E.Bauchet法國慢性病的預防和控制

SurveillanceofNCDsdatabasesandexamplesSinoFrenchRoundtableonNCDsPreventionandControl-August24thFrance631834Km2,551695Mainland66,3millioninhabitants25%<20yearsold18%>65yearsoldLifeexpectancyAtbirth:85,4F,79,2MAt65yearsold23,4F19,1MPrematuremortality…:30%avoidableHealthAgenciesHealthInsuranceOrganizationsInVS,theInstituteforPublicHealthSurveillance:

itsmissionsContinuousmonitoringofthepopulation’shealthHealthsurveillance

Healthalerts

Managementofhealthcrisis

ParticipationinEuropeaninternationalactivitiesGeneralorganisationoftheInVSExecutiveDirectorScientific,deputydirectorDeputydirectorSurveillanceofNCDsinourdepartmentProvidingepidemiologicfollowupofchronicdiseases,oftheircausesandriskfactorsaswellastheircomplicationsMonitoringFrequencyandseverityofchronicdiseasesTimetrendsGeographicandsocio-demographicdisparitiesTheirdeterminantsandtheircomplications

SurveillanceofNCDs

weareaskedtoprovideindicatorsthatarereliableandconstant:tobeabletodocumentepidemiologictrendsofchronicdiseasesAvailablewithinashortperiodoftimeAvailableregularlyAvailableatdifferentgeographiclevel(national,regional,departments,smallerareaInanenvironmentChangingrapidly:numberandquatityofdatasourcesareincreasing,methodsaredeveloppingButwithgrowingfinancialconstraintsTheDMCTfieldsencompasssurveillanceof

CancerandcancernationalscreeningprogramsCardiovasculardiseasesDiabetesChronicrespiratorydiseasesMentalhealthPerinatalhealthNeurodegenerativediseases:Alzheimer’sandParkinson’sNutritionandphysicalactivitySomepopulationsapproaches:neonates,seniors…Burdenofchronicdiseasesisincreasingwiththeagingofthepopulation20%ofthepopulationhasachronicdisease,11millionsareregisteredashavingachronicdiseaseCancer:355000newcasesperyear,148000deaths:30%ofalldeathsCardiovasculardiseases:28%ofalldeathsDiabetes:5%ofthepopulationAsthma:10%ofchildren,6%ofadultsOneoutoftwoadultsisoverweight,amongthem17%isobeseAroundonechildoutof5isoverweight,amongthem3,5%isobeseneuropsychiatrictroubles:1stcauseofhandicap,4thcauseofALD800000to1millionindividualswithAlzheimerdiseasesDatasourcesusedforPublicHealthSurveillanceInformationssystemsSurveysHealthDatabasePMSIRIM-PFrenchNationalInterschemeHealthInformationSystemReimbursementdataHospitaladmissionsOrientedtowardssurveillanceGeneralorspecificpopulationsIncludingclinicalexaminationsand/orbiologicalsamplesMulti-topicsVariousmethodsofdatacollectionCépiDCRegistriesSursaudMonitoringCentersEPACLORSEPBNADeveloppedforotherpurposesMainlyhealthinsurrancedataStudiesinthegeneralpopulationEtudenationalenutritionsanté(2006-2007)Esteban(2014-2015)-Diet.physicalactivity.nutritionalstatus(includingbiochemicalindicators)-Childrenandadults-MainlandFrance49%ofadults(18-74)areoverweightorobese,ofwhich17%areobese(ref.WHO).<1/2ofadultsand1/5childrenconsumeatleast5fruitsandvegetablesperday(ref.WHO).Dailyintakeofsalt:10g/dayformen,7g/dayforwomen(ref.WHO:5g/day).ConsumptionofalcoholaccordingtoWHOrecommendations:77%ofmen(≤3glasses/day)and91%ofwomen(≤2glasses/day)20%ofdiabeticsarenotdiagnosed18%ofchildren(3-17)areoverweightorobese,ofwhich3.5%areobese(ref.IOTF).PublicHealthSurveillancethroughsurveys:SomeResultsoftheNutritionSurveillance12Combiningmedico-administrativedatabase,surveillancededicateddatabaseandsurvey:Entred-métropole,adults,France2007-2010

(2)Three-yearmedicalcareofconsumptionMortalitydataBDMAPatientself-administeredquestionnairePhysician:self-administeredquestionnaire

Combiningmedico-administrativedatabase,surveillancededicateddatabaseandsurvey:Entred-métropole,adults,France2007-2010SamplingfromtheSNIIRAMPharmacologically-treateddiabeticsN=8950Reimbursmentdata3yDiseasemanagement(care,medicalinvestigations)Follow-upofguidelinesAccesstocareContactwiththepatients:agreementforparticipationN=7534Patients/survey

N=4277Self-administeredQuestionnaireSocialdet.,lifestyleHistoryofthediseaseAccesstocare,complications,healtheducation,qualityoflifeFamilyorspecialistphysician/surveySelf-administeredQuestionnaireOutcomesofclinicalandbiologicalinvestigationsComplicationsAccesstocareMortality(CepiDc)5yN=7534DeathMedicalcausesofdeathPMSI:Hospitaladmissions3yN=7534Dg,date,lengthofstayTreateddiabetics:4,6%3millionsindividualsImportantgeographicvariations:PrevalenceSeriousandfrequentcomplications

ENTRED:Follow-upoftheguidelinesMortalitydatainboth2001and2006ENTREDsurveyEnsemble(N=9101)Males(n=4945)Females(n=4156)Numberofdeaths1388807(58%)581(42%)Deaths%15%16%14%Rate/1000person-years32,434,829,5Mean

age

at

death

77y74y80yRéférence:RomonIetal.BullEpidemiolHebd2009;42-43:469-472(www.invs.sante.fr)SurveillanceofIschemicheartdiseasethroughHospitaladmissionsdatabase

TrendsofAcutemyocardialinfarctionAllages<65yearsMenWomenMeanageofAMIhospitalisation(2013):68yrs(65inmenvs.75inwomen)Meanlengthofstay:6,7daysHospitalfatalities:7,2%Ischemicheartdiseases

Regionaldisparitiesofprematuremortality(<65y)

(mainlandFranceandFrenchoverseaterritories)Regionalratescomparedtonationalrate(%)ModellingapproachesExemple1:Ovariancancer(ALD/Registry),Publichealthsurveillanceofcancers:acomplementaritybetweenregistriesandSNIIRAMdatabases.

+=>PublichealthsurveillanceofcancersCancerincidenceandmortalityratesandtrendsfrommorbidityregistersdata1980-2012inFrance5-yearNetSurvivalincancer(%)accordingtogenderinFrance1989-2007

VoiravecFlorence

IncidenceMortalityLocalisationIncidenceRatein2012Meanannual%1980-2012Mortalityin2012Meanannual%1980-2012Males

allcancers362.60.8133.6-1.5Prostate99.410.2-1.5Lung51.70.137-0.5Colorectal38.40.313.3-1.2Stomach7-2.24.4-3.4Females

Allcancers2521.173.2-1Breast881.415.7-0.6Lung

18.65.312.93.7Colorectal23.70.17.9-1.4Stomach2.6-2.61.7-3.8LocalisationmalesfemalesLung13[