In France, almost nine of 10 deaths are caused by non-communicable diseases, and there is significant social inequality in mortality rates. However, it is not easy to collect robust data on the ...incidence and prevalence of such diseases according to socio-economic status. Based on data from the link between the primary longitudinal population sample and the national health data system, the aim of our study was to compute the standardised incidence and prevalence of seven major groups of chronic diseases according to socio-economic status.
Descriptive retrospective cohort study.
This was a descriptive retrospective cohort study on a weighted representative sample of the French population, comprising 3.4 million individuals from data collected 2016–2017. Main chronic disease categories include diabetes, cancers, psychiatric disorders, liver and pancreatic diseases, neurological conditions, respiratory and cardiovascular diseases, calculated from the 2016–2017 period by combining health care consumption and diagnoses received during hospitalisations and/or associated with specific full healthcare coverage. Socio-economic status was measured by disposable income from the 2013–2014 tax returns and census-derived socioprofessional groups, and findings were standardised for age and sex.
For all disease categories except cancers, standardised incidence rates showed a gradient favouring the wealthiest, with a risk ratio between the first and tenth standard of living deciles ranging from 1.4 (cardiovascular diseases) to 2.8 (diabetes). Incidence of all disease categories, except cancers, was higher for all groups compared with executives and higher academic professions (risk ratios between workers and executives ranged from 2.0 to 1.3 in psychiatric and cardiovascular diseases, respectively). Conversely, cancer incidence rate followed a flat curve, reduced in the two poorest standard of living deciles, and there were no significant differences between socioprofessional groups. Standardised prevalence rates followed the same patterns, although risk ratios were highest for psychiatric diseases, varying according to sex and disease.
Deep social inequalities in incidence and prevalence of chronic diseases were observed in a large representative sample of the French population. The reverse social inequalities in cancer incidence and prevalence calls for more detailed research into cancer types and selection mechanisms, the data from which would allow the long-term monitoring of such disparities.
Abstract Background The Baby-Friendly Hospital Initiative (BFHI) is associated with improved breastfeeding outcomes in many high-income countries including the UK and the USA, but its effectiveness ...has never been evaluated in France. We investigated the impact of the BFHI on breastfeeding rates in French maternity units in 2010, 2016 and 2021 to assess if the BFHI aids to reduce inequalities in breastfeeding. Methods We examined breastfeeding in maternity units (exclusive, mixed and any breastfeeding) in mothers of singleton full-term newborns using the 2010 (n = 13 075), 2016 (n = 10 919) and 2021 (n = 10 209) French National Perinatal Surveys. We used mixed-effect hierarchical multinomial regression models adjusting for neonatal, maternal, maternity unit and French administrative department characteristics, and tested certain interactions. Results The adjusted rate of exclusive breastfeeding was higher by +5.8 (3.4–8.1) points among mothers delivering in BFHI-accredited maternity units compared with those delivering in non-accredited units. When compared with average-weight newborns, this difference was sharper for infants with low birthweight: +14.9 (10.0–19.9) points when their birthweight was 2500 g. Mixed breastfeeding was lower by -1.7 points (-3.2–0) in BFHI-accredited hospitals, with no notable difference according to the neonatal or maternal characteristics. Conclusion Mothers delivering in BFHI-accredited maternity units had higher exclusive breastfeeding rates and lower mixed breastfeeding rates than those delivering in non-accredited maternity units. The positive impact of the BFHI was stronger among low-birthweight neonates, who are less often breastfed, helping reduce the gap for this vulnerable group while favouring mothers with higher education levels.
To report results of the 2021 French National Perinatal Survey (ENP) in metropolitan France and assess trends in the main indicators of perinatal health, medical practices, and risk factors in France ...since 1995.
All the samples included all women giving birth at a gestational age of at least 22 weeks of gestation and/or to an infant weighing at least 500 grams in all maternity units in metropolitan France during one week in 1995 (N=13 048), 2003 (N=14 324), 2010 (N=14 546), 2016 (N=12 553), and 2021 (N=12 088). The data came from postpartum interviews of the women at the hospital and their medical records. Comparisons between surveys showed trends over time.
Between 1995 and 2021, maternal characteristics changed. Maternal age and the frequency of women with obesity rose: in 2021, 24.6% of women were 35 years or older (21.1% in 2016, 19.2% in 2010, 15.9% in 2003 and 12.4% in 1995) and 14.4% were obese (11.8% in 2016, 9.9% in 2010 and 7.4% in 2003). Some antenatal prevention behaviors that improved in 2021 were not smoking during the third trimester, acid folic administration before pregnancy, and vaccination against influenza. The percentage of women with an early prenatal appointment ("4
month appointment"), implemented to facilitate screening of maternal vulnerability during pregnancy, has continued to rise. The percentage of women receiving prenatal care by midwives has risen markedly (39.0% in 2021 versus 11.7% in 2016). Serum screening for Down syndrome continues to increase (91.8% of women in 2021). The rate of induction of labor has risen significantly (20.2% in 1995 and 25.8% in 2021). The mode of delivery has not varied significantly since 2003; in 2021, the cesarean rate was 21.4% and the instrumental vaginal delivery rate 12.4%. Episiotomy was increasingly rare, among both primiparous and multiparous women (16.5% and 2.9% in 2021, respectively). The prevalence of coronavirus (SARS-CoV2) infection during pregnancy was 5.7%. Preterm live births increased regularly, slightly but significantly over the 1995-2016 period and then remained stable between 2016 and 2021 (7.0%). In 2021, 56.3% of women exclusively breastfed during their hospital stay, a modest increase in comparison with 2016 (54.6%).
Routine national perinatal surveys highlight positive trends over time in some preventive practices, decreases in some medical interventions consistent with national guidelines, and the increasing role of midwives in prenatal care. Nonetheless, some indicators remain less than optimal and require more detailed analyses.
Several series reported obstetric complications among pregnant women hospitalized for COVID. These data, because they focused on women with the most severe presentations or with specific ...immunosuppression, were likely to overestimate the risks associated with the infection at a global level. To date, population-based studies, most of which collected data from registers of women hospitalized during pregnancy for COVID-19, remain sparse. Neither the prevalence of COVID-19 in pregnant women nor the overall extent of obstetric complications worldwide, compared with uninfected pregnant women is clear. The impact of COVID-19 on perinatal care and obstetric management is thus difficult to evaluate.
To evaluate the prevalence and determinants of COVID-19 diagnosis during pregnancy and assess related obstetric practices and perinatal outcomes.
Used data collected at childbirth in France from women included in the 2021 national perinatal survey, we compared women with and without a COVID-19 diagnosis (for sociodemographic characteristics) and then women with no COVID-19 diagnosis during pregnancy, women diagnosed more than 15 days preceding childbirth, and those diagnosed within those 15 days for outcomes.
The COVID-19 prevalence during pregnancy was 5.7 % (95 %CI 5.3–6.1) (678/11 930). The aOR for COVID-19 diagnosis associated with non-French nationality was 1.27 (95 %CI 1.03–1.58), with non-smoking 0.63 (95 %CI 0.55–0.81) and with multiparity 1.21 (95 %CI 1.02–1.45). Diagnosis occurred in the third trimester for 49 % —28.5 % in the 15 days before childbirth. Women with COVID-19 diagnosed during pregnancy had preterm births more often (9.6 %) than women without this diagnosis (6.9 %) (P = 0.007). Women with COVID-19 diagnosed within the 15 days preceding childbirth had more cesarean deliveries (28.3 %) than those diagnosed earlier (17.4 %) (P = 0.02).
COVID-19 diagnosis during pregnancy was associated with an increased risk of preterm birth. Obstetric outcomes were poorer in women with a COVID-19 diagnosis in the 15 days preceding childbirth.
