Allain Samuel, Naouri Diane, Deroyon Thomas, Costemalle Vianney, Hazo Jean-Baptiste
Direction de la recherche, des études, de l'évaluation et des statistiques (DREES), French Ministry of Health and Solidarity, France.
Direction de la recherche, des études, de l'évaluation et des statistiques (DREES), French Ministry of Health and Solidarity, France.
Public Health. 2024 Mar;228:55-64. doi: 10.1016/j.puhe.2023.12.022. Epub 2024 Feb 2.
In France, almost nine of 10 deaths are caused by non-communicable diseases, and there is significant social inequality in mortality rates. However, it is not easy to collect robust data on the incidence and prevalence of such diseases according to socio-economic status. Based on data from the link between the primary longitudinal population sample and the national health data system, the aim of our study was to compute the standardised incidence and prevalence of seven major groups of chronic diseases according to socio-economic status.
Descriptive retrospective cohort study.
This was a descriptive retrospective cohort study on a weighted representative sample of the French population, comprising 3.4 million individuals from data collected 2016-2017. Main chronic disease categories include diabetes, cancers, psychiatric disorders, liver and pancreatic diseases, neurological conditions, respiratory and cardiovascular diseases, calculated from the 2016-2017 period by combining health care consumption and diagnoses received during hospitalisations and/or associated with specific full healthcare coverage. Socio-economic status was measured by disposable income from the 2013-2014 tax returns and census-derived socioprofessional groups, and findings were standardised for age and sex.
For all disease categories except cancers, standardised incidence rates showed a gradient favouring the wealthiest, with a risk ratio between the first and tenth standard of living deciles ranging from 1.4 (cardiovascular diseases) to 2.8 (diabetes). Incidence of all disease categories, except cancers, was higher for all groups compared with executives and higher academic professions (risk ratios between workers and executives ranged from 2.0 to 1.3 in psychiatric and cardiovascular diseases, respectively). Conversely, cancer incidence rate followed a flat curve, reduced in the two poorest standard of living deciles, and there were no significant differences between socioprofessional groups. Standardised prevalence rates followed the same patterns, although risk ratios were highest for psychiatric diseases, varying according to sex and disease.
Deep social inequalities in incidence and prevalence of chronic diseases were observed in a large representative sample of the French population. The reverse social inequalities in cancer incidence and prevalence calls for more detailed research into cancer types and selection mechanisms, the data from which would allow the long-term monitoring of such disparities.
在法国，近十分之九的死亡由非传染性疾病导致，且死亡率存在显著的社会不平等。然而，要根据社会经济状况收集有关此类疾病发病率和患病率的可靠数据并非易事。基于主要纵向人口样本与国家卫生数据系统之间的关联数据，我们研究的目的是根据社会经济状况计算七大类慢性病的标准化发病率和患病率。
描述性回顾性队列研究。
这是一项针对法国人口加权代表性样本的描述性回顾性队列研究，样本包括2016 - 2017年收集的数据中的340万人。主要慢性病类别包括糖尿病、癌症、精神疾病、肝脏和胰腺疾病、神经系统疾病、呼吸系统和心血管疾病，通过结合2016 - 2017年期间的医疗保健消费以及住院期间接受的诊断和/或与特定全额医疗覆盖相关的诊断来计算。社会经济状况通过2013 - 2014年纳税申报单中的可支配收入和人口普查得出的社会职业群体来衡量，研究结果按年龄和性别进行了标准化。
除癌症外，所有疾病类别的标准化发病率都显示出有利于最富裕人群的梯度差异，生活水平第一和第十分位数之间的风险比在1.4（心血管疾病）至2.8（糖尿病）之间。与高管和高学历职业相比，所有群体中除癌症外的所有疾病类别的发病率都更高（在精神疾病和心血管疾病中，工人与高管之间的风险比分别在2.0至1.3之间）。相反，癌症发病率呈平缓曲线，在生活水平最差的两个分位数中有所降低，且社会职业群体之间没有显著差异。标准化患病率遵循相同模式，尽管精神疾病的风险比最高，且因性别和疾病而异。
在法国人口的一个大型代表性样本中观察到慢性病发病率和患病率存在严重的社会不平等。癌症发病率和患病率的反向社会不平等需要对癌症类型和选择机制进行更详细的研究，这些数据将有助于对此类差异进行长期监测。
