France, the risk of transition from cannabis initiation to daily use has remained consistently higher among less educated cannabis initiators over three generations (1946-60, 1961-75, 1976-92), in contrast to what is observed for initiation.

International audience; PurposeTo assess the prevalence of polypharmacy and frailty, to examine their association, and to establish their independent and combined effects on mortality in a sample of French old people. MethodsThis is a cross-sectional population study of people aged 70years and over. A total of 2350 respondents were interviewed at home in 2008-2010. Frailty was defined as impairment in three domains or more among nutrition, energy, physical activity, strength, and mobility, in the absence of difficulties in basic activities of daily living. Mortality data were documented after a mean follow-up period of 2.6years. ResultsMean age of the population was 83.3+/-7.5years, with 59.4% of women. Prevalence of frailty was 17.0%. Polypharmacy (5-9 drugs) was reported in 53.6% of the population, and excessive polypharmacy (10 drugs or more) in 13.8%. After adjustment for socio-demographic and health variables, polypharmacy and excessive polypharmacy were associated with frailty with odds ratio 1.77 [1.20-2.61] and 4.47 [2.37-8.42], respectively. Frailty (hazard ratio [HR] 2.56 [1.63-4.04]) and excessive polypharmacy (HR 1.83 [1.28-2.62]) were independent predictors of mortality. Compared with non-frail people without polypharmacy, frail people with excessive polypharmacy were six times more likely to die during the follow-up period (HR 6.30 [3.09-12.84]). ConclusionBy showing the independent and combined effects of polypharmacy and frailty on mortality risk, this study should reinforce the awareness of clinicians with regard to these factors, rather prevalent in old peopl

Objective: To measure the impact of AIDS on adult mortality by systematically investigating all deaths during 3 months, in the city of Pointe-Noire where the HIV epidemic emerged 20 years ago and levelled-off around 5% among adults. Design: Exhaustive morgue-based study, in a city where by law all bodies should be registered at the morgue before they can be legally buried. Methods: From 30 June to 19 October 2001, a clinical examination of all bodies registered at the morgue was performed by a physician, and blood samples were systematically drawn for HIV testing. Relatives were interviewed on circumstances of death. Additional information was gathered from hospital files for cases previously hospitalized. Age- and sex-specific mortality rates were calculated using the population at risk derived from the 2001 census. Results: Overall, 1309 adult deaths were investigated and 96.5% of the bodies registered at the morgue were tested for HIV. Forty-five percent of the deaths (570) were due to AIDS. The HIV prevalence was higher in female than in male deaths (57.1 versus 44.8%; P < 0.001). The AIDS-mortality rate among adults was 6.3 per thousand for women and 4.9 per thousand for men. Among 1000 young adults aged 15 years, 442 girls and 482 boys will not reach age 60 years (45q15). Without AIDS these would have been 216 and 307, respectively. Conclusions: Our study provides a direct measure of the impact of AIDS on mortality relative to other causes. In the most productive age group, 25-44 years, mortality is tripled by AIDS.

OBJECTIVES:: The extent to which HIV affects pregnancy-related mortality in countries with high HIV/AIDS and maternal mortality is poorly understood. The objectives of this study were to investigate the mortality of women of reproductive age by both HIV and pregnancy status, and quantify the excess mortality attributable to HIV during pregnancy in Pointe Noire, Congo. DESIGN:: Prospective mortuary investigation of all deaths in women aged 15-44 years, during 112 consecutive days. METHODS:: Mortality rates by HIV and pregnancy were computed. During the study period, 378 corpses were examined, blood was tested for HIV and pregnancy, relatives were interviewed and hospital files were reviewed. Denominators were obtained from a census with women-years assigned to pregnancy and/or HIV based on levels of fertility and HIV prevalence in the city. RESULTS:: The mortality rate was 32 times higher [95% confidence interval (CI), 25-39] among HIV-positive than among HIV-negative women. The relative increase in mortality associated with HIV was much higher in non-pregnant [rate ratio (RR), 41; 95% CI, 32-52] than in pregnant women (RR, 4; 95% CI, 2-9). Among HIV-positive women, pregnancy appeared to confer a survival benefit. CONCLUSION:: These findings have important implications for the interpretation of trends in maternal mortality in the context of HIV. The apparent survival benefit of pregnant HIV-positive women is largely due to their low fertility in the latest stage of the disease. As the HIV epidemic matures and more women become severely ill, any potential adverse effects associated with HIV and pregnancy may be increasingly offset by selection effects, and maternal mortality may not increase further.

a b s t r a c t Background: Cannabis is the most popular illicit drug in the world, but the process of its diffusion through the population has rarely been studied. The unfolding of the tobacco epidemic was accompanied by a shift in the educational gradient of users across generations. As a consequence, cannabis may show the same pattern of widening social inequalities. We test the diffusion hypotheses that a positive value in older cohorts - the more educated experimenting more - shifts to a negative one in younger cohorts - the more educated experimenting less, first for males and then females. Methods: Three nationwide subsamples (18-64 years old) of representative surveys conducted in France (n = 21,818), Germany (n = 7887) and USA (n = 37,115) in 2009-2010 recorded age at cannabis experimen- tation (i.e., first use), educational level, gender, and age. Cumulative prevalence of experimentation was plotted for three retrospective cohorts (50-64, 35-49, 18-34 years old at data collection) and multivariate time-discrete logistic regression was computed by gender and generation to model age at experimen- tation adjusted on age at data collection and educational level. This latter was measured according to four categories derived from the International Standard Classification of Education (ISCED) and a relative (rather than absolute) index of education. Results: The findings demonstrate a consistent pattern of evolution of the prevalence, gender ratio and educational gradient across generations and countries that support the hypothesis of an "epidemic" of cannabis experimentation that mimics the epidemic of tobacco. Conclusion: We provide evidence for a cannabis epidemic model similar to the tobacco epidemic model. In the absence of clues regarding the future of cannabis use, our findings demonstrate that the gender gap is decreasing and, based on the epidemic model, suggest that we may expect widening social inequalities in cannabis experimentation if cannabis use decreases in the future.

This study investigates the evolution of educational disparities in smoking uptake across cohorts for men and women in three countries. Nationally representative surveys of adults in France, Germany and the United States in 2009–2010 include retrospective measures of age of uptake that are compared for three cohorts (born 1946–1960, 1961–1975, and 1976–1992). Discrete logistic regressions and a relative measure of education are used to model smoking histories until age 34. The following patterns are found: a strengthening of educational disparities in the timing of uptake from older to younger cohorts; an earlier occurrence of the strengthening for men than women and for the United States than France or Germany; a faster pace of the epidemic in France than in the United States, and; a divide between the highest level of education and the others in the United States, as opposed to a gradient across categories in France. Those differences in smoking disparities across cohorts, genders and countries help identify the national and temporal circumstances that shape the size and direction of the relationship between education and health and the need for policies that target educational disparities.

BACKGROUND: Although it is generally believed that pregnancy exposes women to a wide variety of excess health risks that go beyond the direct obstetric complications of pregnancy, the epidemiological evidence in support of such excess indirect risks is inconclusive. In this article we attempt to document the contribution of indirect causes of death to maternal mortality in rural Senegal by using an epidemiological approach whereby the time spent during pregnancy and postpartum is considered a transient period of exposure to the health hazards of childbearing. METHODS: We use data from an ongoing demographic surveillance system in Niakhar, Senegal and calculate rate ratios comparing death rates in pregnant or recently pregnant women (exposed) with death rates in other women (unexposed), including and excluding direct obstetric deaths. RESULTS: Between ages 20 and 44, pregnancy does not confer additional risks to women. After excluding direct obstetric deaths, exposed women aged 20--39 have surprisingly lower risks of death than unexposed women of the same age. For the very young (15-19) and the very old (45-49), on the other hand, the excess risks associated with pregnancy are considerable and, among women age 45 or older, persist even after excluding direct obstetric deaths. CONCLUSION: The apparent protective effect of pregnancy on women's health that is observed in this study illustrates the paradoxical nature of the concept of indirect causes of maternal mortality, and the difficulties in measuring the risks of death attributable to the pregnancy. Further studies aimed at separating risks attributable to the pregnancy from those that are incidental to the pregnancy are required.

ObjectiveTo review studies on the morbidity, mortality and nutrition of migrant populations in France.DesignA systematic search of the bibliographic database Medline, and direct contact with associations and institutions concerned with migrants' health.ResultsIn France, as in other host countries, migrants belong to the lowest socio-economic strata. They have on average better health and lower mortality than the local-born population. Health benefits are particularly noticeable in Mediterranean men, especially for affluence-related diseases such as cancer and cardiovascular diseases. North African men smoke as heavily as the local-born of the same occupational categories, and yet their mortality rates from lung cancer are notably lower. Such a paradox may be the result of a synergy between different phenomena such as the selection of the fittest applicants for immigration and the maintenance of healthy lifestyles from the countries of origin. In contrast, migrant women do not enjoy the same health advantages, possibly because they are less likely to be selected on the basis of their health and because they are often non-working. Adult migrants from southern Europe and North Africa report dietary practices consistent with the typical Mediterranean diet, which is renowned for its positive effects on health.ConclusionsThe diet of Mediterranean adults living in France may partly explain the low rates of chronic diseases and high adult life expectancy observed in migrant men from northern Africa. Information about their diets might provide clues for the design of nutritional education campaigns aimed at low-income people.

Little is known about the nature of diseases aggravated by pregnancy or the magnitude of mortality from causes indirectly related to pregnancy. This study aims at clarifying the contribution of indirect causes to maternal mortality by analyzing the problem from an epidemiologic perspective, using population-based data from Matlab, Bangladesh, for the period 1976-1993. The time spent during pregnancy and the puerperium was considered a transitory exposure period in women's lives, and death rates were calculated for women aged 15-44 years, while exposed and while not exposed. During or shortly after pregnancy, death rates from all causes are more than twice as high as outside this period. Once direct obstetric causes and injuries are excluded, the death rates among women while exposed are substantially lower than the death rates among women while not exposed. Several interpretations of this finding are discussed, particularly the role of selective factors ("healthy pregnant woman effect"?). This study highlights the complexity of the concept of indirect causes of maternal mortality and clearly illustrates the inherent difficulties in estimating the excess risk of death attached to pregnancy and the puerperium.This study aims to clarify the contribution of indirect causes to maternal mortality by analyzing the problem from an epidemiological perspective, using population-based data from Matlab, Bangladesh, for the period 1976-93. The time spent during pregnancy and the puerperium was considered a transitory exposure period for women's lives, and death rates were calculated for women aged 15-44 years old, while exposed and not exposed. During or shortly after pregnancy, death rates from all causes are more than twice as high as outside this period. Once direct obstetric causes and injuries are excluded, the death rates among women while exposed are substantially lower than the death rates among women while not exposed. Furthermore, this study was able to highlight the complexity of the mere concept of indirect causes of maternal mortality and clearly illustrates the inherent difficulties in singling out deaths attributable to pregnancy and the puerperium. Deaths from accidents, suicides, or homicides are not usually considered due to the pregnancy, yet they may be indirectly related to the pregnancy. Moreover, even if the changing physiology during pregnancy is associated with an aggravation of certain diseases, the corresponding excess risk cannot be quantified because those diseases are likely to reduce female fertility, be it for physiologic or behavioral reasons.

This study investigates the sociodemographic factors associated with self-report of common mental problems by the psychologically distressed in order to gain insight into the profile of the population subgroups least likely to receive mental health support whenever needed. Data from the 2006–2008 french National Survey on Health, Health Care and Insurance, were used, measuring psychological distress based on the Mental Health Inventory MHI-5. The patterns associated with education, employment situation and living arrangement were investigated in a sample of 11,543 subjects aged 30–54 years. Men with lower educational level were found to be doubly disadvantaged, as they were more subjected to distress than those with higher educational level and at the same time less likely to report common mental problems whenever distressed. While in both genders subjects not living with a spouse and non-employed subjects were also more subjected to distress, they were more likely than the others to report common mental problems in presence of distress. The findings were discussed in terms of living conditions, stigma, mental health literacy and help-seeking behaviour. Mental health promotion programmes should aim at educating the public, and particularly men and the lower educated public, on the signs of distress and their significance.

International audience; This study explores mortality related to temporary employment, about which very little is known to date. In 1996, a health survey was carried out in the French region of Lorraine, and all members of 8,000 randomly chosen households were followed up for mortality over a 13-year period. Mortality of subjects in relation to their employment situation at baseline was analysed using a Cox survival regression. In comparison with permanent workers, for unemployed men, we found age and occupation-adjusted hazard ratios (HR) of 4.1 for all-causes of death and 3.9 for non-violent causes, and for male temporary workers a HR of 2.2 for both all-causes and non-violent causes of death. Bad health, tobacco smoking and alcohol misuse explained 17 % of the excess risk for the unemployed and 41 % of that for temporary workers. The observation of large mortality inequalities across the labour market core-periphery structure has important policy implications, particularly in terms of prevention focused on unhealthy behaviours among male unemployed and temporary workers.

International audience; Heterogeneity in time and risk preferences has been proposed as one of the mechanisms involved in the educational gradient in smoking, but this mechanism has scarcely been explored empirically. Subjective scales were introduced in the 2008 French National Health, Health Care and Insurance Survey in order to elicit measures of time and risk preferences for a representative sample of 5188 men and 5684 women. Men and women were treated separately. First, logistic regressions were used to test the associations between preferences and education and between preferences and smoking. Second, nested logistic models were built to investigate the mediating role of preferences in the educational gradient in smoking, with an econometric treatment of the rescaling problem. Preference for the present and risk loving were found to be: inversely related to educational level; strongly related to each other, and; strongly associated to current smoking, even after adjustment for educational level. There was a weakening of the educational gradient after the control for preferences, which supports the role of these two preferences as partial mediators in the educational gradient in smoking. Among men, time preference was more strongly associated with smoking than risk aversion, while the reverse was found for women. We provide convincing evidence in favour of the mediating role of time preference and risk aversion in educational inequalities in smoking and highlight the connection between those two dimensions. Gender patterns are discussed and potential implications in terms of designing targeted anti-tobacco programmes are delineated.

Migrant populations comprise substantial numbers of individuals who have undergone a change in their environment, sociocultural and physical. The corresponding changes in risk for different cancers have, therefore, been widely used to infer the relative importance of environmental factors versus inherited predisposition in cancer aetiology. The uncontrolled experiment of migration also provides an indication of the possible effects of certain preventive interventions at the population level--especially with respect to diet. In the past, there has been a surprising lack of attention to analytical methods for migrant data, and we review the epidemiological methods available to best bring out the relevant differences in risk. The major sources of bias which confuse interpretation are also described. Migrant studies are classified into four groups, in a hierarchy corresponding to the amount of information which they can provide, and examples of each type are provided.

Whether non-European Mediterranean populations also benefit from the protective effect on health of the so-called Mediterranean diet is not know yet, as national mortality statistics are available in neither North Africa nor the Near East. This article investigates the cancer profile of Maghrebian and Near Eastern migrants, by gathering and discussing data from recent studies on cancer mortality in Mediterranean migrants of various origins in France and Australia. In France, the migrants originating from Morocco, and in Australia, the migrants originating from the Near East, have a lower mortality from all cancers than their host countries and than Italian migrants. Concerning specific sites, Moroccan and Near Eastern migrants have a cancer profile which is quite similar to that of the Italian migrants, with relatively low risks compared with the local-born for certain cancers typical of affluent societies (colon and rectum, breast, ovary, and prostate). In addition, the non-European Mediterranean migrants are protected even more than the Italians in the same host country from esophagus cancer, and Moroccans in France have a much lower risk than the local-born for lung cancer. Lastly, they tend to have a relatively high risk for some cancers which are likely to have a viral etiology: e.g., nasopharynx (Italians and Near Easterners), liver (Near Eastern males), and possibly cervix (Moroccans).

The cancer risk in migrants from China and South-east Asia (Vietnam, Laos and Cambodia) resident in France has been compared to that observed in the local-born population, using mortality data from the period 1979-1985 and population data from the 1982 French census. Risks were adjusted for important confounding factors such as social standing and area of residence. Compared to local-born, South-east Asian migrants of one sex or of both sexes combined have higher risks of cancer of the nasopharynx, stomach, liver, gallbladder, lung (in females only), and cervix. On the other hand, South-east Asian migrants have lower risks of cancer of the oral cavity, other pharynx, colon, rectum, larynx, lung (among males only), bladder, nervous system, breast and prostate. Within this group, the risks are quite similar for Vietnamese, Laotians and Cambodians. Results for Chinese-born migrants are quite similar, for most sites, to those found among South-east Asian migrants, although, because of smaller numbers, few of the estimates are statistically significant. These results are consistent with other studies on Chinese migrants around the world, and with the 3 other previous studies on Vietnamese migrants, in England and Wales, Los Angeles and Australia.

This study explores whether the family socio-economic status (F-SES) and school situation could have an impact on tobacco and cannabis initiation and transition to daily use during adolescence.A French cross-sectional nation-wide survey conducted in 2005 containing retrospective data.French teenagers aged 17 (n = 29 393).The F-SES was defined by the highest occupational category of either parent, with seven categories ranging from unemployed/inactive to managers/professionals. Ages at repeat school years, at leaving school, at the first episode of drunkenness and at initiation of illicit drug use were used to model tobacco and cannabis initiation and transition to daily use with time-discrete logistic regressions.The risk for tobacco initiation was almost equally distributed across F-SES groups, but the risk of a progression to daily use was higher in every F-SES category compared to managers/professionals [odds ratio (OR) from 1.17 to 1.90]. Compared to managers/professionals, risk of cannabis initiation was lower in all F-SES categories (OR from 0.63 to 0.87), but all categories except farmers were at increased risk of transition to daily use: the OR range between 1.29 (intermediate) and 1.98 (unemployed/inactive). Repeating school years and leaving school predicted daily use of tobacco (OR = 2.00 and 2.37) and cannabis (4.58 and 2.07).Adolescents from the highest family socio-economic status categories are at risk for tobacco and cannabis experimentation but are less prone to engage in daily use. Psychological and social mechanisms that inhibit transition to daily use should be investigated, including school attainment and performance.

Purpose To investigate the influence of the family socioeconomic status (F-SES) on various intensities and frequencies of cannabis use in late adolescence. Design/Settings/Participants Data were obtained from a cross-sectional survey conducted in 2008, which was representative of French youth aged 17(n = 39,542). Outcomes were overall use (abstinence, lifetime use, 1–9, and 10+ uses in the past year) for all adolescents, and frequent use for those who smoked cannabis at least 10 times in the past year (≤9, 10–19, 20+ uses in the past month). Additionally, cannabis use disorders and heavy use (having smoked at least 4 joints last time) were studied among previous-year users. F-SES was the highest occupational category of both parents (in 7 categories, from managers/professionals [used as the reference category] to inactive/unemployed). Multinomial logistic regressions were computed controlling for gender; other substances use; parental separation; parental use of alcohol, tobacco, and cannabis; housing, being out of school, and sociability. Findings For overall use , we found a strong positive social gradient: the lower the F-SES or the higher the frequency of use, the lower the odds ratio (OR) (from .85 to .52 for 10+ uses in the past year among farmers). For frequent use , we found a strong negative gradient: the lower the F-SES category, the higher the OR (from 1.02 to 2.05 among inactive/unemployed), and likewise for cannabis use disorder and heavy use (OR = 1.85 and 2.03 among inactive/unemployed). Conclusions Adolescents from affluent families are more prone to experimentation with cannabis and to use it at low levels but present lower levels of frequent, heavy, or problematic use than those from other SES categories. Mechanisms that hinder transition to intensive use should be investigated.

Aims This study investigates the evolution of educational inequalities in smoking initiation and cessation in France according to gender and birth cohort. Methods We used a 2005 nationwide survey comprising 25,239 subjects aged 18–75 years. Three cohort groups were defined (born 1930–1945, 1946–1965 or 1966–1987). We compared their smoking histories until age 40 years with time-discrete logistic regressions. Educational differences in initiation and cessation were quantified using odds ratios and relative indices of inequality (RII), and the gender gap using odds ratios (gender ratios). Results For smoking initiation, in the oldest cohorts, no educational gradient appeared in men, but there was a positive gradient in women (RII = 0.19); in the middle cohorts, a negative gradient emerged in men (RII = 1.55), while the positive gradient reduced in women (RII = 0.74); in the youngest cohorts, there was a strengthening of the negative gradient in men (RII = 2.72), and the emergence of a negative gradient for women (RII = 1.86). The gender ratio narrowed from the oldest cohorts (3.23) to the youngest (1.09), and diminished with increasing educational level within each cohort. For smoking cessation, the educational gradients were negative in both genders, with wider gaps in the youngest cohorts, and gender ratios below 1 reflecting more marked cessation dynamics in women. Conclusion Women are at an earlier stage in the tobacco epidemic than men for initiation and at a later stage for cessation and social inequalities are widening. We believe that they will not decrease unless gender and the psycho-social aspects of smoking are considered in prevention campaigns.

Using both mortality and incidence data, cancer risk in Italian, Spanish and Portuguese migrants to São Paulo were compared with those in the Brazil-born population, and with those in their countries of origin. Italian and Spanish migrants show changes in cancer risks which are rather similar to those observed in migrants of the same origin in other parts of South America: they increase their rates of oropharyngeal, oesophageal, cervical and breast cancers and they decrease their rates of lung cancers. However, for cancer of the oesophagus, the changes are greater in São Paulo, where migrants acquire rates similar to those of the natives. For colon cancer, rates in Italian migrants decrease in the low risk area of São Paulo and increase in the high risk area of Argentina. Changes in Portuguese migrants are less evident: their rates of colorectal cancer remain high, and, as found for Japanese migrants in São Paulo, they also retain their higher risks of stomach cancer.

International audience; Aims:Various types of musculoskeletal disorders (MSDs) have comorbid mental disorders, which may in turn have a negative influence on disease course and role impairment, but the contribution of social factors to this type of comorbidity is a much under-researched area. This study investigates whether there is a socially patterned association of MSDs with different dimensions of mental malaise. Methods: The sample included 3,368 economically active participants aged 18—64 years, randomly selected from the Lorraine region in north-eastern France. Information was provided through a post-mailed questionnaire on fatigue, sadness/depression (Duke questionnaire) and cognitive disability during the last eight days. Results: MSDs were significantly more prevalent in manual workers, clerks and other occupations than in upper and intermediate professionals, and similar occupational disparities were found for cognitive disability, fatigue and sadness/ depression. Stratifying the sample, we found the occupational disparities in cognitive disability to be much stronger among participants suffering from MSDs than among participants not suffering from MSDs, and the occupational disparities in fatigue and sadness/depression to be limited to the subsample of subjects suffering from MSDs. Conclusions: The findings demonstrate that the association of MSDs with mental malaise is much stronger in the lower occupational groups than in the higher groups. Given that psychological factors are implicated in disease prognosis and in the development of disabilities, awareness of the social dimension of the association and treatment of the comorbid mental disorders could open a promising avenue for reducing social inequalities in disability related to MSDs.

International audience; PURPOSE: To assess the association between physical job demands (PJD) and physical/cognitive functional limitations, and the role of adverse health behaviours, obesity, and socio-demographic factors as confounders of those associations. METHODS: The sample included 3,368 active subjects aged 18-64 years, randomly selected from North-eastern France. Subjects completed a post-mailed questionnaire. PJD score was defined as the product of years of employment with the cumulative number of a wide range of high job demands. Data were analysed through the logistic regression models. RESULTS: The physical and cognitive functional limitations affected 16.9 and 28.6% of subjects, respectively. A strong relationship was found between PJD and physical functional limitation: significant odds ratios (OR) adjusted for all the factors studied 1.41 for PJD1-29, 1.72 for PJD30-99, and 2.57 for PJD >or=100 versus PJD0; and between PJD and cognitive functional limitation: OR 1.28 for PJD1-29, 1.60 for PJD30-99, and 2.00 for PJD >or=100 versus PJD0. Adverse health behaviours, obesity and job category were modest confounders of those associations. CONCLUSIONS: This study identified a wide range of job demands and individual characteristics related to physical/cognitive functional limitations. Prevention should aim at improving working conditions and adverse health behaviours.

Cholangiocarcinoma (CCA) is one of the most common cancers in north-east Thailand and has been associated with infestation by the liver fluke Opisthorchis viverrini (OV). Two samples of 12-hr overnight urine (after dosing with proline and ascorbic acid or proline alone) were collected from 20 inhabitants from each of 5 contrasting incidence areas for CCA. The incidence of CCA was not correlated with either the amount of NPRO or other nitrosamino acids, endogenous nitrosation potential (difference in NPRO levels between proline dose and proline and ascorbic dose), or nitrate level. However, when urinary levels of nitrosamino acids were compared in subjects living in high-risk areas, subjects who were positive for OV antibody excreted significantly more (p less than 0.01) NPRO (12.3 +/- 18.7 micrograms/12 hr) after proline ingestion than those who were negative (3.5 +/- 3.2 micrograms/12 hr). After ingestion of ascorbic acid, the NPRO levels in the positive subjects were significantly reduced (p less than 0.01) to 2.4 +/- 2.0 micrograms/12 hr, suggesting that endogenous nitrosation of proline was inhibited. Thus, endogenous nitrosation potential estimated from the difference between NPRO and the sum of nitrosamino acids excreted in the 2 urine samples was significantly higher in subjects positive for the OV antibody. Small amounts of pre-formed nitrosamines were found in fermented fish and pork food items, which are consumed frequently in the high-risk area for CCA. These results suggest that the interaction between chemical carcinogens, especially nitrosamines, and OV infestation may play a role in the development of cholangiocarcinoma in Thailand.

Potential risk factors for cholangiocarcinoma were investigated in a case-control study among inhabitants of north-east Thailand, which included 103 cases from 3 hospitals, with age- and sex-matched controls. A clear association with past or present infection with Opisthorchis viverrini, as indicated by raised serum antibodies, was found (o.r. 5.0), and at least two-thirds of cases can be attributed to this cause. The results suggest that males may be at higher risk than females. There was no association with hepatitis B infection, with aflatoxin intake as estimated from albumin adducts in serum or with any particular dietary patterns. Alcohol consumption was very low in the population, and the risk associated with regular drinking was non-significant. Regular users of betel nut-predominantly female-had a high risk (o.r. 6.4), a possible mechanism being through their increased exposure to nitrosamines.

Background and objectives: Health selection into unemployment may be either direct or operate by reference to health-related behaviours rather than health per se (indirect selection). Panel data are desirable to investigate selection effects, and the two types of selection processes may be concurrent. We examine jointly the roles of health and health-related behaviours as precursors of unemployment, in order to disentangle direct from indirect selection processes. Design: The data of a multi-round nationally representative health survey in France were analysed longitudinally, based on three data collection rounds: 1992–5, 1996–8 and 2000–2. Following employees salaried in the private sector and aged 30–54 years at baseline, we explored through logistic regression the influence of non-optimal self-rated health, smoking and obesity on the risk of being found unemployed 4 years later. Results: After adjustment for self-rated health, obesity was found to be a significant precursor of unemployment in women, and heavy smoking had that role in men. After adjustment for smoking and obesity, poor health at baseline was found to be a significant precursor of unemployment in both genders. Conclusion: Those findings confirm the intrinsic role of poor health and of health-related behaviours as precursors of unemployment, with gender-specific patterns for the latter. Public policy prescriptions regarding employees’ protection from job insecurities should integrate appropriate accommodations of health limitations, and the personal factors underlying unfavourable work and health behaviours should be investigated, in order to thwart indirect selection phenomena.

Data on the incidence of 15 cancers in the Jewish population of Israel from the period 1961-1981 have been studied with emphasis on the risk of disease in relation to birthplace, calendar time, and duration of residence in Israel. The results show wide variations in incidence by birthplace, from less than 2-fold for pancreatic cancer to a 40-fold difference for oesophageal cancer in females; the reasons for these are often little understood. The potential importance of environmental agents in aetiology for different migrant groups is discussed in relation to the size and rapidity of changes in risk related to the duration of residence in Israel.

To compare family reports of pregnancy status in deceased women with a biological assessment of pregnancy using a post-mortem beta-HCG test.We investigated the deaths of females of reproductive age registered at the Pointe Noire morgue from June 30 to October 18, 2001. A physician interviewed relatives about the circumstances of death, in particular whether the woman had been pregnant at the time of death, and whether she had delivered or had an abortion (induced or spontaneous) within the past 6 weeks. The bodies were then examined and blood samples taken for beta-HCG testing.Among 368 deaths of women of reproductive age registered, 34 deaths were identified as pregnancy-related: 23 by both the family interview and the beta-HCG test, five by beta-HCG test only and six were beta-HCG negative but the family had reported a recent delivery.In this setting, the approach based on family reports underestimates mortality during pregnancy by 24% and mortality during pregnancy or within 6 weeks postpartum by 15%.

There is no evidence about an association between violent deaths and HIV in Africa. We report the results of a study performed in Pointe-Noire, Congo, where post-mortem HIV serologies were performed among all deaths referred to the morgue. The HIV prevalence among violent deaths was 37%, significantly higher than 10% among accidental deaths, with an adjusted odds ratio of 6 (P = 0.03). Prevention of domestic violence and fight against stigmatization should be parts of HIV programs in Africa.

Child mortality estimates in Beirut are presented for the late 1970s and the mid 1980s, and changes in socio-religious differentials of mortality across time are investigated.Baseline information was obtained from maternity registries in Beirut in 1984 and 1991. Age of mother, number of children ever born and number of children alive, hospitalization class (1, 2 or 3 within each hospital, depending on the room rate, the services and the doctor's fees), and religion of newborn was recorded. Brass and Macrae's technique was used to convert the proportion dead among children ever born to mothers in age group 30-34 into 5q0 estimates for the reference periods 1978 (1984 data) and 1985 (1991 data). Using hospitalization class as a proxy for social class, religious differentials in child mortality were explored by logistic regression analysis within each period.Overall, 5q0 is estimated at 46 per 1000 in the late 1970s, and at 36 per 1000 in the mid 1980s. The religious differentials in 5q0 mortality estimates were quite large in the former period, with a risk for Muslims relative to Christians of 1.53, which declined to 1.35 in the latter period. The regression analysis of the proportion dead among children ever born; (1) confirmed the magnitude of the religious differentials in child mortality, and their reduction over time; (2) demonstrated the existence of an interaction between religion and social class, as the religious differentials in child mortality were found to be highly prevalent in the lower social classes, and almost insignificant in the middle and upper ones; (3) highlighted the decisive role of differential fertility in generating differential child mortality, with higher fertility and higher child mortality in Muslims, and with the disappearance of religious differentials in child mortality after adjustment for fertility.The findings confirm the hypothesis of a reduction over time of religious-based child mortality differences in the capital city of Lebanon, in agreement with the pattern found for religious-based fertility differences. Comparisons with other countries in the region indicate that the war in Lebanon has slowed down the decline in child mortality, causing the country to loose its priviledged position among Arab countries.The authors investigated changes in socioreligious differentials of mortality over time using baseline information from maternity registries in Beirut in 1984 and 1991. Mother's age, number of children ever born, number of children alive, hospitalization class, and religion of newborn were recorded. Brass and Macrae's technique was used to convert the proportion dead among children ever born to mothers in age group 30-34 years into mortality estimates for 1978 and 1985. Using hospitalization class as a proxy for social class, religious differentials in child mortality were explored by logistic regression analysis within each period. A reduction over time of religious-based child mortality differences was observed in Beirut, in agreement with the pattern found for religious-based fertility differences. Relative to other countries in the region, the war in Lebanon has slowed down the decline in child mortality.

Using data from a French national survey, preventive and dietary habits, alcohol and smoking consumption of three groups of migrants (Italy, Spain and Portugal, Maghreb) were compared to those of French nationals. Odds ratios were estimated using a logistic regression, after adjustment by age, socio-professional group and place of residence. Differences in attitude were observed, in particular: lower primary and secondary practice of prevention; lower consumption of meat and dairy products and higher consumption of starchy food and dried vegetables; lower consumption of alcohol and higher tobacco intake among Maghrebian migrants. The observed differences were interpreted in the light of other available data in France. They confirm notably imported dietary habits and a weaker perception of preventive messages, as shown in other studies.

The author examines the applicability of case-control methods to demographic studies and finds that "of the numerous epidemiologic research strategies case-control studies are of particular interest whenever direct estimation of demographic indices is questionable. I shall elaborate upon two applications...in order to demonstrate the usefulness of the case-control method for better investigation of mortality rates and differentials in various contexts." The geographical scope is worldwide with a focus on developing countries. (EXCERPT)

This study investigated social class differentials in cancer mortality in Sao Paulo county, Brazil, for the period 1978 to 1982. A measure of socioeconomic status based on education was used, and cancer risk by level of education was estimated by a case-control approach in which other cancers were considered as controls. For most cancers, the socioeconomic differences in risk were similar to those found in western Europe and North America. For lung cancer, however, the highest risk was observed in men and women with the most education. Other cancers related to tobacco-cancer of the larynx, pharynx, and esophagus-showed a negative association with education. The differences between social classes in consumption habits of alcohol and mate and the use of black tobacco are probably responsible for these contrasting patterns. For breast and cervix uteri cancer the social class patterns were similar to those found in developed countries -a positive relationship for breast and a negative one for cervix uteri cancer. The magnitude of the differences observed between social classes for these cancers was frequently greater in South America than in the United States or western Europe.

Mortality rates from different cancers in migrants to Argentina from 11 individual countries and 6 groups of countries were compared with those in the Argentina-born population and in their countries of origin. Almost all countries of origin had higher mortality rates from gastric cancer than Argentina, but the risk declines in migrants, and for European migrants becomes similar to that of the Argentina-born. In contrast, mortality from oesophageal cancer is significantly lower in European countries than in Argentina. For cancer of the colon and breast, most countries have lower mortality rates than the Argentina-born, the exceptions being Uruguay and Germany, and migrants demonstrate a convergence of risk towards that of Argentina-born. These results suggest that migrants to Argentina undergo changes in some environmental exposure, probably dietary, which give rise to substantial alterations in cancer risk within their lifespan.