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The regular performance of Pap tests reduces the mortality of cervical cancer. Obesity is associated with low Pap test rates. We analyze the combined role of obesity and low income. We calculated a Slope Index of Inequality. Among the 28,905 women included, 23.1% were underscreened. The rate of underscreening increased with BMI. The income gradient increased significantly from 0.17 among normal-weight women to 0.19 in overweight and 0.23 in obese women (p = 0.047). Women who are obese are subject to a double penalty in cervical cancer screening: they are underscreened and subject to a more unfavorable economic gradient than normalweight women.

To assess whether lack of trust in the government and scientists reinforces social and racial inequalities in vaccination practices.A follow-up of the EpiCov random population-based cohort survey.In July 2021, in France.Eighty-thousand nine hundred and seventy-one participants aged 18 years and more.Adjusted odds ratios of COVID-19 vaccination status (received at least one dose/ intends to get vaccinated/ does not know whether to get vaccinated/refuses vaccination) were assessed using multinomial regressions to test associations with social and trust factors and to study how these two factors interacted with each other.In all, 72.2% were vaccinated at the time of the survey. The population of unvaccinated people was younger, less educated, had lower incomes, and more often belonged to racially minoritized groups, as compared to vaccinated people. Lack of trust in the government and scientists to curb the spread of the epidemic were the factors most associated with refusing to be vaccinated: OR = 8.86 (7.13 to 11.00) for the government and OR = 9.07 (7.71 to 10.07) for scientists, compared to vaccinated people. Lack of trust was more prevalent among the poorest which consequently reinforced social inequalities in vaccination. The poorest 10% who did not trust the government reached an OR of 16.2 (11.9 to 22.0) for refusing to be vaccinated compared to the richest 10% who did.There is a need to develop depoliticised outreach programmes targeted at the most socially disadvantaged groups, and to design vaccination strategies conceived with people from different social and racial backgrounds to enable them to make fully informed choices.

BackgroundWe aimed to study whether social patterns of exposure to SARS-CoV-2 infection changed in France throughout the year 2020, in light to the easing of social contact restrictions.MethodsA population-based cohort of individuals aged 15 years or over was randomly selected from the national tax register to collect socio-economic data, migration history, and living conditions in May and November 2020. Home self-sampling on dried blood was proposed to a 10% random subsample in May and to all in November. A positive anti-SARS-CoV-2 ELISA IgG result against the virus spike protein (ELISA-S) was the primary outcome. The design, including sampling and post-stratification weights, was taken into account in univariate and multivariate analyses.ResultsOf the 134,391 participants in May, 107,759 completed the second questionnaire in November, and respectively 12,114 and 63,524 were tested. The national ELISA-S seroprevalence was 4.5% [95%CI: 4.0%-5.1%] in May and 6.2% [5.9%-6.6%] in November. It increased markedly in 18-24-year-old population from 4.8% to 10.0%, and among second-generation immigrants from outside Europe from 5.9% to 14.4%. This group remained strongly associated with seropositivity in November, after controlling for any contextual or individual variables, with an adjusted OR of 2.1 [1.7-2.7], compared to the majority population. In both periods, seroprevalence remained higher in healthcare professions than in other occupations.ConclusionThe risk of Covid-19 infection increased among young people and second-generation migrants between the first and second epidemic waves, in a context of less strict social restrictions, which seems to have reinforced territorialized socialization among peers.

Additional file 1: Supplementary Table 1. Factors associated with possible COVID-19: adjusted OR (95% CI) Multinomial regression results. Additional adjustments on chronic disease, obesity, smoking and individual preventive measures.

Supplemental material, sj-pdf-1-msc-10.1177_0969141320914323 for Patterns of gynaecological check-up and their association with body mass index within the CONSTANCES cohort by Jeanna-eve Franck, Virginie Ringa, Laurent Rigal, Jeanne Sassenou, Mireille Cœuret-Pellicer, Pierre Chauvin and Gwenn Menvielle in Journal of Medical Screening

Supplemental material, MSC914323 Supplementary material for Patterns of gynaecological check-up and their association with body mass index within the CONSTANCES cohort by Jeanna-eve Franck, Virginie Ringa, Laurent Rigal, Jeanne Sassenou, Mireille Cœuret-Pellicer, Pierre Chauvin and Gwenn Menvielle in Journal of Medical Screening

Notre pays — et la planète — traverse une crise épidémique majeure. Comme toute crise, elle peut être révélatrice des forces et faiblesses de la société, et de ses composantes : celles de son système de santé, de son système de recherche, du fonctionnement de la démocratie sanitaire… Cet article aborde la question des inégalités sociales au temps du Covid-19 : la crise sanitaire, la réaction politique et celle du système de santé les ont-elles amplifiées, atténuées ou les ont-elles laissées telles qu’elles étaient auparavant ? Ce numéro spécial de la revue Questions de Santé Publique apporte un éclairage sur cette question à partir de résultats originaux provenant de l’enquête « Épidémiologie et conditions de vie » (EpiCoV), permettant de documenter dans les meilleurs délais la situation exceptionnelle que nous traversons.

Background Smoking only partly explains the higher lung cancer incidence observed among socially deprived people. Occupational exposures may account for part of these inequalities, but this issue has been little investigated. We investigated the extent to which smoking and occupational exposures to asbestos, silica and diesel motor exhaust mediated the association between education and lung cancer incidence in men. Methods We analysed data from a large French population-based case-control study, the ICARE study (1976 lung cancers and 2648 controls). Detailed information on lifelong tobacco consumption and occupational exposures to various carcinogens was collected. We conducted inverse probability-weighted marginal structural models. Results A strong association was observed between education and lung cancer risk. The indirect effect through smoking varied by educational level, with the strongest indirect effect observed for those with the lowest education (OR = 1.34 (1.14–1.57)). The indirect effect through occupational exposures was substantial among men with primary (OR = 1.22 (1.15–1.30) for asbestos and silica) or vocational secondary education (OR = 1.18 (1.12–1.25)). The contribution of smoking to educational differences in lung cancer incidence ranged from 22% (10–34) for men with primary education to 31% (−3–84) for men with a high school degree. The contribution of occupational exposures ranged from 15% (10–20) for men with a high school degree to 20% (13–28) for men with vocational secondary education. Conclusion Our results highlight the urgent need for public health policies that aim at decreasing exposure to carcinogens at work, in addition to tobacco control policies, if we want to reduce socioeconomic inequalities in the cancer field.

International audience; Background Recent randomized trials report that mortality is lower with high-convection-volume hemodiafiltration (HDF) than with hemodialysis (HD). Study Design We used data from the French national Renal Epidemiology and Information Network (REIN) registry to investigate trends in HDF use and its relationship with mortality in the total population of incident dialysis patients. Setting & Participants The study included those who initiated HD therapy from January 1, 2008, through December 31, 2011, and were dialyzed for more than 3 months; follow-up extended to the end of 2012. Factor HDF use at the patient and facility level. Outcomes All-cause and cardiovascular mortality, using Cox models to estimate HRs of HDF as time-dependent covariate at the patient level, with age as time scale and fully adjusted for comorbid conditions and laboratory data at baseline, catheter use, and facility type as time-dependent covariates. Analyses completed by Cox models for HRs of the facility-level exposure to HDF updated yearly. Results Of 28,407 HD patients, 5,526 used HDF for a median of 1.2 (IQR, 0.9-1.9) years; 2,254 of them used HDF exclusively. HRs for all-cause and cardiovascular mortality associated with HDF use were 0.84 (95% CI, 0.77-0.91) and 0.73 (95% CI, 0.61-0.88), respectively. In patients treated exclusively with HDF, these HRs were 0.77 (95% CI, 0.67-0.87) and 0.66 (95% CI, 0.50-0.86). At the facility level, increasing the percentage of patients using HDF from 0% to 100% was associated with HRs for all-cause and cardiovascular mortality of 0.87 (95% CI, 0.77-0.99) and 0.72 (95% CI, 0.54-0.96), respectively. Limitations Observational study. Conclusions Whether analyzed as a patient- or facility-level predictor, HDF treatment was associated with better survival

Background Acetate-free dialysis (AFD) improves haemodynamic stability during dialysis, compared with standard haemodialysis (HD) with a small amount of acetic acid. Using the national REIN registry, we classified 15 160 incident patients who started HD from 2008 to 2010 into three exposure categories according to the type of dialysate used in their dialysis unit: standard dialysate only (reference), both standard and AFD (mixed unit) or HCl dialysate only (100% HCl unit). Methods Cox survival analysis was adjusted for 15 baseline comorbidities, laboratory data and haemodiafiltration (HDF). We took patient clustering within units into account, used age as the time scale and treated patient exposure to AFD and to HDF as time-dependent variables. Results Median age (interquartile range) was 70.5 years (58.1-78.8). Over a median follow-up of 1.8 years (1.2-2.6), 658 patients were dialysed in a 100% HCl unit, 3021 in a mixed unit and 11 481 were never exposed to AFD. The relation between AFD and mortality was not constant with age (Schoenfeld residuals test P = 0.01 for mixed group and P = 0.03 for 100%HCl group). Patients older than 70 years had a significantly lower mortality risk associated with AFD [hazard ratio (HR) = 0.79, 95% confidence interval (CI) = 0.67 to 0.94 for patients exposed in a 100% HCl unit; HR = 0.83, 95% CI = 0.74 to 0.94 for patients exposed in a mixed unit], but no association was found in younger patients. Conclusions AFD was associated with improved survival independent of comorbidities and HDF in patients aged 70 years and older but not in patient younger than 70 years.

Introduction Le tabagisme n’explique que partiellement l’incidence elevee de cancer du poumon observe chez les hommes socialement defavorises. Une partie de ces inegalites est potentiellement attribuable aux expositions professionnelles, mais leur contribution a ete peu etudiee. Notre etude vise a quantifier les effets de mediation du tabagisme, des expositions professionnelles a l’amiante, a la silice et aux fumees de diesel dans la relation entre le diplome et l’incidence du cancer du poumon chez les hommes. Methodes Nous avons analyse les donnees de l’etude cas-temoins francaise ICARE (1976 cas et 2648 temoins), qui inclut des informations sur la consommation tabagique vie entiere et les expositions professionnelles a divers cancerigenes. Les effets de mediation ont ete estimes par des modeles structuraux marginaux ponderes. Resultats Une forte association a ete observee entre le diplome et le risque de cancer du poumon. Comparativement aux hommes ayant un diplome universitaire, l’effet indirect passant par le tabagisme differait selon le diplome et etait maximal chez les moins diplomes (niveau d’etudes primaire) (OR = 1,34 [1,15–1,30]). L’effet indirect des expositions professionnelles etait important parmi les moins diplomes (OR = 1,22 [1,15–1,30] pour l’amiante et la silice) et les hommes ayant un CAP/BEP (OR = 1,18 [1,12–1,25]). La contribution du tabagisme aux differences sociales d’incidence du cancer du poumon variait de 22 % (10–34) pour les moins diplomes a 31 % (-3–84) pour ceux ayant le baccalaureat. La contribution des expositions professionnelles variait de 15 % (10–20) pour les hommes ayant le baccalaureat a 20 % (13–28) pour ceux ayant un CAP/BEP. Conclusion Nos resultats soulignent la contribution importante des expositions professionnelles aux inegalites sociales d’incidence du cancer du poumon chez les hommes en France. Pour reduire ces inegalites, des actions de prevention des expositions professionnelles aux cancerigenes sont donc necessaires, en plus des mesures de lutte antitabac.