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Ce chapitre porte sur les inégalités sociales de mortalité des adultes en France, relevées à partir de certains indicateurs individuels relatifs à la situation sociale : le niveau d’études, la situation des individus face à l’emploi et la catégorie socioprofessionnelle. Cette dernière est codée à l’aide de la classification PCS (Profession et catégorie socioprofessionnelle), l’indicateur habituellement utilisé en France pour caractériser cette situation. Les inégalités sont d’abord décrites p...

Spearman correlation coefficients between cumulative exposures to petroleum-based and oxygenated solvents. (PDF 193 kb)

Categories of exposure indices. (PDF 140 kb)

Association between hypopharyngeal and laryngeal cancers and exposure to oxygenated solvents, with adjustment for socioeconomic status. (PDF 116 kb)

Association between hypopharyngeal and laryngeal cancers and exposure to petroleum-based solvents, with adjustment for socioeconomic status. (PDF 115 kb)

International audience; The present study aimed to assess socioeconomic inequalities in general and mental health, depression and substance use disorders (daily tobacco use, hazardous alcohol use). Data from the 2010 SIRS (French acronym for Health, Inequalities, and Social Ruptures) study, which is deemed to be representative of the French-speaking adult population living in the Paris Metropolitan Area, were analysed. Different socioeconomic position indicators were selected: education, income and perceived financial status. Absolute measures (the slope index of inequality (SII)) and relative measures (the odds ratio (OR) and relative index of inequality (RII)) of health inequalities were used. The OR, RII and SII were adjusted for age, household type and migration characteristics and all analyses were performed separately for men and women. The study included 3,006 adults. The results showed significant relative and absolute socioeconomic inequalities in general, mental health and depression for all socioeconomic position indicators considered (education, income, and perceived financial status). The absolute inequalities were greater for women than for men. Strongest inequalities were observed by perceived financial status for men and women. Education seemed to play a stronger role in inequalities for women, whereas, for men, income seemed to play a stronger role. Only few socioeconomic inequalities were found in daily tobacco use, while a reversed gradient was observed for hazardous alcohol use. We hope that these results will be regularly re-evaluated and compared across time in order to monitor socioeconomic inequalities in health.

International audience; Smoking is a major preventable cause of cancers and is increasingly concentrated among the most deprived individuals leading to increasing socioeconomic inequalities in the incidence of cancers linked to smoking. We aimed to estimate the tobacco‐attributable cancer burden according to socioeconomic position in France. The analysis was restricted to cancer sites for which tobacco smoking was recognized as a risk factor. Cancer cases by sex, age group and European Deprivation Index (EDI) among people aged 30–74 between 2006 and 2009 were obtained from cancer registries covering ∼20% of the French population. The tobacco‐attributable burden of cancer according to EDI was estimated applying the population attributable fraction (PAF) computed with the Peto‐Lopez method. The PAF increased from 56% in the least deprived EDI quintile to 70% in the most deprived EDI quintile among men and from 26% to 38% among women. In total, 28% of the excess cancer cases in the four most deprived EDI quintiles in men and 43% in women could be prevented if smoking in these 4 EDI quintiles was similar to that of the least deprived EDI quintile. A substantial smoking‐attributable burden of cancer by socioeconomic position was observed in France. The results highlight the need for policies reducing tobacco consumption. More comprehensive interventions integrating the various dimensions of health determinants and proportionate according to socioeconomic position may essentially contribute to the reduction of socioeconomic inequalities in cancer.

Background It is now widely accepted that social and physical environment participate in shaping health. While mortality is used to guide public health policies and is considered as a synthetic measure of population health, few studies deals with the contextual features potentially associated with mortality in a representative sample of an entire country. This paper investigates the possible role of area deprivation (FDep99) and travel time to health care on French cause-specific mortality in a proper multilevel setting. Methods The study population was a 1% sample representative of the French population aged from 30 to 79 years in 1990 and followed up until 2007. A frailty Cox model was used to measure individual, contextual effects and spatial variances for several causes of death. The chosen contextual scale was the Zone d’Emploi of 1994 (348 units) which delimits the daily commute of people. The geographical accessibility to health care score was constructed with principal component analysis, using 40 variables of hospital specialties and health practitioners’ travel time. Results The outcomes highlight a positive and significant association between area deprivation and mortality for all causes (HR = 1.24), cancers, cerebrovascular diseases, ischemic heart diseases, and preventable and amenable diseases (HR from 1.14 to 1.29). These contextual associations exhibit no substantial differences by sex except for premature ischemic heart diseases mortality which was much greater in women. Unexpectedly, mortality decreased as the time to reach health care resources increased. Only geographical disparities in cerebrovascular and ischemic heart diseases mortality were explained by compositional and contextual effects. Discussion The findings suggest the presence of confounding factors in the association between mortality and travel time to health care, possibly owing to population density and health-selected migration. Although the spatial scale considered to define the context of residence was relatively large, the associations with area deprivation were strong in comparison to the existing literature and significant for almost all the causes of deaths investigated. Conclusion The broad spectrum of diseases associated with area deprivation and individual education support the idea of a need for a global health policy targeting both individual and territories to reduce social and socio-spatial inequalities. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4562-7) contains supplementary material, which is available to authorized users.

Contains the results for education-related trends in slope index of inequality and relative index of inequality for obesity for both men and women. All analyses were performed according to the method section described in the main manuscript. (PDF 224Â kb)

ICD codes of the causes of death investigated. Table S2. Services and specialties included in the travel time to health care score. Table S3. Association between cause-specific mortality and sex, individual education, contextual deprivation, time to health care and population density. (DOCX 25 kb)

The prevalence of obesity increased dramatically in many European countries in the past decades. Whether the increase occurred to the same extent in all socioeconomic groups is less known. We systematically assessed and compared the trends in educational inequalities in obesity in 15 different European countries between 1990 and 2010.

Contains the results for trends in obesity prevalence and occupation-related inequalities in obesity for both men and women. All analyses were performed according to the method section described in the main manuscript. (PDF 332Â kb)

Contains the results for trends in obesity prevalence for the low- and high-educated groups separately. The analysis was performed according to the method section described in the main manuscript. (PDF 219Â kb)

En France, les cancers du poumon et des voies aérodigestives supérieures (VADS) sont parmi les cancers les plus fréquents chez les hommes et ils sont en forte augmentation chez les femmes. Les principaux facteurs de risque de ces cancers sont le tabac pour le cancer du poumon, et le tabac et l’alcool pour les cancers des VADS. Les expositions professionnelles sont aussi des facteurs de risque importants pour ces cancers. À partir de l’étude "Icare", qui inclut plus de 9.000 personnes avec des informations détaillées sur leurs caractéristiques sociodémographiques et comportementales ainsi que leur histoire professionnelle, ce projet avait pour objectif de mieux comprendre les causes de la survenue d’un cancer respiratoire.

Characteristics of women eligible for cervical and breast cancer screening. (DOCX 30Â kb)

International audience; BACKGROUND: The aim of this study was to compare inequalities in mortality (all causes and by cause) by occupational group and educational level between men and women living in France in the 1990s. METHODS: Data were analysed from a permanent demographic sample currently including about one million people. The French Institute of Statistics (INSEE) follows the subjects and collects demographic, social and occupational information from the census schedules and vital status forms. Causes of death were obtained from the national file of the French Institute of Health and Medical Research (INSERM). A relative index of inequality (RII) was calculated to quantify inequalities as a function of educational level and occupational group. Overall all-cause mortality, mortality due to cancer, mortality due to cardiovascular disease and mortality due to external causes (accident, suicide, violence) were considered. RESULTS: Overall, social inequalities were found to be wider among men than among women, for all-cause mortality, cancer mortality and external-cause mortality. However, this trend was not observed for cardiovascular mortality, for which the social inequalities were greater for women than for men, particularly for mortality due to ischaemic cardiac diseases. CONCLUSIONS: This study provides evidence for persistent social inequalities in mortality in France, in both men and women. These findings highlight the need for greater attention to social determinants of health. The reduction of cardiovascular disease mortality in low educational level groups should be treated as a major public health priority.

Higher socioeconomic position has been reported to be associated with increased risk of breast cancer mortality. Our aim was to see if this is consistently observed within 11 European populations in the 1990s. Longitudinal data on breast cancer mortality by educational level and marital status were obtained for Finland, Norway, Denmark, England and Wales, Belgium, France, Switzerland, Austria, Turin, Barcelona and Madrid. The relationship between breast cancer mortality and education was summarised by means of the relative index of inequality. A positive association was found in all populations, except for Finland, France and Barcelona. Overall, women with a higher educational level had approximately 15% greater risk of dying from breast cancer than those with lower education. This was observed both among never- and ever-married women. The greater risk of breast cancer mortality among women with a higher level of education was a persistent and generalised phenomenon in Europe in the 1990s.