H Allemand

Bordeaux School of Public Health, Burdeos, Aquitaine, France

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Publications (133)226.19 Total impact

  • Revue d Épidémiologie et de Santé Publique 08/2014; 62:S125. DOI:10.1016/j.respe.2014.05.029 · 0.66 Impact Factor
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    ABSTRACT: Introduction Prostate-specific antigen (PSA) testing is high in France. The aim of this study was to estimate their frequency and those of biopsy and newly diagnosed cancer (PCa) according to the presence or absence of treated benign prostatic hyperplasia (BPH). Patients and methods This study concerned men 40 years and older covered by the main French national health insurance scheme (73 % of all men of this age). Data were collected from the national health insurance information system (SNIIRAM). This database comprehensively records all of the outpatient prescriptions and healthcare services reimbursed. This information are linked to data collected during hospitalisations. Results The frequency of men without diagnosed PCa (10.9 millions) with at least one PSA test was very high in 2011 (men aged 40 years and older: 30 %, 70–74 years: 56 %, 85 years and older: 33 % and without HBP: 25 %, 41 % and 19 %). Men with treated BPH totalized 9 % of the study population, but 18 % of the men with at least one PSA test, 44 % of those with at least one prostate biopsy and 40 % of those with newly managed PCa. Over a 3-year period, excluding men with PCa, 88 % of men with BPH had at least one PSA test and 52 % had three or more PSA tests versus 52 % and 15 % for men without BPH. One year after PSA testing, men of 55–69 years with BPH more frequently underwent prostate biopsy than those without BPH (5.4 % vs 1.8 %) and presented PCa (1.9 % vs 0.9 %). Conclusions PSA testing frequencies in France are very high even after exclusion of men with BPH, who can be a group with more frequent managed PCa. Level of evidence 4.
    Progrès en Urologie 07/2014; 24(9). DOI:10.1016/j.purol.2014.03.004 · 0.77 Impact Factor
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    ABSTRACT: National population-based management and outcome data for patients of all ages hospitalized for heart failure have rarely been reported. National population-based management and outcome of patients of all ages hospitalized for heart failure have rarely been reported. The present study reports these results, based on 77% of the French population, for patients hospitalized for the first time for heart failure in 2009. The study population comprised French national health insurance general scheme beneficiaries hospitalized in 2009 with a principal diagnosis of heart failure, after exclusion of those hospitalized for heart failure between 2006 and 2008 or with a chronic disease status for heart failure. Data were collected from the national health insurance information system (SNIIRAM). A total of 69,958 patients (mean age, 78 years; 48% men) were studied. The hospital mortality rate was 6.4%, with 1-month, 1-year and 2-year survival rates of 89%, 71% and 60%, respectively. Heart failure and all-cause readmission-free rates were 55% and 43% at 1 year and 27% and 17% at 2 years, respectively. Compared with a reference sample of 600,000 subjects, the age- and sex-standardized relative risk of death was 29 (95% confidence interval [CI] 28-29) at 2 years, 82 (95% CI 72-94) in subjects aged<50 years and 3 (95% CI 3-3) in subjects aged≥90 years. For subjects aged<70 years who survived 1 month after discharge, factors associated with a reduction in the 2-year mortality rate were: female sex; age<55 years; absence of co-morbidities; and use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, beta-blockers, lipid-lowering agents or oral anticoagulants during the month following discharge. Poor prognostic factors were treatment with a loop diuretic before or after hospitalization and readmission for heart failure within 1 month after discharge. This large population-based study confirms the severe prognosis of heart failure and the need to promote the use of effective medications and management designed to improve survival.
    Archives of cardiovascular diseases 03/2014; 107(3). DOI:10.1016/j.acvd.2014.01.012 · 1.66 Impact Factor
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    ABSTRACT: The frequencies of treated cardiovascular disease (CVD) and their associated risk factors (CVRF) may vary according to socioeconomic and territorial characteristics. These frequencies have been described for 48million policyholders of the French general health insurance scheme, according to a metropolitan geographical deprivation index in five quintiles (from the least to the most deprived: Q1 to Q5), the existence of universal complementary health cover (CMUC) in individuals under the age of 60, and residence in a French overseas territory (FOT). The information system (SNIIRAM) was used to identify CVDs and anti-diabetic, anti-hypertensive or lipid-lowering treatments by three reimbursements in 2010. After age- and sex-specific adjustment, the inhabitants of the most deprived areas more often suffered from distal arterial disease (Q5/Q1=1.5), coronary artery disease (1.2) and cerebral vascular accident (1.1), as did the CMUC beneficiaries compared to non-beneficiaries (ratios of 1.7, 1.3 and 1.5), and the FOT residents in comparison to the most deprived metropolitan quintile (Q1), with the exception of coronary artery disease (1.2, 0.6 and 1.2). Inhabitants of the most deprived areas more often received anti-diabetic and anti-hypertensive treatment (Q5/Q1=1.4 and 1.2), as did the people on the CMUC (2.0 and 1.2) and the FOT inhabitants (FOT/Q1=2.4 and 1.3). These ratios were of 1.1, 1.0 and 0.8 for lipid-lowering drugs. These results pinpoint populations for which specific preventative initiatives could be supported. While health care service utilisation is facilitated (CMUC), it is probably not yet effective enough in view of the persistent increased cardiovascular risk.
    International journal of cardiology 03/2014; 173(3). DOI:10.1016/j.ijcard.2014.03.012 · 6.18 Impact Factor
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    ABSTRACT: Using the French claims database (Système National d'Information Inter-Régimes de l'Assurance Maladie) linked to the hospital discharge database (Programme de Médicalisation des Systèmes d'Information), this observational study compared the effectiveness of rosuvastatin and simvastatin prescribed at doses with close LDL-cholesterol-lowering potency on all-cause mortality and cardiovascular and cerebrovascular diseases (CCDs) in primary prevention. This historical cohort included patients with no prior CCD, aged 40-79 years, who initiated statin therapy with rosuvastatin 5 mg or simvastatin 20 mg in 2008-2009 in general practice. Follow-up started after a 1-year period used to select patients who regularly received the initial treatment. In an intention-to-treat analysis, patients were followed up to December 2011. In a per-protocol analysis, they were censored prematurely when they discontinued their initial treatment. Adjustment for baseline covariates (age, deprivation index, comedications, comorbidities, prior hospital admissions) was carried out by a Cox proportional hazards model. In the per-protocol analysis, estimation was done by "inverse probability of censoring weighting" using additional time-dependent covariates. Analyses were gender-specific. A total of 106 941 patients initiated statin therapy with rosuvastatin 5 mg and 56 860 with simvastatin 20 mg. Mean follow-up was 35.8 months. For both genders and both types of analyses, the difference in incidence rates of mortality and/or CCD between rosuvastatin 5 mg and simvastatin 20 mg users was not statistically significant after adjustment (e.g., for CCD and/or mortality in men, in intention-to-treat analysis HR = 0.94 [95% CI = 0.85-1.04], in per-protocol analysis HR = 0.98 [0.87-1.10]). The results of this real-life study based on medico-administrative databases do not support preferential prescription of rosuvastatin compared to simvastatin for primary prevention of CCD. © 2013 The Authors. Pharmacoepidemiology and Drug Safety published by John Wiley & Sons Ltd.
    Pharmacoepidemiology and Drug Safety 03/2014; 23(3). DOI:10.1002/pds.3544 · 3.17 Impact Factor
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    ABSTRACT: OBJECTIVES:Isotretinoin, a drug widely prescribed for severe acne, has been suspected to increase the risk of ulcerative colitis (UC), but data are conflicting. To further examine the association between isotretinoin use and risk for UC and Crohn's disease (CD), we conducted a large nationwide case-control study in France.METHODS:We used information from the National Health Insurance system for all French people covered by the general scheme between 1 January 2008 and 31 December 2010, totaling over 50 million individuals (i.e., 76% of the whole French population). All incident claims for UC and CD and all medical drug reimbursements were automatically recorded in the database. For each case, four controls were matched on age, gender, year of enrollment, and follow-up duration. The association between isotretinoin use and UC or CD claim was estimated by conditional logistic regression.RESULTS:We included 7,593 cases of inflammatory bowel disease (IBD; 3,187 UC, 4,397 CD, and 9 indeterminate colitis) and 30,372 controls; among them, 26 cases (0.3%) (15 UC (0.5%) and 11 CD (0.3%)) and 140 controls (0.4%) were exposed to isotretinoin. Isotretinoin exposure was not associated with an increased risk for UC (odds ratio (OR)=1.36 (95% confidence intervals (CI): 0.76, 2.45)) but was associated with a decreased risk for CD (OR=0.45 (95% CI: 0.24, 0.85)), P value for homogeneity between UC and CD=0.001. Results were similar in analyses restricted to individuals below the age of 40 years, to cases with colonoscopy or intestinal surgery, or when adjusting for other acne treatments.CONCLUSIONS:In this population-based case-control study, isotretinoin use was not associated with increased UC risk but was associated with a decreased CD risk. This study provides reassuring data for people using isotretinoin.Am J Gastroenterol advance online publication, 18 February 2014; doi:10.1038/ajg.2014.8.
    The American Journal of Gastroenterology 02/2014; 109(4). DOI:10.1038/ajg.2014.8 · 9.21 Impact Factor
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    ABSTRACT: Objectif Selon les recommandations les diabétiques en prévention primaire à haut risque cardiovasculaire devraient recevoir une statine. Malgré ce consensus, il est courant d’observer des fibrates prescrits à ces patients. Notre objectif est d’évaluer la fréquence et les conséquences cliniques de l’utilisation des fibrates en prévention primaire chez les diabétiques de type 2 à haut risque cardiovasculaire. Patients et méthodes Une étude de cohorte issue des bases de données médico-administratives de l’assurance maladie (SNIIRAM) et du PMSI a identifié du 01/07/08 au 31/12/09 les patients diabétiques ayant eu une instauration de fibrate ou de statine en monothérapie par un généraliste. Nous avons sélectionné des patients à haut risque cardiovasculaire (hypertendus traités), âgés de plus de 50 (hommes) ou 60 ans (femmes) et sans évènement cardiovasculaire enregistré en ALD ou dans les 30 mois d’hospitalisation précédents. Le suivi a été effectué jusqu’à 900 jours (infarctus du myocarde, AVC, amputation, décès). Résultats Parmi les 31 652 sujets inclus, 4 058 (12,8 %) ont reçu un fibrate. 167 évènements sont survenus dans le groupe fibrate, contre 1 026 parmi les 27 594 patients traités par statine. Les taux annuels ajustés (sexe et âge) des évènements étaient de 2,42 % (fibrate) et 2,21 % (statine). Les courbes de survie suggéraient que l’hypothèse de proportionnalité requise pour le modèle de Cox n’était pas respectée pour la variable fibrate/statine. Le modèle multivarié a intégré tous les facteurs prédictifs en univarié, et un Hazard Ratio avant et après 540 jours de suivi (HR < 540 et HR > 540) montre que les fibrates sont associés à un risque augmenté au-delà de 540 jours : HR < 540 = 0,95 (IC 95 % : 0,78–1,16), et HR > 540 = 1,73 (1,28–2,32). Conclusion En France la prescription de fibrates chez des patients diabétiques à haut risque cardiovasculaire est fréquente et en faveur d’une perte de chance.
    Revue d Épidémiologie et de Santé Publique 02/2014; 39:A7–A8. DOI:10.1016/S1262-3636(13)71642-2 · 0.66 Impact Factor
  • Revue d Épidémiologie et de Santé Publique 02/2014; 62:S21-S22. DOI:10.1016/j.respe.2013.11.053 · 0.66 Impact Factor
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    ABSTRACT: To estimate the perforation and haemorrhage rate after colonoscopy in the French population in 2010 and to identify risk factors for these complications. Study based on SNIIRAM and the PMSI databases. Patients treated for IBD or colorectal cancer were excluded. Two types of complications were investigated: perforation and haemorrhage. OR adjusted for patient (gender, age, chronic disease) and colonoscopy (polypectomy, emergency) characteristics were calculated by using a logistic regression model. The cohort was composed of 947,061 individuals. The estimated perforation rate was between 4.5 and 9.7 per 10,000 procedures and the estimated haemorrhage rate was between 9.9 and 11.0 per 10,000 procedures. The main risk factors associated with perforation and haemorrhage were the patient's age (over 80 years compared to under 40, OR=7.51 and 3.23), resection of polyps larger than 1cm or more than 4 polyps (compared to no polypectomy, OR=2.72 and 5.12) and emergency colonoscopy (OR=4.63 and 5.99). Colonoscopy performed by a gastroenterologist performing less than 244 colonoscopies per year was associated with an increased risk of perforation (OR=2.29). Complication rates were higher in institutions performing less than 510 colonoscopies per year, but this was no longer the case after adjustment for emergency colonoscopies. This study, which includes nearly one million colonoscopies, suggests taking the gastroenterologist's number of colonoscopies into account to ensure optimal organization of the management of very elderly patients requiring colonoscopy.
    Gastroentérologie Clinique et Biologique 11/2013; 38(1). DOI:10.1016/j.clinre.2013.10.005 · 1.98 Impact Factor
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    ABSTRACT: The incidence of heart failure (HF) is stable in industrialized countries, but its prevalence continues to increase, especially due to the ageing of the population, and mortality remains high. To estimate the incidence in France and describe the management and short-term outcome of patients hospitalized for HF for the first time. The study population comprised French national health insurance general scheme beneficiaries (77% of the French population) hospitalized in 2009 with a principal diagnosis of HF after exclusion of those hospitalized for HF between 2006 and 2008 or with a chronic disease status for HF. Data were collected from the national health insurance information system (SNIIRAM). A total of 69,958 patients (mean age 78years; 48% men) were included. The incidence of first hospitalization for HF was 0.14% (≥55years, 0.5%; ≥90years, 3.1%). Compared with controls without HF, patients more frequently presented cardiovascular or other co-morbidities. The hospital mortality rate was 6.4% and the mortality rate during the 30days after discharge was 4.4% (3.4% without readmission). Among 30-day survivors, all-cause and HF 30-day readmission rates were 18% (<70years, 22%; ≥90years, 13%) and 5%, respectively. Reimbursements among 30-day survivors comprised at least a beta-blocker in 54% of cases, diuretics in 85%, angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) in 67%, a diuretic and ACEI/ARB combination in 23% and a beta-blocker, ACEI/ARB and diuretic combination in 37%. Patients admitted for HF presented high rates of co-morbidity, readmission and death at 30days, and there remains room for improvement in their drug treatments; these findings indicate the need for improvement in return-home and therapeutic education programmes.
    Archives of cardiovascular diseases 10/2013; 106(11). DOI:10.1016/j.acvd.2013.08.002 · 1.66 Impact Factor
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    ABSTRACT: The frequencies of treatment for cardiovascular risk factors are poorly documented in large populations, particularly according to the presence or absence of cardiovascular disease (CVD). To assess frequencies of reimbursements for antihypertensive, lipid-lowering and antidiabetic medications in France among national health insurance beneficiaries in 2010 and their associations according to age, sex, French regions, level deprivation and the presence of certain CVD. Treatment frequencies were calculated among the beneficiaries (58 million people) on the basis of reimbursements for three specific categories of medicinal products in 2010. The presence of CVD was defined by a diagnosis associated with chronic disease status and hospital stays in 2010. Among people aged greater or equal to 20years, treatment frequencies were 22% (men 20% vs. women 23%) for antihypertensives, 15% (14% vs. 16%) for lipid-lowering agents and 6% (6% vs. 5%) for antidiabetic medications. These frequencies were, respectively, 33%, 23% and 8% in patients aged greater or equal to 40years and 55%, 38% and 14% in patients aged greater or equal to 60 years. The frequency of at least one treatment for at least one of the three risk factors was 41% in patients aged greater or equal to 40 years and 66% in patients aged greater or equal to 60 years. Among patients aged greater or equal to 20 years, 22% were treated for at least one risk factor in the absence of CVD and 3% were treated for at least one risk factor in the presence of CVD. Regional differences were observed, with higher frequencies of antihypertensive and antidiabetic use in the North, North-East and Overseas regions. Treatment frequencies increased with level of deprivation, especially for antidiabetics. This national study more clearly defines treatment frequencies and the populations and regions with the highest treatment frequencies.
    Archives of cardiovascular diseases 05/2013; 106(5):274-86. DOI:10.1016/j.acvd.2013.02.005 · 1.66 Impact Factor
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    ABSTRACT: Objectif Étudier les hospitalisations pour amputation et plaie du pied (PP) chez les personnes diabétiques. Patients et méthodes Les séjours hospitaliers pour amputation et PP ont été isolés à partir du PMSI 2011 pour les assurés du régime général de l’assurance maladie (environ 90 % de la population en France). Du fait de nombreuses hospitalisations de longue durée dans cette population spécifique, l’existence d’un diabète a été recherchée par la présence de ≥ 3 remboursements d’antidiabétiques oraux/insuline au cours d’1 des 3 dernières années, ou l’existence d’une affection de longue durée diabète dans le SNIIRAM. Résultats En 2011, on dénombre 9 591 séjours et 7 687 personnes hospitalisées pour amputation ; ainsi que 29 287 séjours et 17 346 personnes hospitalisées pour PP. Entre 2008 et 2011, l’effectif a augmenté mais le taux standardisé de personnes amputées a diminué (304/10 0000 vs 272/100 000) ; alors que les effectifs et les taux de personnes hospitalisées pour PP ont augmenté, chez les hommes et les femmes. L’âge moyen est de 71 ans chez les amputés et ceux hospitalisés pour PP. Il est stable chez les amputés mais s’est un peu élevé chez ceux hospitalisés pour PP. La proportion d’hommes est élevée (amputés : 72 %, PP : 60 %) et a un peu augmenté entre 2008 et 2011. Le niveau d’amputation s’est modifié, vers des amputations un peu plus souvent distales : 50 % au niveau des orteils (versus 46 % en 2008), 18 % du pied (versus 17 %), 18 % de la jambe (versus 19 %), et 14 % de la cuisse ou du sacrum (versus 17 %). Conclusion Alors que la prévalence du diabète augmente, on observe une diminution de la fréquence d’une complication grave du diabète, compensée par une plus grande fréquence des hospitalisations pour PP. Ces analyses seront complétées par l’étude de la prise en charge (par forfait podologique) des personnes ayant une hospitalisation pour PP.
    Diabetes & Metabolism 03/2013; 39:A1. DOI:10.1016/S1262-3636(13)71613-6 · 2.85 Impact Factor
  • Revue d Épidémiologie et de Santé Publique 03/2013; 61:S16. DOI:10.1016/j.respe.2013.01.039 · 0.66 Impact Factor
  • Revue d Épidémiologie et de Santé Publique 03/2013; 61:S20. DOI:10.1016/j.respe.2013.01.052 · 0.66 Impact Factor
  • Revue d Épidémiologie et de Santé Publique 03/2013; 61:S8. DOI:10.1016/j.respe.2013.01.013 · 0.66 Impact Factor
  • Annales de Dermatologie et de Vénéréologie 12/2012; 139(12):B109-B110. DOI:10.1016/j.annder.2012.10.133 · 0.67 Impact Factor
  • Diabetologia 11/2012; 56(1). DOI:10.1007/s00125-012-2769-9 · 6.88 Impact Factor
  • Progrès en Urologie 11/2012; 22(13):833. DOI:10.1016/j.purol.2012.08.212 · 0.77 Impact Factor
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    ABSTRACT: Objectif Évaluer le taux de couverture vaccinale (TCV) contre la grippe saisonnière en 2010 et en 2011, ainsi que les facteurs associés à un non renouvellement de cette vaccination en 2010, un an après la pandémie de grippe A(H1N1). Méthodes Le régime général de l’Assurance maladie organise chaque année une campagne annuelle de vaccination pour les groupes cibles que sont les sujets de moins de 65 ans atteints de certaines affections de longue durée (ALD) ou bénéficiant d’un remboursement de médicaments pour l’asthme ; et ceux de 65 ans et plus, soit environ 11,5 millions d’assurés. Résultats Le TCV global hors asthme (50,4 %) a diminué en 2010 comparativement aux trois années précédentes où il était proche de 60,0 %, et il demeurait à 51,0 % en 2011. Pour les sujets de moins de 65 ans, il a baissé de 40,3 % en 2009 à 31,6 % en 2010 (33,1 % en 2011) et pour les sujets de 65 ans et plus de 63,3 % à 53,8 % (54,0 % en 2011). Le TCV de chacune des maladies ciblées chez les sujets de moins de 65 ans a diminué pour les maladies cibles (surtout pour l’asthme) à l’exception de l’infection par le virus de l’immunodéficience humaine (VIH) dont la prise en charge a été modifiée pour 2010. Il a baissé pour les sujets de 65 ans et plus ayant une maladie cible (72,3 % en 2009, 60,4 % en 2010, 60,7 % en 2011). Le non renouvellement d’une vaccination en 2010 était essentiellement associé à un jeune âge, à une moindre délivrance de médicaments et à moins de consultations chez un généraliste ou spécialiste, à une hospitalisation, à un lieu de résidence dans une région du sud et surtout hors métropole. Il était moindre en présence de certaines ALD. Conclusion Une baisse importante des TCV a été observée en 2010, elle persistait en 2011, alors que le TCV recommandé est de 75 %. Des efforts doivent être fournis pour améliorer la confiance des personnes assurées, surtout pour les groupes les plus fragiles. Ce qui était connu•La grippe saisonnière augmente la mortalité et la morbidité et a des conséquences économiques. La vaccination diminue les infections et leurs complications.•La loi relative à la politique de santé publique a fixé pour 2008 l’objectif d’un taux de couverture vaccinale de 75 % pour les personnes à risque, comme il est recommandé par l’OMS.•La campagne de vaccination et l’innocuité du vaccin contre la grippe A(H1N1) ont donné lieu à de nombreux débats et controverses en 2009. En 2010, une souche de virus A(H1N1) a été incluse dans la composition du vaccin contre la grippe saisonnière.Ce qu’apporte l’article•Le taux de couverture globale des sujets assurés du régime général ciblés par cette vaccination chute de 60,0 % à 50,4 % en 2010 et reste à ce niveau en 2011 (51,0 %).•Cette diminution concerne tous les âges et la quasi-totalité des groupes ciblés par la vaccination.•Le non renouvellement d’une vaccination en 2010 était principalement associé à un jeune âge, à une moindre délivrance annuelle de médicaments et moins de consultations chez un généraliste ou un spécialiste, une hospitalisation, à un lieu de résidence dans une région du sud, et, surtout hors métropole.
    La Presse Médicale 11/2012; 41(11):e568–e576. DOI:10.1016/j.lpm.2012.05.017 · 1.17 Impact Factor

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849 Citations
226.19 Total Impact Points

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  • 1995
    • Bordeaux School of Public Health
      Burdeos, Aquitaine, France