Publications by authors named "Catherine Quantin"

142 Publications

Association between moderated level of air pollution and fetal growth: the potential role of noise exposure.

Sci Rep 2021 May 27;11(1):11238. Epub 2021 May 27.

Service de Biostatistiques et d'Information Médicale, CHU Dijon Bourgogne, 21000, Dijon, France.

This study aims to analyze, in a population of singletons, the potential confounding or modifying effect of noise on the relationship between fetal growth restriction (FGR) or small for gestational age (SGA) and environmental exposure to air pollution. All women with single pregnancies living in one of two medium-sized cities (Besançon, Dijon) and who delivered at a university hospital between 2005 and 2009 were included. FGR and SGA were obtained from medical records. Outdoor residential exposure to nitrogen dioxide (NO) and particulate matter (PM) was quantified at the mother's address at delivery over defined pregnancy periods; outdoor noise exposure was considered to be the annual average daily noise levels in the façade of building (L). Adjusted odds ratios (OR) were estimated by multivariable logistic regressions. Among the 8994 included pregnancies, 587 presented FGR and 918 presented SGA. In the two-exposure models, for SGA, the OR for a 10-µg/m increase of PM during the two last months before delivery was 1.18, 95%CI 1.00-1.41 and for FGR, these OR were for the first and the third trimesters, and the two last months before delivery: 0.77 (0.61-0.97), 1.38 (1.12-1.70), and 1.35 (1.11-1.66), respectively. Noise was not associated with SGA or FGR and did not confound the relationship between air pollution and SGA or FGR. These results are in favor of an association between PM exposure and fetal growth, independent of noise, particularly towards the end of pregnancy, and of a lack of association between noise and fetal growth.
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http://dx.doi.org/10.1038/s41598-021-90788-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8160128PMC
May 2021

Variation in end-of-life care and hospital palliative care among hospitals and local authorities: A preliminary contribution of big data.

Palliat Med 2021 May 25:2692163211019299. Epub 2021 May 25.

Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France.

Background: Many studies explore the clinical and ethical dimensions of care at the end-of-life, but fewer use administrative data to examine individual and geographic differences, including the use of palliative care.

Aim: Provide a population-based perspective on end-of-life and hospital palliative care among local authorities and hospitals in France.

Design: Retrospective cohort study of care received by 17,928 decedents 65 and over (last 6 months of life), using the French national health insurance database.

Results: 55.7% of decedents died in acute-care hospitals; 79% were hospitalized in them at least once; 11.7% were admitted at least once for hospital palliative care. Among 31 academic medical centers, intensive care unit admissions ranged from 12% to 67.4%; hospital palliative care admissions, from 2% to 30.6%. Across local authorities, for intensive care unit days and hospital palliative care admissions, the ratios between the values at the third and the first quartile were 2.4 and 1.5. The odds of admission for hospital palliative care or to an intensive care unit for more than 7 days were more than twice as high among people ⩽85 years (aOR = 2.11 (1.84-2.43) and aOR = 2.59 (2.12-3.17), respectively). The odds of admission for hospital palliative care were about 25% lower ( = 0.04) among decedents living in local authorities with the lowest levels of education than those with the highest levels.

Conclusion: The variation we document in end-of-life and hospital palliative care across different categories of hospitals and 95 local authorities raises important questions as to what constitutes appropriate hospital use and intensity at the end-of-life.
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http://dx.doi.org/10.1177/02692163211019299DOI Listing
May 2021

Impact of the COVID-19 pandemic on preterm birth and stillbirth: a nationwide, population-based retrospective cohort study.

Am J Obstet Gynecol 2021 May 19. Epub 2021 May 19.

Biostatistics and Bioinformatics (DIM), CHU Dijon Bourgogne, Dijon, France; Clinical Epidemiology/Clinical Trials Unit, Clinical Investigation Center, CHU Dijon Bourgogne, Dijon, France; High-Dimensional Biostatistics for Drug Safety and Genomics, CESP, Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Villejuif, France.

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http://dx.doi.org/10.1016/j.ajog.2021.05.015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8131554PMC
May 2021

Chronic respiratory diseases are predictors of severe outcome in COVID-19 hospitalised patients: a nationwide study.

Eur Respir J 2021 May 20. Epub 2021 May 20.

Biostatistics and Bioinformatics (DIM), Dijon University Hospital, Dijon, France; Bourgogne Franche-Comté University, Dijon, France.

Background: Influenza epidemics were initially considered to be a suitable model for the COVID-19 epidemic, but there is a lack of data concerning patients with chronic respiratory diseases (CRD), who were supposed to be at risk of severe forms of COVID-19.

Methods: This nationwide retrospective cohort study describes patients with prior lung disease hospitalised for COVID-19 (March-April 2020) or influenza (2018-2019 influenza outbreak). We compare the resulting pulmonary complications, need for intensive care and in-hospital mortality depending on respiratory history and virus.

Results: In the 89 530 COVID-19 cases, 16.03% had at least one CRD, which was significantly less frequently than in the 45 819 seasonal influenza patients. Patients suffering from chronic respiratory failure, chronic obstructive pulmonary disease, asthma, cystic fibrosis and pulmonary hypertension were underrepresented, contrary to those with lung cancer, sleep apnea, emphysema, and interstitial pulmonary diseases (ILD). COVID-19 patients with CRD developed significantly more ventilator-associated pneumonia and pulmonary embolism than influenza patients. They needed intensive care significantly more often and had a higher mortality rate (except for asthma) when compared to patients with COVID-19 but without CRD, or patients with influenza.

Conclusion: Patients with prior respiratory diseases were globally less likely to be hospitalised for COVID-19 than for influenza but were at higher risk of developing severe COVID-19 and had a higher mortality rate compared to influenza patients and patients without a history of respiratory illness.Our data suggest that these patients should have priority access to SARS-CoV2 vaccination.
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http://dx.doi.org/10.1183/13993003.04474-2020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8135927PMC
May 2021

Extremely and Very Preterm Deliveries in a Maternity Unit of Inappropriate Level: Analysis of Socio-Residential Factors.

Clin Epidemiol 2021 14;13:273-285. Epub 2021 Apr 14.

Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France.

Purpose: To analyze the socio-residential factors associated with extremely and very preterm deliveries occurring in non-level 3 maternity units in France.

Materials And Methods: This is a population-based observational retrospective study using national hospital data from 2012 to 2014. A generalized estimating equations regression model was used to study the characteristics of women who delivered very preterm and the socio-residential risk factors for not delivering in a level 3 maternity unit at 24-31+6d weeks of gestation.

Results: Among deliveries resulting in live births and without contraindication to in-utero transfer, we identified 9198 extremely or very preterm deliveries; 2122 (23.1%) of these were managed in a non-level 3 unit. Our study showed that young maternal age (women under 20 years at delivery) was associated with the risk of giving birth prematurely in a non-level 3 maternity, and particularly in a level 1 maternity unit (adjusted relative risk, 1.53; 95% CI 1.09-2.16). Living more than 30 minutes away from the closest level 3 unit increased the risk of delivering very preterm in a level 1 or 2 unit. Living in an urban area or urban periphery increased the risk of giving birth in a level 2 maternity unit (adjusted relative risk, 1.53; 95% CI 1.28-1.83 and 1.42; 95% CI 1.17-1.71, respectively).

Conclusion: This study shows that young pregnant women living more than 30 minutes from a level 3 hospital have an increased risk of delivering in a maternity unit that is not equipped to deal with premature births. The risk also increases with an urban place of residence when the delivery occurs in a level 2 unit. A clearer understanding of the population at risk of delivering prematurely in a non-level 3 maternity could lead to improvements in structuring healthcare to encourage earlier management and better support.
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http://dx.doi.org/10.2147/CLEP.S288046DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8053703PMC
April 2021

Detecting Hospital Outliers in Post-Pancreatectomy Care Using Funnel Plots from 2009-2018 Based on Nationwide Medico-Administrative Data.

World J Surg 2021 Jul 5;45(7):2210-2217. Epub 2021 Apr 5.

Department of Biostatistics, Dijon University Hospital, University of Burgundy, Dijon, France.

Objectives: Our objective was to identify hospitals with unusual mortality rates for major pancreatectomies over a period of ten years using 30-day mortality data from the French national database.

Methods: Data for all patients who underwent pancreatectomy were extracted from the national medico-economic database (Programme de Médicalisation des Systèmes d'Information). To identify quality outliers for each hospital, the observed-to-expected 30-day mortality rates were used as a quality indicator.

Results: A total of 19 494 patients underwent a major pancreatectomy in France between January 2009 and December 2018. The overall 30-day mortality rate was 4.8% (n = 944). For the 2009-2014 period, the funnel plot showed that 10 of the 176 hospitals lie outside the central 95% region and 7 lie outside the central 99.8% region. For the 2015-2018 period, out of 176 hospitals, 6 lie outside the central 95% region and 2 lie outside the central 99.8% region. The change in standardized mortality ratios between 2009-2014 and 2015-2018 testing for differences from the overall change, they were there 4 hospitals lie outside the central 95% region and 0 lie outside the central 99.8% region.

Conclusion: Over time, the improvement in hospital quality was weak. This study suggests that there is a pressing need to reorganize the supply of care for pancreatic surgery in France.
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http://dx.doi.org/10.1007/s00268-021-06078-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8154844PMC
July 2021

Comparison of Cancer Patients to Non-Cancer Patients among COVID-19 Inpatients at a National Level.

Cancers (Basel) 2021 Mar 21;13(6). Epub 2021 Mar 21.

Biostatistics and Bioinformatics (DIM), University Hospital, Bourgogne Franche-Comté University, BP 77908, 21079 Dijon, France.

(1) Background: Several smaller studies have shown that COVID-19 patients with cancer are at a significantly higher risk of death. Our objective was to compare patients hospitalized for COVID-19 with cancer to those without cancer using national data and to study the effect of cancer on the risk of hospital death and intensive care unit (ICU) admission. (2) Methods: All patients hospitalized in France for COVID-19 in March-April 2020 were included from the French national administrative database, which contains discharge summaries for all hospital admissions in France. Cancer patients were identified within this population. The effect of cancer was estimated with logistic regression, adjusting for age, sex and comorbidities. (3) Results: Among the 89,530 COVID-19 patients, we identified 6201 cancer patients (6.9%). These patients were older and were more likely to be men and to have complications (acute respiratory and kidney failure, venous thrombosis, atrial fibrillation) than those without cancer. In patients with hematological cancer, admission to ICU was significantly more frequent (24.8%) than patients without cancer (16.4%) ( < 0.01). Solid cancer patients without metastasis had a significantly higher mortality risk than patients without cancer (aOR = 1.4 [1.3-1.5]), and the difference was even more marked for metastatic solid cancer patients (aOR = 3.6 [3.2-4.0]). Compared to patients with colorectal cancer, patients with lung cancer, digestive cancer (excluding colorectal cancer) and hematological cancer had a higher mortality risk (aOR = 2.0 [1.6-2.6], 1.6 [1.3-2.1] and 1.4 [1.1-1.8], respectively). (4) Conclusions: This study shows that, in France, patients with COVID-19 and cancer have a two-fold risk of death when compared to COVID-19 patients without cancer. We suggest the need to reorganize facilities to prevent the contamination of patients being treated for cancer, similar to what is already being done in some countries.
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http://dx.doi.org/10.3390/cancers13061436DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8004216PMC
March 2021

Impact of the COVID-19 Epidemic on hospitalization for diabetic foot ulcers during lockdown: A French nationwide population-based study.

Diabet Med 2021 07 13;38(7):e14577. Epub 2021 Apr 13.

INSERM Unit, LNC-UMR 1231, University of Burgundy, Dijon, France.

Aims/hypothesis: The aim of this study was to examine the impact of the COVID-19 epidemic on the hospitalization rates for diabetic foot ulcer (DFU), osteomyelitis and lower limb revascularization procedure in people with DFU.

Methods: This nationwide retrospective cohort study included hospital data on all people hospitalized in France for diabetes in weeks 2-43 in 2020, including the COVID-19 lockdown period, compared to same period in 2019.

Results: The number of hospitalizations for DFU decreased significantly in weeks 12-19 (during the lockdown) (p < 10 ). Hospitalization for foot osteomyelitis also decreased significantly in weeks 12-19 (p < 10 ). The trend was the same for lower limb amputations and revascularizations associated with DFU or amputation.

Conclusions/interpretation: The marked drop in hospitalization rates for DFU, osteomyelitis and lower limb revascularization procedures in people with DFU observed in France during the lockdown period suggests that COVID-19 was a barrier to DFU care, and may illustrate the combined deleterious effects of hospital overload and changes in health-related behaviour.
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http://dx.doi.org/10.1111/dme.14577DOI Listing
July 2021

Incidence of rhegmatogenous retinal detachment in France from 2010 to 2016: seasonal and geographical variations.

Br J Ophthalmol 2021 Mar 3. Epub 2021 Mar 3.

Ophthalmology Department, Dijon University Hospital, Dijon, France.

Aims: To investigate the annual and monthly hospital incidence rate of rhegmatogenous retinal detachments (RRDs) from 2010 to 2016 in France at the national and regional levels.

Methods: In this nationwide database study, we identified hospital and clinic admissions of French residents for a first episode of RRD in France during 2010-2016 from the national administrative database. The annual and monthly hospital incidence rates of RRD per 100 000 population were calculated for the whole country and for each region.

Results: The average annual national hospital incidence rate of RRD was 21.97±1.04 per 100 000 population. The annual national hospital incidence rate of RRD was the lowest in 2010 (20.91 per 100 000 population) after which it increased until 2015 (23.55 per 100 000 population). The average monthly national RRD hospital incidence rate was the highest in June (2.03±0.12 per 100 000 population) and the lowest in August (1.60±0.09). The average annual age-standardised and sex-standardised regional hospital incidence rate was the highest in Guadeloupe and Pays de la Loire (28.30±2.74 and 26.13±0.84 per 100 000 population, respectively) and the lowest in French Guiana and Martinique (15.51±3.50 and 17.29±2.12 per 100 000 population, respectively).

Conclusions: The average annual national hospital incidence rate of RRD increased from 2010 to 2015. The hospital incidence rate of RRD seemed to vary according to season and geographical location.
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http://dx.doi.org/10.1136/bjophthalmol-2020-318457DOI Listing
March 2021

Hospitalizations for Stroke in France During the COVID-19 Pandemic Before, During, and After the National Lockdown.

Stroke 2021 04 25;52(4):1362-1369. Epub 2021 Feb 25.

Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France (A.-S.M., E.B., J.C., A.R., C.Q.).

Background And Purpose: In France, the entire population was put under a total lockdown from March 17 to May 11, 2020 during the peak of the coronavirus disease 2019 (COVID-19) pandemic. Whether the lockdown had consequences on the management of medical emergencies such as stroke and transient ischemic attack (TIA) has yet to be fully evaluated. This article describes hospitalization rates for acute stroke in 2 French regions that experienced contrasting rates of COVID-19 infection, before, during, and after the nationwide lockdown (January to June 2020).

Methods: All patients admitted for acute stroke/TIA into all public and private hospitals of the 2 study regions were included. Data were retrieved from the National Hospitalization Database (PMSI). In the most affected region (Grand-Est), the hospitalization rates observed in April 2020 were compared with the rates in the same period in the least affected region (Occitanie) and in the 3 prior years (2017-2019).

Results: There was a significant decline in hospitalization rates for stroke/TIA within the region most affected by COVID-19 during the month of April 2020 compared with previous years, while no significant change was seen in the least affected region. After lockdown, we observed a fast rebound in the rate of hospitalization for stroke/TIA in the most affected region, contrasting with a slower rebound in the least affected region. In both regions, patients with COVID-19 stroke more frequently had ischemic stroke, a nonsignificant greater prevalence of diabetes, they were less frequently admitted to stroke units, and mortality was higher than in patients without COVID-19.

Conclusions: Our results demonstrates a significant drop in stroke/TIA hospitalizations and a fast recovery after the end of the French lockdown in the most affected region, while the least affected region saw a nonsignificant drop in stroke/TIA hospitalizations and a slow recovery. These results and recommendations could be used by the health authorities to prepare for future challenges.
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http://dx.doi.org/10.1161/STROKEAHA.120.032312DOI Listing
April 2021

Failure to rescue in patients with distal pancreatectomy: a nationwide analysis of 10,632 patients.

HPB (Oxford) 2021 Feb 8. Epub 2021 Feb 8.

Dijon University Hospital, Clinical Epidemiology/Clinical Trials Unit, Clinical Investigation Center, Dijon F-21000, France.

Background: FTR appears as a major cause of postoperative mortality (POM). Hospital volume has an impact on FTR in pancreatic surgery but no study has investigated this relationship more specifically in DP.

Methods: We analysed patients with DP between 2009 and 2018 through a nationwide database. FTR definition was mortality among patients who experiment major complications. The cutoff between high and low volume centers was 20 pancreatectomies per year.

Results: Some 10,632 patients underwent DP, 5048 (47.5%) were operated in 602 (95.4%) low volume centers and 5584 (52.5%) in 29 (4.6%) high volume centers. Overall FTR occurred in 11.2% of patients and was significantly reduced in high volume centers compared to low volume centers (10.2% vs 12.5%, p = 0.047). In multivariate analysis, surgery in a high volume center was a protective factor for POM (OR = 0.570, CI95% [0.505-0.643], p < 0.001) and also for FTR (OR = 0.550, CI95% [0.486-0.630], p < 0.001).

Conclusion: Hospital volume has a positive impact on FTR in DP. Patients with higher risk of FTR are men, with high modified Charlson comorbidity index, malignant conditions and open procedures.
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http://dx.doi.org/10.1016/j.hpb.2021.02.002DOI Listing
February 2021

Chronic Pulmonary Aspergillosis: Prevalence, favouring pulmonary diseases and prognosis.

Eur Respir J 2021 Jan 21. Epub 2021 Jan 21.

Sorbonne Université, Paris, France.

Chronic pulmonary aspergillosis (CPA) is an emerging disease in patients with common chronic pulmonary diseases (CPD). While its prevalence is linked to tuberculosis (TB) in endemic countries, epidemiologic and prognostic data are lacking in low TB incidence countries. The aim of this study was to describe these features in CPA patients hospitalised in France between 2009 and 2018.We estimated the prevalence and mortality of hospitalised CPA patients using the French nationwide administrative hospital database. We also assessed the association with CPDs, thoracic interventions, and malnutrition.From 2009 to 2018, 17 290 patients were hospitalised in France for CPA, with an increasing prevalence during this period. Most patients were male (63.5%) with a median age of 65 years at CPA diagnosis, living in farming regions and large cities. The proportion of underlying chronic obstructive pulmonary disease (COPD) and emphysema during the previous 5 years was 44% and 22%, respectively, whereas it was only 3% for both TB and non-TB mycobacterial (NTM) infections. The mortality rates during the first hospitalisation, at 1 year, and at 5 years were 17%, 32%, and 45%, respectively. In multivariate analysis, mortality rates were increased in patients aged over 65 years, males and patients with malnutrition, diabetes, or lung cancer history. The risk of mortality in patients with COPD or emphysema was higher compared to those with previous mycobacterial lung infection.In France CPA is an emerging infection commonly associated with non-mycobacterial CPD. This shift in the distribution profile of underlying CPD will likely worsen CPA mortality.
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http://dx.doi.org/10.1183/13993003.03345-2020DOI Listing
January 2021

Increased Risk of Hospitalization for Pancreatic Cancer in the First 8 Years after a Gestational Diabetes Mellitus regardless of Subsequent Type 2 Diabetes: A Nationwide Population-Based Study.

Cancers (Basel) 2021 Jan 15;13(2). Epub 2021 Jan 15.

High-Dimensional Biostatistics for Drug Safety and Genomics, Inserm U1018 Center of Research in Epidemiology and Population Health (CESP), Université Paris-Saclay, 94800 Villejuif, France.

The aim of this large retrospective cohort study was to use a quasi-exhaustive national medico-administrative database of deliveries in France to determine the risk of developing pancreatic cancer (PC) in women with a history of gestational diabetes mellitus (GDM). This nationwide population-based study included women aged 14-55 who gave birth between 1st January 2008 and 31 December 2009. The women were followed-up epidemiologically for eight years. Survival analyses using Cox regression models, adjusted for age, subsequent type 2 diabetes, and tobacco consumption, were performed on the time to occurrence of hospitalization for PC. The onset of GDM, tobacco consumption and subsequent type 2 diabetes were considered as time-dependent variables. Among 1,352,560 women included, 95,314 had a history of GDM (7.05%) and 126 women were hospitalized for PC (0.01%). Over the eight years of follow-up, GDM was significantly associated with a higher risk of hospitalization with PC in the first Cox regression model adjusted for age and subsequent type 2 diabetes (HR = 1.81 95% CI [1.06-3.10]). The second Cox regression model adjusted for the same covariates, plus tobacco consumption, showed that GDM was still significantly associated with a higher risk of hospitalization for PC with nearly the same estimated risk (HR = 1.77 95% CI [1.03-3.03]). Gestational diabetes was significantly associated with a greater risk of hospital admission for pancreatic cancer within eight years, regardless of subsequent type 2 diabetes.
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http://dx.doi.org/10.3390/cancers13020308DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7829937PMC
January 2021

Impact of time-varying cumulative bevacizumab exposures on survival: re-analysis of data from randomized clinical trial in patients with metastatic colo-rectal cancer.

BMC Med Res Methodol 2021 01 9;21(1):14. Epub 2021 Jan 9.

INSERM, U1231, EPICAD team, Equipe EPICAD, 7, Bld Jeanne d'Arc, Dijon, France.

Background: As cancer treatment, biotherapies can be as effective as chemotherapy while reducing the risk of secondary effects, so that they can be taken over longer periods than conventional chemotherapy. Thus, some trials aimed at assessing the benefit of maintaining biotherapies during chemotherapy-free intervals (CFI). For example, the recent PRODIGE9 trial assessed the effect of maintaining bevacizumab during CFI in metastatic colorectal cancer (mCRC) patients. However, its analysis was hindered by a small difference of exposure to the treatment between the randomized groups and by a large proportion of early drop outs, leading to a potentially unbalanced distribution of confounding factors among the trial completers. To address these limitations, we re-analyzed the PRODIGE9 data to assess the effects of different exposure metrics on all-cause mortality of patients with mCRC using methods originally developed for observational studies.

Methods: To account for the actual patterns of drug use by individual patients and for possible cumulative effects, we used five alternative time-varying exposure metrics: (i) cumulative dose, (ii) quantiles of the cumulative dose, (iii) standardized cumulative dose, (iv) Theoretical Blood Concentration (TBC), and (v) Weighted Cumulative Exposure (WCE). The last two metrics account for the timing of drug use. Treatment effects were estimated using adjusted Hazard Ratio from multivariable Cox proportional hazards models.

Results: After excluding 112 patients who died during the induction period, we analyzed data on 382 patients, among whom 320 (83.8%) died. All time-varying exposures improved substantially the model's fit to data, relative to using only the time-invariant randomization group. All exposures indicated a protective effect for higher cumulative bevacizumab doses. The best-fitting WCE and TBC models accounted for both the cumulative effects and the different impact of doses taken at different times.

Conclusions: All time-varying analyses, regardless of the exposure metric used, consistently suggested protective effects of higher cumulative bevacizumab doses. However, the results may partly reflect the presence of a confusion bias. Complementing the main ITT analysis of maintenance trials with an analysis of potential cumulative effects of treatment actually taken can provide new insights, but the results must be interpreted with caution because they do not benefit from the randomization.

Trial Registration: clinicaltrials.gov, NCT00952029 . Registered 8 August 2009.
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http://dx.doi.org/10.1186/s12874-020-01202-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7796644PMC
January 2021

Comparison of the characteristics, morbidity, and mortality of COVID-19 and seasonal influenza: a nationwide, population-based retrospective cohort study.

Lancet Respir Med 2021 03 17;9(3):251-259. Epub 2020 Dec 17.

Inserm CIC 1432, Clinical Epidemiology/Clinical Trials Unit, Clinical Investigation Centre, Dijon University Hospital, Dijon, France; Biostatistics and Bioinformatics (DIM), Dijon University Hospital, Dijon, France; Faculty of Medicine, University of Bourgogne-Franche-Comté, Dijon, France; Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, High-Dimensional Biostatistics for Drug Safety and Genomics, CESP, Villejuif, France. Electronic address:

Background: To date, influenza epidemics have been considered suitable for use as a model for the COVID-19 epidemic, given that they are respiratory diseases with similar modes of transmission. However, data directly comparing the two diseases are scarce.

Methods: We did a nationwide retrospective cohort study using the French national administrative database (PMSI), which includes discharge summaries for all hospital admissions in France. All patients hospitalised for COVID-19 from March 1 to April 30, 2020, and all patients hospitalised for influenza between Dec 1, 2018, and Feb 28, 2019, were included. The diagnosis of COVID-19 (International Classification of Diseases [10th edition] codes U07.10, U07.11, U07.12, U07.14, or U07.15) or influenza (J09, J10, or J11) comprised primary, related, or associated diagnosis. Comparisons of risk factors, clinical characteristics, and outcomes between patients hospitalised for COVID-19 and influenza were done, with data also stratified by age group.

Findings: 89 530 patients with COVID-19 and 45 819 patients with influenza were hospitalised in France during the respective study periods. The median age of patients was 68 years (IQR 52-82) for COVID-19 and 71 years (34-84) for influenza. Patients with COVID-19 were more frequently obese or overweight, and more frequently had diabetes, hypertension, and dyslipidaemia than patients with influenza, whereas those with influenza more frequently had heart failure, chronic respiratory disease, cirrhosis, and deficiency anaemia. Patients admitted to hospital with COVID-19 more frequently developed acute respiratory failure, pulmonary embolism, septic shock, or haemorrhagic stroke than patients with influenza, but less frequently developed myocardial infarction or atrial fibrillation. In-hospital mortality was higher in patients with COVID-19 than in patients with influenza (15 104 [16·9%] of 89 530 vs 2640 [5·8%] of 45 819), with a relative risk of death of 2·9 (95% CI 2·8-3·0) and an age-standardised mortality ratio of 2·82. Of the patients hospitalised, the proportion of paediatric patients (<18 years) was smaller for COVID-19 than for influenza (1227 [1·4%] vs 8942 [19·5%]), but a larger proportion of patients younger than 5 years needed intensive care support for COVID-19 than for influenza (14 [2·3%] of 613 vs 65 [0·9%] of 6973). In adolescents (11-17 years), the in-hospital mortality was ten-times higher for COVID-19 than for influenza (five [1·1% of 458 vs one [0·1%] of 804), and patients with COVID-19 were more frequently obese or overweight.

Interpretation: The presentation of patients with COVID-19 and seasonal influenza requiring hospitalisation differs considerably. Severe acute respiratory syndrome coronavirus 2 is likely to have a higher potential for respiratory pathogenicity, leading to more respiratory complications and to higher mortality. In children, although the rate of hospitalisation for COVID-19 appears to be lower than for influenza, in-hospital mortality is higher; however, low patient numbers limit this finding. These findings highlight the importance of appropriate preventive measures for COVID-19, as well as the need for a specific vaccine and treatment.

Funding: French National Research Agency.
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http://dx.doi.org/10.1016/S2213-2600(20)30527-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7832247PMC
March 2021

Episiotomy practices in France: epidemiology and risk factors in non-operative vaginal deliveries.

Sci Rep 2020 11 19;10(1):20208. Epub 2020 Nov 19.

Biostatistics and Bioinformatics (DIM), University Hospital, University of Burgundy and Franche-Comté, Dijon, France.

Episiotomy use has decreased due to the lack of evidence on its protective effects from maternal obstetric anal sphincter injuries. Indications for episiotomy vary considerably and there are a great variety of factors associated with its use. The aim of this article is to describe the episiotomy rate in France between 2013 and 2017 and the factors associated with its use in non-operative vaginal deliveries. In this retrospective population-based cohort study, we included vaginal deliveries performed in French hospitals (N = 584) and for which parity was coded. The variable of interest was the rate of episiotomy, particularly for non-operative vaginal deliveries. Trends in the episiotomy rates were studied using the Cochran-Armitage test. Hierarchical logistic regression was used to identify variables associated with episiotomy according to maternal age and parity. Between 2013 and 2017, French episiotomy rates fell from 21.6 to 14.3% for all vaginal deliveries (p < 0.01), and from 15.5 to 9.3% (p < 0.01) for all non-operative vaginal deliveries. Among non-operative vaginal deliveries, epidural analgesia, non-reassuring fetal heart rate, meconium in the amniotic fluid, shoulder dystocia, and newborn weight (≥ 4,000 g) were risk factors for episiotomy, both for nulliparous and multiparous women. On the contrary, prematurity reduced the risk of its use. For nulliparous women, breech presentation was also a risk factor for episiotomy, and for multiparous women, scarred uterus and multiple pregnancies were risk factors. In France, despite a reduction in episiotomy use over the last few years, the factors associated with episiotomy have not changed and are similar to the literature. This suggests that the decrease in episiotomies in France is an overall tendency which is probably related to improved care strategies that have been relayed by hospital teams and perinatal networks.
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http://dx.doi.org/10.1038/s41598-020-70881-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7677317PMC
November 2020

Survival in patients with HR+/HER2- metastatic breast cancer treated with initial endocrine therapy versus initial chemotherapy. A French population-based study.

Br J Cancer 2020 09 17;123(7):1071-1077. Epub 2020 Jul 17.

Breast and Gynecologic Cancer Registry of Côte d'Or, Georges-François Leclerc Comprehensive Cancer Care Centre, 1 rue Professeur Marion, Dijon, France.

Background: According to international guidelines, endocrine therapy (ET) is the preferred option for hormone receptor-positive (HR+) HER2-negative (HER2-) metastatic breast cancer. In spite of clear recommendations, these are not strictly followed in daily practice. The objectives of this study were to investigate the effect of the first anti-metastatic treatment therapy choice on progression-free survival (PFS) and overall survival (OS).

Methods: In this population-based study, we included patients with HR+/HER2- metastatic breast cancer recorded in the Côte d'Or Breast Cancer Registry. Differences in PFS and OS between patients initially treated with chemotherapy (CT) or ET were analysed in Cox proportional hazards models. In a sensitivity analysis, we used a propensity score (PS) to limit the indication bias.

Results: Altogether, 557 cases were included, 280 received initial ET and 277 received initial CT. PFS and OS in patients initially treated with ET was improved significantly when compared to patients with initial CT (respectively, HR = 0.83 (95% CI 0.69-0.99) and HR = 0.71 (95% CI 0.58-0.86)). The results of the sensitivity analysis supported these findings.

Conclusion: This study shows that treating patients with HR+/HER2- metastatic breast cancer with initial ET could provide a survival advantage in comparison with initial CT.
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http://dx.doi.org/10.1038/s41416-020-0979-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7525445PMC
September 2020

Survival in patients with HR+/HER2- metastatic breast cancer treated with initial endocrine therapy versus initial chemotherapy. A French population-based study.

Br J Cancer 2020 09 17;123(7):1071-1077. Epub 2020 Jul 17.

Breast and Gynecologic Cancer Registry of Côte d'Or, Georges-François Leclerc Comprehensive Cancer Care Centre, 1 rue Professeur Marion, Dijon, France.

Background: According to international guidelines, endocrine therapy (ET) is the preferred option for hormone receptor-positive (HR+) HER2-negative (HER2-) metastatic breast cancer. In spite of clear recommendations, these are not strictly followed in daily practice. The objectives of this study were to investigate the effect of the first anti-metastatic treatment therapy choice on progression-free survival (PFS) and overall survival (OS).

Methods: In this population-based study, we included patients with HR+/HER2- metastatic breast cancer recorded in the Côte d'Or Breast Cancer Registry. Differences in PFS and OS between patients initially treated with chemotherapy (CT) or ET were analysed in Cox proportional hazards models. In a sensitivity analysis, we used a propensity score (PS) to limit the indication bias.

Results: Altogether, 557 cases were included, 280 received initial ET and 277 received initial CT. PFS and OS in patients initially treated with ET was improved significantly when compared to patients with initial CT (respectively, HR = 0.83 (95% CI 0.69-0.99) and HR = 0.71 (95% CI 0.58-0.86)). The results of the sensitivity analysis supported these findings.

Conclusion: This study shows that treating patients with HR+/HER2- metastatic breast cancer with initial ET could provide a survival advantage in comparison with initial CT.
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http://dx.doi.org/10.1038/s41416-020-0979-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7525445PMC
September 2020

Evaluation of the Quality of French Hospital Data for Perinatal Algorithms.

Stud Health Technol Inform 2020 Jun;270:213-217

Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France.

The aim of our validation study was to assess the quality of hospital data for perinatal algorithms on a national level. In each hospital, we selected 150 discharge abstracts of delivery (after 22 weeks of gestation), in 2014, and their corresponding medical records. Overall, 23 hospitals were included and 3,246 discharge abstracts were studied. This first national validation study of several case-funding algorithms using various perinatal variables suggests that the French national hospital discharge abstracts database is an appropriate data source for epidemiological studies.
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http://dx.doi.org/10.3233/SHTI200153DOI Listing
June 2020

Could venous thromboembolism and major bleeding be indicators of lung cancer mortality? A nationwide database study.

BMC Cancer 2020 May 24;20(1):461. Epub 2020 May 24.

Biostatistics and Bioinformatics (DIM), University Hospital, Bourgogne Franche-Comté University, Dijon, France.

Background: Venous thromboembolism (VTE) is highly prevalent in cancer patients and can cause severe morbidity. VTE treatment is essential, but anticoagulation increases the risk of major bleeding. The purpose was to evaluate the impact of VTE and major bleeding on survival and to identify significant risk factors for these events in lung cancer patients.

Methods: Data were extracted from a permanent sample of the French national health information system (including hospital and out-of-hospital care) from 2009 to 2016. All episodes of VTE and major bleeding events within one year after cancer diagnosis were identified. A Cox model was used to analyse the effect of VTE and major bleeding on the patients' one-year survival. VTE and major bleeding risk factors were analysed with a Fine and Gray survival model.

Results: Among the 2553 included patients with lung cancer, 208 (8%) had a VTE episode in the year following diagnosis and 341 (13%) had major bleeding. Almost half of the patients died during follow-up. Fifty-six (60%) of the patients presenting with pulmonary embolism (PE) died, 48 (42%) of the patients presenting with deep vein thrombosis (DVT) alone died and 186 (55%) of those presenting with a major bleeding event died. The risk of death was significantly increased following PE and major bleeding events. VTE concomitant with cancer diagnosis was associated with an increased risk of VTE recurrence beyond 6 months after the first VTE event (sHR = 4.07 95% CI: 1.57-10.52). Most major bleeding events did not appear to be related to treatment.

Conclusion: VTE is frequent after a diagnosis of lung cancer, but so are major bleeding events. Both PE and major bleeding are associated with an increased risk of death and could be indicators of lung cancer mortality.
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http://dx.doi.org/10.1186/s12885-020-06930-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7245783PMC
May 2020

Validation study: evaluation of the metrological quality of French hospital data for perinatal algorithms.

BMJ Open 2020 05 12;10(5):e035218. Epub 2020 May 12.

Service de Biostatistique et Informatique Médicale, Centre Hospitalier Universitaire, Dijon, France

Objective: The aim of our validation study was to assess the metrological quality of hospital data for perinatal algorithms on a national level.

Design: Validation study.

Setting: This was a multicentre study of the French medicoadministrative database on perinatal indicators.

Participants: In each hospital, we selected 150 discharge abstracts for delivery (after 22 weeks of gestation), in 2014, and their corresponding medical records. Overall, 22 hospitals were included.

Interventions: A single investigator performed blind data collection from medical records in order to compare data from discharge abstracts with data from medical records. Finally, 3246 discharge abstracts were studied.

Primary And Secondary Outcome Measures: Seventy items, including maternal and delivery characteristics and maternal morbidity, were collected for each delivery stay.

Results: The concordance rate of maternal age at delivery was 94.8% (95% CI 93.8 to 95.4). Combining the two forms of pre-existing diabetes, the algorithm presented a PPV of 65.9% and a sensitivity of 75.7%. The concordance rate of gestational age at delivery was 91.8% (90.9 to 92.7). Regarding gestational diabetes, the PPV was 80.8% (79.4 to 82.2) and the sensitivity was 79.5% (78.1 to 80.9). Regardless of the algorithm explored, the PPV for vaginal delivery was over 99%. For the diagnosis codes corresponding to immediate postpartum haemorrhage, the PPV was 77.7% (76.3 to 79.1) and the sensitivity was 75.5% (74.0 to 77.0). The algorithm for stillbirth presented a PPV of 89.4% (88.3 to 90.5) and a sensitivity of 95.4% (94.7 to 96.1).

Conclusions: This first national validation study of many perinatal algorithms suggests that the French national hospital database is an appropriate data source for epidemiological studies, except for some indicators which presented low PPV and/or sensitivity.
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http://dx.doi.org/10.1136/bmjopen-2019-035218DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7228531PMC
May 2020

The effect of primary care on potentially avoidable hospitalizations in France: a cross-sectional study.

BMC Health Serv Res 2020 Mar 31;20(1):268. Epub 2020 Mar 31.

CHU de Dijon, 2 Boulevard du Maréchal de Lattre de Tassigny, 21000, Dijon, France.

Background: Potentially avoidable hospitalizations are an indirect measure of access to primary care. However, the role and quality of primary care might vary by geographical location. The main objective was to assess the impact of primary care on geographic variations of potentially avoidable hospitalizations in Occitanie, France.

Methods: We conducted a retrospective analysis of claims and socio-economic data for the French Occitanie region in 2014. In order to account for spatial heterogeneity, the region was split into two zones based on socio-economic traits: median pre-tax income and unemployment rate. Age- and sex-adjusted hospital discharge potentially avoidable hospitalization rates were calculated at the ZIP-code level. Demographic, socio-economic, and epidemiological determinants were retrieved, as well as data on supply of, access to and utilization of primary care.

Results: 72% of PAH are attributable to two chronic conditions: chronic obstructive pulmonary disease and heart failure. In Zone 1, the potentially avoidable hospitalization rate was positively associated with premature mortality and with the number of specialist encounters by patients. It was negatively associated with the density of nurses. In Zone 2, the potentially avoidable hospitalization rate was positively associated with premature mortality, with access to general practitioners, and with the number of nurse encounters by patients. It was negatively associated with the proportion of the population having at least one general practitioner encounter and with the density of nurses.

Conclusions: This study suggests that the role of primary care in potentially avoidable hospitalizations might be geography dependent.
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http://dx.doi.org/10.1186/s12913-020-05132-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7106616PMC
March 2020

Oral health treatment habits of people with schizophrenia in France: A retrospective cohort study.

PLoS One 2020 9;15(3):e0229946. Epub 2020 Mar 9.

Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France.

Objective: To identify the differences between persons with schizophrenia (PWS) and general population in France in terms of oral health treatment (tooth scaling, dental treatment and tooth extraction) and the factors associated with these differences.

Methods: This retrospective cohort study included PWS identified from a representative sample of 1/97th of the French population (general sample of beneficiaries). PWS were identified from 2014 data by an algorithm that included: F2 diagnostic codes in the register of long-term diseases in 2014 AND {(at least three deliveries of antipsychotics in 2014) OR (F20 diagnostic codes as a main or associated diagnosis in hospital discharge abstracts in 2012 or 2013 (hospital data for medicine, surgery and obstetrics)}. Follow-up dental care was explored for all people over a period of 3 years (2014 to 2017).

Results: In 2014, 580,219 persons older than 15 years were identified from the 96 metropolitan departments in France; 2,213 were PWS (0.4%). Fewer PWS were found along a diagonal line from north-east to south-west France, and the highest numbers were located in urban departments. PWS were more often male (58.6% vs 48.7%, p<0.001). They were less likely to have had tooth scaling but more likely to have undergone a dental extraction. In one third of departments, more than 50% of PWS had at least one tooth scaling over a three-year period; the rate of dental extraction in these departments ranged from 6 to 23%. Then, a quarter of the departments in which 40 to 100% of PWS had had at least one dental extraction (2/8) presented a rate of tooth scaling ranging from 0 to 28% over the study period.

Conclusions: Compared with the general population, PWS were less likely to have had tooth scaling and dental treatment but more likely to have undergone dental extraction.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0229946PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7062238PMC
June 2020

Efficiency of telemedicine for acute stroke: a cost-effectiveness analysis from a French pilot study.

Int J Technol Assess Health Care 2020 Apr 2;36(2):126-132. Epub 2020 Mar 2.

Inserm CIC 1432, Clinical Epidemiology Unit, Dijon University Hospital, Dijon, France.

Objectives: Telestroke is an effective way to improve care and health outcomes for stroke patients. This study evaluates the cost-effectiveness of a French telestroke network.

Methods: A decision analysis model was built using population-based data. We compared short-term clinical outcomes and costs for the management of acute ischemic stroke patients before and after the implementation of a telestroke network from the point of view of the national health insurance system. Three effectiveness endpoints were used: hospital death, death at 3 months, and severe disability 3 months after stroke (assessed with the modified Rankin scale). Most clinical and economic parameters were estimated from the medical files of 742 retrospectively included patients. Sensitivity analyses were performed.

Results: The analyses revealed that the telestroke strategy was more effective and slightly more costly than the reference strategy (25 disability cases avoided per 1,000 at 3 months, 6.7 avoided hospital deaths, and 13 avoided deaths at 3 months for an extra cost of EUR 97, EUR 138, and EUR 154, respectively). The results remained robust in the sensitivity analyses.

Conclusions: In France, telestroke is an effective strategy for improving patient outcomes and, despite the extra cost, it has a legitimate place in the national health care system.
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http://dx.doi.org/10.1017/S0266462320000057DOI Listing
April 2020

Out-of-maternity deliveries in France: A nationwide population-based study.

PLoS One 2020 24;15(2):e0228785. Epub 2020 Feb 24.

Biostatistics and Bioinformatics (DIM), Inserm, France University Hospital, Bourgogne Franche-Comté University, Dijon, France.

Introduction: In France, many maternity hospitals have been closed as a result of hospital restructuring in an effort to reduce costs through economies of scale. These closures have naturally increased the distance between home and the closest maternity ward for women throughout the country. However, studies have shown a positive correlation between this increase in distance and the incidence of unplanned out-of-maternity deliveries (OMD). This study was conducted to estimate the frequency of OMD in France, to identify the main risk factors and to assess their impact on maternal mortality and neonatal morbidity and mortality.

Materials And Methods: We conducted a population-based observational retrospective study using data from 2012 to 2014 obtained from the French hospital discharge database. We included 2,256,797 deliveries and 1,999,453 singleton newborns in mainland France, among which, 6,733 (3.0‰) were OMD. The adverse outcomes were maternal mortality in hospital or during transport, stillbirth, neonatal mortality, neonatal hospitalizations, and newborn hypothermia and polycythemia. The socio-residential environment was also included in the regression analysis. Maternal and newborn adverse outcomes associated with OMD were analyzed with Generalized Estimating Equations regressions.

Results: The distance to the nearest maternity unit was the main factor for OMD. OMD were associated with maternal death (aRR 6.5 [1.6-26.3]) and all of the neonatal adverse outcomes: stillbirth (3.3 [2.8-3.8]), neonatal death (1.9 [1.2-3.1]), neonatal hospitalization (1.2 [1.1-1.3]), newborn hypothermia (5.9 [5.2-6.6]) and newborn polycythemia (4.8 [3.5-6.4]).

Discussion: In France, OMD increased over the study period. OMD were associated with all the adverse outcomes studied for mothers and newborns. Caregivers, including emergency teams, need to be better prepared for the management these at-risk cases. Furthermore, the increase in adverse outcomes, and the additional generated costs, should be considered carefully by the relevant authorities before any decisions are made to close or merge existing maternity units.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0228785PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7039464PMC
May 2020

Are direct oral anticoagulants an economically attractive alternative to low molecular weight heparins in lung cancer associated venous thromboembolism management?

J Thromb Thrombolysis 2020 Oct;50(3):642-651

Biostatistics and Bioinformatics (DIM), University Hospital, Bourgogne Franche-Comté University, Dijon, France.

Venous thromboembolism is highly prevalent in lung cancer patients. Low molecular weight heparins are recommended for long term treatment of cancer associated venous thromboembolism. Direct oral anticoagulants are however an interesting alternative as they are administered orally and don't require monitoring. There are currently studies comparing both their efficacy and tolerance for cancer patients and more and more guidelines suggest considering direct oral anticoagulants for cancer associated venous thromboembolism treatment. The objective of this study was to evaluate the budgetary impact that direct oral anticoagulants use would have for lung cancer associated venous thromboembolism treatment and prevention in France. An economic model was made to evaluate the cost of venous thromboembolism treatment and prevention among patients with primary lung cancer in France by two strategies: current guidelines versus direct oral anticoagulants use. The model was fed with clinical and economic data extracted from the French national health information system. The analysis was conducted from the national mandatory Health insurance point of view. The time horizon of the study was the evaluation of the annual management cost. Lung cancer associated venous thromboembolism management's mean cost was estimated of 836€ per patient, that is a total cost of about 40 million euros per year at a national level. A 76% decrease of this cost can be expected with direct oral anticoagulants use. However, despite their benefits, these treatments raise new issues (medication interactions, bleeding management), and would likely not be recommended for all patients.
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http://dx.doi.org/10.1007/s11239-020-02047-1DOI Listing
October 2020

Long-Term Relative Survival after Stroke: The Dijon Stroke Registry.

Neuroepidemiology 2020 19;54(6):498-505. Epub 2019 Dec 19.

Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular diseases (PEC2), University Hospital of Dijon, University of Bourgogne-Franche Comté, Dijon, France,

Objective: The aim of this study was to assess long-term survival after stroke and to compare survival profiles of patients according to stroke subtypes, age, and sex, using relative survival (RS) method.

Methods: All patients with a first-ever stroke were prospectively recorded in the population-based Dijon Stroke Registry from 1987 to 2016. RS is the survival that would be observed if stroke was the only cause of death. Ten-year RS was estimated using a flexible parametric model of the cumulative excess mortality rate, which was obtained by matching the observed all-cause mortality in the stroke cohort to the expected mortality in the general population. A separate model was fitted for each stroke subtypes, first fitted for each age and sex separately, and then adjusted for age and sex.

Results: In total, 5,259 patients (mean age 74.9 ± 14.3 years, 53% women) were recorded including 4,469 ischemic strokes (IS), 655 intracerebral hemorrhages (ICH), and 135 undetermined strokes. In IS patients, unadjusted RS was 82% at 1 year and decreased to 62% at 10 years. Adjusted RS showed a lower survival in older age groups (p < 0.001), but no difference between men and women (p = 0.119). In ICH patients, unadjusted RS was 56 and 42% at 1 and 10 years, respectively, with a lower adjusted survival in older age groups (p < 0.001), but no sex differences (p = 0.184).

Conclusion: This study showed that RS after stroke is lower in older than in younger patients but without significant sex differences, and survival profiles differ according to stroke subtypes. Since RS allows a better estimation of stroke-related death than observed survival does, especially in old patients, such a method is adapted to provide reliable information when considering long-term outcome.
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http://dx.doi.org/10.1159/000505160DOI Listing
December 2019

Incidence of acute postoperative endophthalmitis following macular surgery in France between 2006 and 2016.

Acta Ophthalmol 2020 May 3;98(3):e333-e338. Epub 2019 Nov 3.

Department of Ophthalmology, Dijon University Hospital, Dijon, France.

Purpose: To report the incidence of acute postoperative endophthalmitis (POE) after macular surgery in France between 2006 and 2016 and to identify associated factors.

Methods: This retrospective database study included all hospital discharge records involving a surgical procedure for an epiretinal membrane or a macular hole in France from January 2006 to October 2016. Acute POE was identified by two codes in the tenth edition of the International Classification of Diseases within 42 days of a macular surgical procedure in the French national administrative database.

Results: In France, 152 034 macular surgical procedures for epiretinal membranes or macular holes were recorded from 1 January 2006 to 31 October 2016. Suspected acute POE was reported in 381 cases. The incidence of POE was 0.25% overall, 0.30% for epiretinal membrane surgery and 0.14% for macular hole surgery. In multivariable Poisson regression analysis, epiretinal membrane surgery was associated with POE [incidence rate ratio (IRR), 2.24; 95% CI, 1.62-3.11; p < 0.001]. For epiretinal membrane surgery, the 2010-2011 period was significantly associated with a higher risk of POE (IRR, 1.66; 95% CI, 1.13-2.42; p = 0.03).

Conclusion: The incidence of POE after macular surgery was 0.25% overall in France between 2006 and 2016 and twice higher for epiretinal membrane surgery than for macular hole surgery. For epiretinal surgery only, the incidence of POE was higher in 2010-2011 (period of the switch to transconjunctival vitrectomy) than in the rest of the study period.
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http://dx.doi.org/10.1111/aos.14279DOI Listing
May 2020