National Institute for Demographic Studies

Background This observational study aimed to assess the impact of the pandemic on the way kidney transplantation, survival, and vaccination evolved in chronic dialysis recipients (CDR) over the course of the COVID-19 pandemic waves and inter-waves. Methods Using the French national health claims database, incident persons with end-stage kidney disease in the years 2015 to 2021 treated with dialysis were followed up until 31 December, 2022. Kidney transplantation and survival in the pandemic sub-periods compared to the pre-pandemic period were investigated using longitudinal models with time-dependent covariates. In addition, the impact of cumulative doses of COVID-19 vaccine on hospitalization and survival was studied, comparing CDR and matched controls. Results Here, we show that the follow-ups of the 71,583 CDR and the 143,166 controls totalize 639,341 person-years (CDR: 184,909; controls: 454,432). The likelihood of receiving a kidney transplant is lower in all pandemic sub-periods. The 3 waves are associated with a higher risk of death (hazard ratio (HR [95% confidence interval]): 1.19 [1.13–1.27], 1.19 [1.15–1.23], and 1.12 [1.07–1.17], respectively). While vaccine coverage declines with each booster dose, receiving these doses is associated with a lower risk of COVID-19-related hospitalization (0.66 [0.56–0.77], 0.83 [0.72–0.94] for 1st booster versus 2nd dose and 2nd booster versus 1st booster, respectively) and death (corresponding HR: 0.55 [0.51–0.59], 0.88 [0.83–0.95]). Conclusions The evolving patterns in mortality and vaccination outcomes are similar in CDR and controls, suggesting that the impact of the pandemic on CDR is not specific to kidney disease per se.

Since the 1970s, twin birth rates have increased sharply in developed countries. In Africa, where the rate is the highest globally, its evolution and variation are poorly understood. This article aims to estimate the twinning rate in sub-Saharan African (SSA) countries throughout 1986–2016 and analyze its spatial, temporal, and ethnic variations. It also seeks to identify social and demographic factors associated with a high probability of twin births and outline a forecast of the twinning rate. We used data from 174 Demographic and Health Surveys from 42 countries. We supplemented them with the UN World Population Prospects (WPP). The twinning rate was calculated by reporting the number of twin births per thousand total births. We used logistic regression to analyze the factors associated with twin births. We projected the twinning rate based on WPP. The overall SSA twinning rate is 17.4 per 1000, but it has changed very little over time, and we expect it will grow a little between 2015 and 2050, increasing at most from 17.4 per 1000 to 18.4 per 1000. We also show significant differences in the twinning rate in SSA according to mother ethnicity. Most ethnic groups with high twinning rates belong to the large Bantu ethnic family. SSA remains the ‘land of twins’, with the twinning rate changing slowly. However, specific health policies must target twin births in SSA to address the public health challenges they present.

The neonatal, infant and under‐5 mortality rates are important indicators of child health used by countries to monitor their health policies and for international comparisons. Coverage and completeness of registration systems are critical for the quality of these indicators. However, under registration of deaths is still a major problem today, especially where registration systems are still in the process of being established, particularly in low‐ and middle‐income countries. In the last two decades, Türkiye stands out with its rapidly declining child and infant mortality, as well as its developing VR system. However, the completeness of under‐5 deaths in the VR system in Türkiye has not been fully evaluated yet. The fact that the regions in Türkiye that are disadvantaged in terms of early‐age mortality are less populated poses the risk of neglecting areas that need more investment and improvement in child mortality and data quality. In this study, we assess the completeness of under‐5 deaths at the national and regional levels by using a recently developed model for estimating under‐5 mortality by detailed age. We apply this model at both the national and regional levels to assess the completeness of under‐5 deaths in the VR system of Türkiye from 2009 to 2022. The results confirm the presence of early death omission in the eastern regions at the beginning of the studied period, for which we propose a correction. The prediction of the model also indicates a strong improvement over time in the completeness of death registration in these regions. This study stresses the importance of revealing regional disadvantages rather than relying on national progress in the completeness of under five deaths, especially in low‐ and middle‐income countries where registration systems are still in the process of being established.

Background Mitigation measures implemented in response to the COVID‐19 pandemic led to significant changes in maternity care across Europe, including restrictions on companions during labor and birth. This cross‐sectional study explores the association between the presence of a companion of choice and a positive perception of the birth experience. Additionally, it explores the association between health professionals' attention, assistance, and availability during labor and birth and a positive perception of birth. Methods We utilized a structured, validated online questionnaire, available in 25 languages, to assess the quality of maternal care during the COVID‐19 pandemic from women's perspectives. We conducted logistic regression to explore associations between variables related to the presence of a companion of choice, health professionals' attention, assistance, and availability, and positive perceptions of birth, when controlled for confounders, including birth mode and medical interventions. Results Responses from 48,039 women across 20 countries in the WHO European Region were included. Always having a companion of choice during birth (aOR: 2.11) and always receiving adequate care from health professionals (assistance aOR: 2.12, attention aOR: 36.64, availability aOR: 2.12) were associated with positive birth perception. Instrumental births (aOR: 0.76), episiotomies (aOR: 0.74), fundal pressure (aOR: 0.52), and cesarean births (planned aOR: 0.80, unplanned prelabor aOR: 0.60, unplanned in‐labor aOR: 0.52) were associated with less positive birth perceptions. Discussion This study highlights the critical role of having a chosen companion and receiving adequate attention, assistance, and availability from health professionals in promoting positive birth perceptions, even in times of crisis such as the COVID‐19 pandemic. Ensuring the presence of a companion of choice and comprehensive professional support is crucial for delivering high‐quality, respectful maternity care.

Introduction Breast cancer is a global public health challenge. It is the most commonly diagnosed cancer and the leading cause of cancer-related death in women. Several inequalities remain among women facing this disease, depending on their country of birth and their sociodemographic characteristics. The SENOVIE study (Therapeutic mobility and breast cancer) aims to understand the life trajectories of women born in France and in sub-Saharan Africa treated for breast cancer in four hospitals in the greater Paris area. Methods and analysis The SENOVIE study is a mixed methods study, combining a quantitative and a qualitative approach. A quantitative retrospective life-event survey is conducted in four hospital centres in the greater Paris area, France, to (1) understand how breast cancer (diagnosis, treatment and possibly reconstruction) impacts the life trajectories of women in many spheres (migration, family life, professional life, financial situation, etc); (2) study the access to healthcare by women living with breast cancer and their determinants; and (3) examine how gender relations may shape breast cancer experience. Women born in France and women born in sub-Saharan Africa are recruited: 1000 women, including 500 per group. In the standardised, face-to-face questionnaire, each dimension of interest is collected year by year from birth until the time of the survey. Clinical and laboratory information is documented with a short medical questionnaire filled out by the medical teams. The qualitative survey is conducted specifically with women born in sub-Saharan Africa who came to France for treatment to better understand their trajectories and the specific obstacles they faced. To analyse the quantitative data collected, descriptive analyses will be used to visualise trajectories (sequence analysis), along with longitudinal analysis methods (survival models and duration models). Ethics and dissemination The study is conducted in accordance with the Declaration of Helsinki. The French Data Protection Authority (Commission Nationale de l’Informatique et des Libertés, declaration number 2231238) and the Committee for Persons’ Protection East I (Comité de Protection des Personnes Est I, national number 2023-A01311-44) approved it. We will disseminate the findings through scientific publications, policy briefs, conferences and workshops. Trial registration number The SENOVIE France study is registered on Clinicaltrial.gov ( NCT06503393 ; registration date: 7 September 2024; https://clinicaltrials.gov/study/NCT06503393 ).

The end of a person's active life is often a key moment in the emergence of new life projects involving, in particular, important issues linked to the choice of the place of residence or even the adoption of poly‐residence practices. It is within this framework that many retired Moroccan immigrants in France choosing to return to Morocco as a residential choice for retirement are to be found in this particular situation. One option is a return migration to Morocco. However, the alternative to a move to Morocco often turns into Moroccans leading transnational lives which, in view of the ageing process, can be a questionable practice. Thus, this article analyses the different residential and mobility strategies implemented by ageing Moroccan immigrants. Have these retirees taken ageing into consideration in their residential strategies? The article is based on a survey conducted between 2017 and 2019 in the Souss‐Massa region (Morocco) among 20 Moroccan retirees either returning permanently to Morocco or in regular circulation between France and Morocco. The article shows that the ageing of these ‘returning’ migrants raises several challenges of a financial, health and social isolation nature and that their care practices are transnational. Ageing sometimes implies changes in their initial residential and migratory projects. This could involve, for example, a wish to be reunited with the family, adapting their residential requirements and considering new mobility. However, we will also see that those without dual nationality and in precarious situations find their migration projects and residential choices restrained, particularly by difficulties in accessing certain social rights.

Understanding widowhood duration is essential for individuals and effective widow support policies, yet widowhood duration remains an understudied topic. In this article, we provide a quantitative estimation of the impact of three primary determinants of expected widowhood duration at age 60 in a unified framework: (1) the degree of overlap between male and female mortality distributions, (2) the spousal age gap, and (3) the dependence of spousal mortality. Using French life tables from 1962 to 2070 and simulations based on the Gompertz law and a bivariate Gaussian copula, we assess each determinant's relative influence. Our findings show that ignoring spousal mortality dependence overestimates widowhood duration by three years, whereas disregarding the spousal age gap underestimates it by one year. In France, expected widowhood duration at age 60 in 2020 was 10.4 years for females and 5.8 years for males. Despite converging gender life expectancies, our projections suggest that widowhood duration will remain high until 2070, at 9.2 years for females and 6.2 years for males. Notably, we identify a negative gradient in widowhood duration along the standard-of-living distribution.

Though the number of divorces has stabilized in several European countries at prime age, it continues to increase at older ages. Drawing upon a large French administrative database, the Échantillon Démographique Permanent (Permanent Demographic Sample), a panel study that follows 4.4% of the French population every year, this paper presents new findings on the economic consequences of grey divorces, occurring at age 50 and over and their mechanisms. We implement a two-way fixed-effect regression with a control group to assess the causal effects of divorce on men and women. To do so, we compare divorced individuals with people that will divorce but have not done so yet. The results confirm that the decrease in living standards is larger, on average, for women than for men. For women, this decrease is larger when divorce occurs after 50 (26% one year after the divorce) than before (20%). Thus, grey divorce increases gender inequalities following break-ups. Public and private transfers mitigate post-grey divorce gender inequalities, especially for the poorest women. Recovery through re-partnering plays an important role in moderating the negative consequences of divorce.

Background Hypertension remains a global public health problem. This study aimed to evaluate the impact of hypertension on premature mortality among people living in Moramanga, Madagascar. Methods Three communes of Moramanga district have been monitored since 2012 as part of the MHURAM project (Moramanga Health Survey in Urban and Rural Areas in Madagascar). In 2013, individuals aged 15 years and above were surveyed to estimate the prevalence of hypertension and identify risk factors. A follow-up survey was conducted in 2016–2017 to record deaths; causes of death were assessed through verbal autopsy (VA). The occurrence of premature death was evaluated using a retrospective cohort study design applied to data collected from adults aged 30 to 70 who participated in the hypertension survey. Mortality rates and partial life expectancy by sex and hypertension status were estimated using survival analysis; covariates associated with premature risk of mortality were identified using a Cox proportional hazards model. The contribution of causes of death to the difference in partial life expectancy between hypertensive and non-hypertensive individuals was evaluated using a decomposition analysis. Results There were 4,472 participants in the hypertension survey aged between 30 and 70 during the follow-up. The average follow-up was 2.7 years per individual, resulting in 11,892 person-years in total with 117 deaths reported giving a mortality rate of 9.8‰ (13.1‰ for males and 7.1‰ for females). An estimated 3.2 years of life was lost among those diagnosed with hypertension compared to normotensive (32.0 years and 35.2 years respectively). Adjusted for gender, smoking habit, sedentary lifestyle, and wealth index, hypertension is a risk factor for premature death [HR = 1.58 95%CI (1.07–2.36)]. Hypertensive individuals also experienced higher all-cause and communicable disease mortality in people aged between 30 and 39 years. Conclusion Hypertension is associated with higher risks of premature death in the community of Moramanga. In addition, hypertension contributes not only to mortality via cardiovascular diseases, but also through all causes combined. The health system should enhance prevention efforts, particularly for young hypertensive patients, when risk is most pronounced.

Background A key-population approach to sexually transmitted disease prevention does not fully take into account the multidimensional nature of sexual risk behavior. Visits to sexual health centers for HIV/STI screening provide an opportunity to spread prevention messages and tools, but few data are available on patients’ sexual and prevention behaviors. This study aimed to identify the profile of patients consulting for HIV/STI testing in a Parisian sexual health center. Methods This observational study included 5,130 patients who attended the center for HIV/STI testing from August 2017 through January 2020 and completed a self-administered electronic questionnaire. Data were obtained from the consultation database and the questionnaire. The data included STI results, sociodemographic characteristics, sexual and prevention behaviors, as well as HIV knowledge. To identify homogeneous groups of patients regarding sexual risky behavior, we conducted a mixed approach including both a priori classification and agglomerative hierarchical clustering (AHC) based on multiple correspondence analysis (MCA). Sexual behaviors and substance use were included in the MCA. Results Median age of patients was 26 years [Q1–Q3:23–32]. Seven clusters of patients were identified. Two clusters had a high HIV/STI positivity rate (15–19%) with very different profiles: cluster 1 included socially disadvantaged patients who had no health insurance and cluster 5 included 89% of men who have sex with men. Two clusters had an HIV/STI positivity rate corresponding to that observed in the overall study population (10–11%) but exhibited risky behaviors (cluster 7 with a high frequency of unprotected sexual intercourse, substance use, cannabis use and weekly binge drinking) or lack of knowledge on HIV (cluster 6 including 100% of patients having transactional sex). Conclusions The multidimensional approach demonstrated that both key populations and lower-risk populations visit a sexual health center. While several groups could benefit from tailored interventions, knowledge of HIV and its treatment should be enhanced for every patient visiting a sexual health center. To provide a complete offer in sexual health, patients’ profiles and expectations need to be taken into account.

Commonly used measures of socioeconomic inequalities in mortality, such as the slope and the relative index of inequality, are based on summary measures of the group-specific age-at-death distributions (e.g. standardized mortality rate or life expectancy). While this approach is informative, it ignores valuable information contained in the group-specific distributions. A recent approach applied a measure of distributional dissimilarity (the non-overlap index) to measure lifespan stratification. In this paper, we rigorously evaluate and further implement the multi-group extension of the non-overlap index ($S^P$) to measure socioeconomic inequalities in mortality across a number of groups, and assess whether differences across countries and over time are driven by mortality or compositional changes in two applications with different data availability: educational groups (Sweden and Denmark) and groups defined by an area-level deprivation measure (England). Our findings suggest that the multi-group $S^P$ is sensitive not only to changes in the means or variances, but also to broader mortality changes that affect distributional shapes. The method can be employed to any context where mortality rates by age are available by sub-groups. Furthermore, levels and trends in mortality inequalities computed with the multigroup $S^P$ often differ compared to other conventional summary-based measures. Moreover, we find that the contribution of mortality changes to changes in inequalities is generally greater than that of the changes in the population composition. Whereas levels and trends of inequalities may depend on whether life expectancy- or lifespan variation-based measures are employed, the multi-group $S^P$ provides a holistic perspective by capturing both dimensions simultaneously.

As measurement of sexual minority (SM) people's demographic characteristics has evolved over time, it is of interest to understand how identity intersections within SM communities, such as SM parents, have also changed. The current study aimed to investigate how SM parents may or may not differ in demographic characteristics from SM childfree adults and how the demographic characteristics of SM parents may differ across three cohorts. Participants could be part of one of three age cohorts, with each cohort reflecting distinct historic or cultural events related to LGBTQ+ people's experiences. We used data from a national probability study of 1502 SM adults conducted between 2016 and 2017 to compare demographic characteristics by parent and cohort status. SM parents ( n = 297) and childfree adults differed in sexual and gender identity, relationship status, educational attainment, urbanicity, and poverty status. There were differences among SM parents based on cohort status in sexual and gender identity, partner status (and gender of the partner), educational attainment, poverty status, and urbanicity. However, there were no differences based on racial/ethnic identity or geographic region among SM parents. This work contributes to the ongoing literature on SM parent families by providing a view of the ways in which SM parents have, and have not, changed demographically over time in the United States.

Household air pollution (HAP) presents numerous health challenges. The association between HAP and sleep problems has not been extensively studied. This paper examined the effect of HAP due to solid fuel use on sleep problems among older adults in India. Data from the initial phase of the Longitudinal Aging Study in India, which included 51,060 individuals aged 50 years and older, was utilised. Sleep problems were defined as experiencing difficulty falling asleep, waking up during the night, or waking up too early at least five times per week and were classified as a binary variable. Exposure to HAP was defined as the use of solid fuel for household purposes. Multivariate logistic regression was employed to assess the association, and additionally, interaction analysis was conducted to explore the potential moderating effects of age, gender, and residence on this association. The prevalence of sleep problems among older adults was around 12.7%. Sleep problems were higher among older adults who used solid fuel for cooking (OR = 1.25; 95% CI: 1.17, 1.33) and other purposes (OR = 1.13; 95% CI: 1.06, 1.20) in the adjusted model. The place of cooking, ventilation, and type of stove played a significant role in the association between solid fuel use and sleep problems. Individuals over 65, females, and those residing in rural areas were particularly vulnerable to sleep problems due to HAP exposure. The findings highlight the importance of reducing HAP exposure by transitioning to clean fuels as a public health priority within initiatives aimed at promoting healthy aging.

Objectives Sub-Saharan African immigrants are particularly affected by HIV in France, with many acquiring the infection after migration due to precarious circumstances that increase their vulnerability. This study aimed to explore the association between HIV risk perception, knowledge of biomedical HIV prevention methods and sexual behaviours among sub-Saharan African immigrants living in precarious conditions in the greater Paris area. Methods This cross-sectional study analysed data from 614 participants in the MAKASI project, conducted in the greater Paris area (2019–2020). Sociodemographic characteristics, living conditions, knowledge of biomedical HIV prevention methods (postexposure prophylaxis, treatment as prevention and pre-exposure prophylaxis (PrEP)) and sexual behaviours were described by sex using Pearson’s χ ² tests. HIV risk perception, defined as self-reported exposure to HIV comparable to or greater than the general population, was analysed by participant characteristics. A multivariable logistic regression model identified factors associated with HIV risk perception using variables with a significance threshold of 20%. Results Most participants (76.5%) were men, with a median age of 34 years (IQR: 29–41) and living in precarious conditions. Forty-one per cent of respondents reported perceiving their HIV exposure risk as comparable to or greater than the general population. Participants aware of PrEP (adjusted OR (aOR) =2.60 (1.17–5.80); p<0.020) and those who had sex with occasional partners without a condom within in the 3 months preceding the survey (aOR=1.89 (1.12–3.18); p<0.017) were more likely to report the same or greater risk of HIV exposure. Conclusions Our findings reveal that PrEP knowledge and sex with occasional partners, particularly participants who did not use condoms, are associated with increased HIV risk perception among sub-Saharan African immigrants. Further research should explore the relationship between PrEP uptake and HIV risk perception in this population. Trial registration number NCT04468724

Objective This study aims to investigate the role of state policies in the contexts of accessing parenthood for sexual minority individuals and same-sex couples. Background These are LGBTQ people who want to have children face significant barriers for achieving parenthood, notably depending on the policies regulating access to assisted reproductive technologies, foster care, and adoption. Methods We use a national probability sample of 1507 sexual minority adults living across US states and belonging to three age cohorts. Results Although the proportion of LGBQ parents did not vary across the country, the pathways to parenthood did. In states with more inclusive policies, LGBQ parents accessed parenthood through formal (ART/adoption) or alternative pathways (co-parenting or step-parenting), whereas different-sex pathways were dominant in states with less inclusive policies. Conclusion State policy context is not associated with whether sexual minority adults are parents, but rather how they become parents. Policy Implications Additional policies could be implemented in order to protect sexual minority prospective parents from experiencing discrimination when they try to access adoption, foster care, or ART. Additionally, professionals and families could receive training about gender and sexual minority families.

The Fukushima Daiichi Nuclear Power Plant accident caused the release of large amounts of radioactive material into the environment. Radiation from radionuclides cause DNA lesions, mainly via oxidation, which adversely affect wild organisms by damaging their germ cells. Here, we investigated the effects of radiation on the reproductive organs of Japanese field mice (Apodemus speciosus) by estimating the dose rate of radiation exposure, the accumulation of DNA lesions, and the expression of DNA repair enzymes. In highly contaminated areas, mouse testes received a radiation dose rate > 0.1 mGy/d. According to the International Commission on Radiological Protection, there is a very low probability of effects in the reference rat species at this exposure level. The results of the current study do not definitively conclude that the expression of 8-oxoguanine DNA glycosylase 1 and superoxide dismutase in mouse testes increase with dose rate and lifetime dose. However, 8-hydroxy-2′-deoxyguanosine accumulation increases in a dose rate- and lifetime dose-dependent manner in mouse testes, but is not observed in the sperm of the cauda epididymis. These results suggest that, although DNA lesions occurred in male germ cells of Fukushima mice, most were successfully repaired by DNA repair enzymes at the observed gene expression level. Supplementary Information The online version contains supplementary material available at 10.1038/s41598-024-80869-2.