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1. Social inequalities in participation in cancer screening: does the mode of data collection matter? The CONSTANCES cohort

Author

Mireille Coeuret-Pellicer, Jeanna-Eve Franck, Jeanne Sassenou, Virginie Ringa, Gwenn Menvielle, Ezequiel Aranda, Laurent Rigal, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Cohortes épidémiologiques en population (CONSTANCES), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay-Université de Paris (UP), Sexualité et soins (Genre, Sexualité, Santé) (CESP - INSERM U1018 - Equipe 7), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay-Université Paris Cité (UPCité), and HAL-SU, Gestionnaire

Subjects
Inequality, media_common.quotation_subject, [SDV]Life Sciences [q-bio], Uterine Cervical Neoplasms, [SDV.CAN]Life Sciences [q-bio]/Cancer, Cervical Cancer Screening, 03 medical and health sciences, 0302 clinical medicine, Breast Cancer Screening, [SDV.CAN] Life Sciences [q-bio]/Cancer, Bias, Surveys and Questionnaires, Cancer screening, Per capita, Humans, Medicine, Social inequality, 030212 general & internal medicine, Early Detection of Cancer, media_common, Data collection, business.industry, 030503 health policy & services, fungi, Public Health, Environmental and Occupational Health, Odds ratio, Social class, Socioeconomic Factors, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Administrative record, Cohort, Educational Status, Household income, Female, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, 0305 other medical science, business, Self-reported data, Demography
Abstract

Background Self-reported data are prone to item non-response and misreporting. We investigated to what extent the use of self-reported data for participation in breast (BCS) and cervical cancer screening (CCS) impacted socioeconomic inequalities in cancer screening participation. Methods We used data from a large population-based survey including information on cancer screening from self-reported questionnaire and administrative records (n = 14 122 for BCS, n = 27 120 CCS). For educational level, occupation class and household income per capita, we assessed the accuracy of self-reporting using sensitivity, specificity and both positive and negative predictive value. In addition, we estimated to what extent the use of self-reported data modified the magnitude of socioeconomic differences in BCS and CCS participation with age-adjusted non-screening rate difference, odds ratios and relative indices of inequality. Results Although women with a high socioeconomic position were more prone to report a date for BCS and CCS in questionnaires, they were also more prone to over-declare their participation in CCS if they had not undergone a screening test within the recommended time frame. The use of self-reported cancer screening data, when compared with administrative records, did not impact the magnitude of social differences in BCS participation but led to an overestimation of the social differences in CCS participation. This was due to misreporting rather than to item non-response. Conclusions Women’s socioeconomic position is associated with missingness and the accuracy of self-reported BCS and CCS participation. Social inequalities in cancer screening participation based on self-reports are likely to be overestimated for CCS.

Published
2021
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2. Social inequalities and dynamics of the early COVID-19 epidemic: a prospective cohort study in France

Author

Nathalie Bajos, François Beck, Nathalie Lydié, Claude Martin, Florence Jusot, Laurence Meyer, Rémy Slama, Josiane Warszawski, Jeanna-eve Franck, Emilie Counil, Ariane Pailhé, Alexis Spire, Guillaume Bagein, Muriel Barlet, Aude Leduc FlorenceJusot, Delphine Rahib NicolasPaliod, Philippe Raynaud, Alexandra Rouquette, Patrick Sicard, Institut de Recherche Interdisciplinaire sur les enjeux Sociaux - sciences sociales, politique, santé (IRIS), École des hautes études en sciences sociales (EHESS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Sorbonne Paris Nord, Institut national d'études démographiques (INED), Université Paris Dauphine-PSL, Université Paris sciences et lettres (PSL), Laboratoire d'Economie de Dauphine (LEDa), Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Université Paris Dauphine-PSL, Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL), Centre de Recherches sur l'Action Politique en Europe (ARENES), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut d'Études Politiques [IEP] - Rennes-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Centre National de la Recherche Scientifique (CNRS), École des Hautes Études en Santé Publique [EHESP] (EHESP), Santé publique France - French National Public Health Agency [Saint-Maurice, France], Institute for Advanced Biosciences / Institut pour l'Avancée des Biosciences (Grenoble) (IAB), Centre Hospitalier Universitaire [Grenoble] (CHU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement français du sang - Auvergne-Rhône-Alpes (EFS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA), AP-HP. Université Paris Saclay, INSERM (Institut National de la Sante et de la Recherche Medicale) Institut National de la Sante et de la Recherche Medicale (Inserm), French Ministry for Research, Drees (Direction de la Recherche, des Etudes, de l'Evaluation et des Statistiques), European Research Council under the European Union's Horizon 2020 research and innovation program [856478], Université Paris-Saclay, EpiCoV study group: Nathalie Bajos, Josiane Warszawski, Guillaume Bagein, Muriel Barlet, François Beck, Emilie Counil, Aude Leduc FlorenceJusot, Nathalie Lydie, Claude Martin, Laurence Meyer, Ariane Pailhé, Delphine Rahib NicolasPaliod, Philippe Raynaud, Alexandra Rouquette, Patrick Sicard, Rémy Slama, Alexis Spire, Université Paris sciences et lettres (PSL)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Sorbonne Paris Cité (USPC)-École des hautes études en sciences sociales (EHESS)-Université Paris 13 (UP13), Etablissement français du sang - Auvergne-Rhône-Alpes (EFS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Universitaire [Grenoble] (CHU)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA), Université de Rennes (UR)-Institut d'Études Politiques [IEP] - Rennes-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Centre National de la Recherche Scientifique (CNRS), and Spire, Alexis

Subjects
INFECTIOUS_DISEASES, [SHS.SOCIO] Humanities and Social Sciences/Sociology, Epidemiology, Population, HEALTH_INEQUALITY, EPIDEMICS, Social class, Cohort Studies, 03 medical and health sciences, social medicine, 0302 clinical medicine, Social medicine, Medicine, Humans, Social inequality, 030212 general & internal medicine, Prospective Studies, education, Socioeconomic status, Pandemics, education.field_of_study, SOCIAL_INEQUALITY, 030505 public health, [SHS.SOCIO]Humanities and Social Sciences/Sociology, business.industry, SARS-CoV-2, public health, COVID-19, General Medicine, Ageusia, [SHS.SCIPO]Humanities and Social Sciences/Political science, 3. Good health, COHORT_ANALYSIS, Socioeconomic Factors, Cohort, Communicable Disease Control, Female, France, medicine.symptom, 0305 other medical science, business, Cohort study, Demography
Abstract

ObjectiveAlthough social inequalities in COVID-19 mortality by race, gender and socioeconomic status are well documented, less is known about social disparities in infection rates and their shift over time. We aim to study the evolution of social disparities in infection at the early stage of the epidemic in France with regard to the policies implemented.DesignRandom population-based prospective cohort.SettingFrom May to June 2020 in France.ParticipantsAdults included in the Epidémiologie et Conditions de Vie cohort (n=77 588).Main outcome measuresSelf-reported anosmia and/or ageusia in three categories: no symptom, during the first epidemic peak (in March 2020) or thereafter (during lockdown).ResultsIn all, 2052 participants (1.53%) reported anosmia/ageusia. The social distribution of exposure factors (density of place of residence, overcrowded housing and working outside the home) was described. Multinomial regressions were used to identify changes in social variables (gender, class and race) associated with symptoms of anosmia/ageusia. Women were more likely to report symptoms during the peak and after. Racialised minorities accumulated more exposure risk factors than the mainstream population and were at higher risk of anosmia/ageusia during the peak and after. By contrast, senior executive professionals were the least exposed to the virus with the lower rate of working outside the home during lockdown. They were more affected than lower social classes at the peak of the epidemic, but this effect disappeared after the peak.ConclusionThe shift in the social profile of the epidemic was related to a shift in exposure factors under the implementation of a stringent stay-at-home order. Our study shows the importance to consider in a dynamic way the gender, socioeconomic and race direct and indirect effects of the COVID-19 pandemic, notably to implement policies that do not widen health inequalities.

Published
2021
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3. Patterns of gynaecological check-up and their association with Body Mass Index within the CONSTANCES cohort

Author

Gwenn Menvielle, Laurent Rigal, Pierre Chauvin, Virginie Ringa, Jeanne Sassenou, Mireille Cœuret-Pellicer, Jeanna-Eve Franck, Sorbonne Université (SU), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de recherche en épidémiologie et santé des populations (CESP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Cohortes épidémiologiques en population (CONSTANCES), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay-Université de Paris (UP), Gestionnaire, Hal Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), and Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay-Université Paris Cité (UPCité)

Subjects
[SDV]Life Sciences [q-bio], Uterine Cervical Neoplasms, Overweight, Logistic regression, Cohort Studies, Breast cancer screening, 0302 clinical medicine, Mass Screening, Cervical cancer screening, 030212 general & internal medicine, Early Detection of Cancer, 2. Zero hunger, Cervical cancer, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, medicine.diagnostic_test, Obstetrics, Health Policy, Middle Aged, 3. Good health, [SDV] Life Sciences [q-bio], barriers to screening, 030220 oncology & carcinogenesis, Cohort, Female, France, medicine.symptom, Mammography, Adult, medicine.medical_specialty, visit to the gynaecologist, Breast Neoplasms, body mass index, gynaecological check-up, 03 medical and health sciences, medicine, Humans, Social determinants of health, Obesity, Socioeconomic status, Aged, Vaginal Smears, business.industry, Public Health, Environmental and Occupational Health, Patient Acceptance of Health Care, medicine.disease, breast cancer screening, screening regularity, Logistic Models, Gynecology, business, Body mass index, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

Objectives To investigate the relationship between patterns of gynaecological check-up and body mass index while accounting for various determinants of health care use. Methods Sequence analysis and clustering were used to highlight patterns of gynaecological check-up, which included the regularity of breast and cervical cancer screening and visits to the gynaecologist over four years, among 6182 women aged 54–65 included in the CONSTANCES cohort between 2013 and 2015 in France. Multinomial logistic regressions were used to study the association between these patterns and women’s body mass index. Results We identified four patterns of gynaecological check-up, from (A) no or inappropriate check-up (20%) to (D) almost one visit to the gynaecologist every year, overscreening for cervical cancer and frequent use of opportunistic breast cancer screening (12%). From patterns A to D, the proportion of obese women decreased and that of women with normal body mass index increased. Obese and overweight women underwent more breast than cervical cancer screening and were less often overscreened than normal weight women. These differences were only partly explained by the lower socioeconomic situation of overweight and obese women. Beyond the financial barrier, the screening modality and the type of exam may play a role. Among women who were screened for cervical cancer, obese and overweight women were less often screened by a gynaecologist. Conclusion Further efforts should be made to enhance the take-up of screening among obese women who are deterred by the healthcare system.

Published
2020
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4. The determinants of cervical cancer screening uptake in women with obesity: Application of the Andersen's behavioral model to the CONSTANCES survey

Author

Mireille Cœuret-Pellicer, Pierre Chauvin, Virginie Ringa, Gwenn Menvielle, Jeanna-Eve Franck, Sorbonne Université (SU), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de recherche en épidémiologie et santé des populations (CESP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Cohortes épidémiologiques en population (CONSTANCES), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay-Université de Paris (UP), Gestionnaire, Hal Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), and Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay-Université Paris Cité (UPCité)

Subjects
Cancer Research, [SDV]Life Sciences [q-bio], Health Behavior, Uterine Cervical Neoplasms, Comorbidity, Cervical cancer screening, Health Services Accessibility, Body Mass Index, 0302 clinical medicine, Surveys and Questionnaires, Health care, Financial strain, Mass Screening, Medicine, Prospective Studies, 030212 general & internal medicine, Early Detection of Cancer, Cervical cancer, education.field_of_study, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, Middle Aged, 3. Good health, [SDV] Life Sciences [q-bio], Oncology, 030220 oncology & carcinogenesis, Female, France, Adult, Healthcare use, Population, Andersen’s model, Structural equation modeling, Health status, 03 medical and health sciences, Environmental health, Humans, Obesity, education, Socioeconomic status, Aged, business.industry, fungi, medicine.disease, Competitive care, Cross-Sectional Studies, Social Class, Patient Compliance, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

International audience; PURPOSE:Despite their higher risk for and mortality from cervical cancer, evidence indicates low rates of cervical cancer screening (CCS) among women with obesity. The literature on the specific factors related to CCS nonadherence in this population is limited.METHODS:We examined the data on 2,934 women with obesity included in the CONSTANCES survey from 2012 to 2015. Using the Andersen's behavioral model, we studied the relationships between the socioeconomic, sociodemographic, health, health personal behaviors, and healthcare use-related factors with CCS nonadherence. The analysis was performed using structural equation models.RESULTS:Regular follow-up by a gynecologist, good quality of primary care follow-up, and comorbidities were negatively associated with CCS nonadherence. Limited literacy, older age, being single, living without children, and financial strain were positively associated with CCS nonadherence. Our results do not point to competitive care, since women with comorbidities had better CCS behaviors, which were explained by a good quality of primary care follow-up.CONCLUSION:Our study identified the factors that explain CCS nonadherence among women with obesity and clarified the effects of health status and healthcare use on screening. Further efforts should be undertaken to reduce the obstacles to CCS by improving care among women with obesity.

Published
2020
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5. Combined Effect of Health Status and Primary Care Use on Participation in Cancer Screening: The CONSTANCES Cohort

Author

Mireille Cœuret-Pellicer, Jeanna-Eve Franck, Gwenn Menvielle, Virginie Ringa, Laurent Rigal, Thi-Van-Trinh Tran, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Cohortes épidémiologiques en population (CONSTANCES), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay-Université Paris Cité (UPCité), Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, INCa, ANR-11-INBS-0002,CONSTANCES,La cohorte CONSTANCES - Infrastructure épidémiologique ouverte pour la recherche et la surveillance(2011), HAL UVSQ, Équipe, Infrastructures - La cohorte CONSTANCES - Infrastructure épidémiologique ouverte pour la recherche et la surveillance - - CONSTANCES2011 - ANR-11-INBS-0002 - INBS - VALID, Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay-Université de Paris (UP)

Subjects
Oncology, medicine.medical_specialty, cervical cancer screening, Medicine (miscellaneous), health status, [SDV.CAN]Life Sciences [q-bio]/Cancer, Primary care, Cervical cancer screening, 03 medical and health sciences, Breast cancer screening, 0302 clinical medicine, [SDV.CAN] Life Sciences [q-bio]/Cancer, Internal medicine, Maternity and Midwifery, Cancer screening, medicine, primary care utilization, 030212 general & internal medicine, Advanced and Specialized Nursing, medicine.diagnostic_test, business.industry, fungi, Public Health, Environmental and Occupational Health, Obstetrics and Gynecology, 3. Good health, breast cancer screening, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, 030220 oncology & carcinogenesis, Cohort, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business
Abstract

International audience; Background: The combined association between primary care utilization and health status with breast cancer screening (BCS) and cervical cancer screening (CCS) remains unclear. Our aim was to identify women's profiles based on their health status and primary care utilization and study their associated adherence to BCS and CCS recommendations.Methods: Using data from the cohort of people visiting health screening centers (CONSTANCES) in France (2012–2015), we first identified women's profiles based on their health status (self-perceived health, physical, and mental health) and primary care utilization (visit to the General Practitioner [GP], uptake of blood tests) using a multiple correspondence analysis and a hierarchical cluster analysis. We then investigated the association of these profiles to BCS and CCS using logistic regression models adjusted for age, smoking status, sociodemographic and socioeconomic characteristics, and the regularity of gynecologist consultation.Results: We identified five distinct profiles of women with contrasted participation in BCS (n = 14,122) and CCS (n = 27,120). In multivariate analyses, cancer screening participation increased from women with very good health and poor primary care utilization, to those with poor health and frequent visits to the GP, and those with very good health and average primary care utilization. The most favorable profiles regarding cancer screening rates were women with average-to-poor health and regular visits to the GP and uptake of blood tests.Conclusions: Our results suggest that policies aiming at increasing cancer screening participation should simultaneously account for women's use of primary care and health and consider more specific subgroups than what is usually done. Further research should investigate factors motivating cancer screening practice, such as women's beliefs regarding cancer screening and women's psychological characteristics

Published
2020
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6. Role of obesity in differences in cervical cancer screening rates by migration history. The CONSTANCES survey

Author

Mireille Coeuret-Pellicer, Cyrielle Crampe-Casnabet, Pierre Chauvin, Virginie Ringa, Gwenn Menvielle, Jeanna-Eve Franck, Sorbonne Université (SU), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de recherche en épidémiologie et santé des populations (CESP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Gestionnaire, Hal Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), Cohortes épidémiologiques en population (CONSTANCES), and Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay-Université Paris Cité (UPCité)

Subjects
Adult, Cancer Research, Adolescent, Epidemiology, [SDV]Life Sciences [q-bio], Population, Health Behavior, Emigrants and Immigrants, Uterine Cervical Neoplasms, Overweight, Body Mass Index, 03 medical and health sciences, symbols.namesake, Young Adult, 0302 clinical medicine, Surveys and Questionnaires, medicine, Humans, Cervical cancer screening, 030212 general & internal medicine, Poisson regression, Obesity, 10. No inequality, education, Socioeconomic status, Early Detection of Cancer, Aged, Demography, education.field_of_study, business.industry, fungi, Middle Aged, medicine.disease, 3. Good health, [SDV] Life Sciences [q-bio], Migration status, Oncology, 030220 oncology & carcinogenesis, Cohort, symbols, Female, France, medicine.symptom, Underweight, business, Body mass index
Abstract

International audience; BACKGROUND:Immigrant women often have lower cervical cancer screening (CCS) rates, tend to have a higher body mass index (BMI) and may be more vulnerable to BMI-related stigmatization. Our aim was to assess the role of BMI in differences in CCS rates by migration history.METHODS:Analyses were based on the 2012-2015 inclusion data (n = 27,226) for the population-based CONSTANCES cohort, including detailed, self-reported information on demographics and socioeconomic characteristics, migration history, health behaviours, health, and health care use. Measured BMI (underweight (30)) was collected. Poisson regression models with robust variance were conducted to assess the contribution of BMI to differences in CCS rates by migration history, and analyses stratified by BMI were done. Multiple imputations were performed.RESULTS:The CCS rates ranged from 87% among French-born women with two French parents to 86% among French-born women with at least one parent of foreign origin, 82% among naturalized immigrants and 74% among non-naturalized immigrants. After adjusting for covariates, non-naturalized immigrants showed an 11% (95% CI: 8%-14%) lower CCS rate than French-born women with two French parents. Adjusting for BMI did not change the estimates. When stratifying by BMI category, non-naturalized immigrants showed an 11% (7%-14%) lower CCS rate then French-born with two French parents when normal weight, a 9% (2%-16%) lower CCS rate when overweight, and an 18% (5%-30%) lower CCS rate when obese.CONCLUSION:Migration history and BMI jointly impact CCS rates. They were lower among all non-naturalized immigrants, particularly those who were obese.

Published
2019
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7. Occupational prestige trajectory and the risk of lung and head and neck cancer among men and women in France

Author

Danièle Luce, Matthieu Carton, Gwenn Menvielle, Jeanna-Eve Franck, Julien Dugas, Isabelle Stücker, Brigitte Trétarre, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pierre et Marie Curie - Paris 6 (UPMC), Institut de recherche en santé, environnement et travail (Irset), Université d'Angers (UA)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), CHU Pontchaillou [Rennes], Institut Curie [Paris], UNICANCER - Institut régional du Cancer Montpellier Val d'Aurelle (ICM), CRLCC Val d'Aurelle - Paul Lamarque, Centre de recherche en épidémiologie et santé des populations (CESP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), EST-2009/1/65, French Agency for Food, Environmental and Occupational Health and Safety (ANSES), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), and Jonchère, Laurent

Subjects
Male, Risk, medicine.medical_specialty, Health (social science), Lung Neoplasms, Alcohol Drinking, Occupational prestige, Occupational prestige trajectory, [SDV.CAN]Life Sciences [q-bio]/Cancer, Logistic regression, 03 medical and health sciences, 0302 clinical medicine, [SDV.CAN] Life Sciences [q-bio]/Cancer, Occupational Exposure, medicine, Humans, 030212 general & internal medicine, Occupations, Head and neck, Lung, Occupational exposures, business.industry, Public health, Incidence, Head and neck cancer, Smoking, Public Health, Environmental and Occupational Health, Health Status Disparities, medicine.disease, medicine.anatomical_structure, Social Class, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Head and Neck Neoplasms, 030220 oncology & carcinogenesis, Case-Control Studies, Female, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, France, Cancer risk, business, Alcohol, Alcohol consumption, Respiratory cancer, Demography
Abstract

International audience; Objectives: This study aimed at investigating the associations between occupational prestige trajectories and lung and head and neck (HN) cancer risk and to assess to what extent smoking, alcohol drinking, and occupational exposures contribute to these associations.Methods: Using data from the ICARE case–control study (controls (2676 men/715 women), lung cancers (2019 men/558 women), HN cancers (1793 men/305 women), we defined occupational prestige trajectories using group-based modeling of longitudinal data. We conducted logistic regression models.Results: Among men, a gradient was observed from the downward “low to very low” trajectory to the stable very high trajectory. The associations were reduced when adjusting for tobacco and alcohol consumption and occupational exposures. Among women, when compared to the stable high trajectory, there was an increased cancer risk in all trajectories. The associations remained globally unchanged or even increased after adjustment for tobacco and alcohol consumption and did not change when adjusting for occupational exposures. The ORs were smaller for lung than for HN cancers in men.Conclusions: Occupational prestige trajectory is strongly associated with lung and HN cancer risk in men and women.

Published
2018
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8. Contextual determinants of participation in cervical cancer screening in France, 2010

Author

Mélanie Araujo, Emmanuelle Cadot, Arnaud Gautier, Pierre Chauvin, Virginie Ringa, Jeanna-Eve Franck, Laurent Rigal, Gwenn Menvielle, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hydrosciences Montpellier (HSM), Institut national des sciences de l'Univers (INSU - CNRS)-Institut de Recherche pour le Développement (IRD)-Université Montpellier 2 - Sciences et Techniques (UM2)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Santé publique France - French National Public Health Agency [Saint-Maurice, France], Institut national d'études démographiques (INED), Centre de recherche en épidémiologie et santé des populations (CESP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Institut de Recherche pour le Développement (IRD)-Institut national des sciences de l'Univers (INSU - CNRS)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), and HAL-UPMC, Gestionnaire

Subjects
Adult, Cancer Research, medicine.medical_specialty, Urban agglomeration, Contextual factors, Epidemiology, Uterine Cervical Neoplasms, [SDV.CAN]Life Sciences [q-bio]/Cancer, Cervical cancer screening, History, 21st Century, 03 medical and health sciences, symbols.namesake, 0302 clinical medicine, [SDV.CAN] Life Sciences [q-bio]/Cancer, Surveys and Questionnaires, parasitic diseases, medicine, Marginal Poisson regression model, Humans, Mass Screening, 030212 general & internal medicine, Poisson regression, Potential spatial accessibility to care, Socioeconomic status, Early Detection of Cancer, health care economics and organizations, Aged, Gynecology, regression model, Marginal Poisson, business.industry, Socioeconomic level, Middle Aged, 3. Good health, Disadvantaged, Oncology, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, 030220 oncology & carcinogenesis, symbols, Residence, Female, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, France, business, Demography
Abstract

International audience; Background: Some contextual factors associated with participation in cervical cancer screening are reported in the literature, but few studies have examined their combined effect. Our objective was to assess the role of contextual characteristics, separately and in combination, in participation in cervical cancer screening in France.Methods: Marginal Poisson regression models – taking into account the correlation between women in a given commune – were conducted using data from the Baromètre Santé 2010 survey. The characteristics of the commune of residence of the women studied were the potential spatial accessibility to general practitioners (GP) and gynecologists, the agglomeration category, and the socioeconomic level.Results: The analyses were performed in 3380 women, 88.2% of whom were up to date with their cervical cancer screening. Once the individual characteristics were taken into account, the screening participation rate was similar in all the communes, with the exception of those with poor access to a gynecologist and good access to a GP, where the rate was 6% lower (95%CI: 0.5–11%) than in the communes with good access to both GP and gynecologist. The same association with accessibility was observed in small agglomerations. Compared to women living in the more advantaged communes, the screening participation rate was 8% (2–12%) lower in those living in the more disadvantaged ones, except when accessibility to both types of physician was high.Discussion: We observed an association between potential spatial accessibility to care in women’s residential communities and their cervical cancer screening practices, in particular in small agglomerations, rural communes, and more disadvantaged communes.

Published
2017
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9. Quantifying the mediating effects of smoking and occupational exposures in the relation between education and lung cancer: the ICARE study

Author

Gwenn Menvielle, Anne-Valérie Guizard, Loredana Radoï, Jeanna-Eve Franck, Marie Sanchez, Danièle Luce, Isabelle Stücker, Joelle Fevotte, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pierre et Marie Curie - Paris 6 (UPMC), Centre de recherche en épidémiologie et santé des populations (CESP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Université Paris Descartes - Paris 5 (UPD5), Unité Mixte de Recherche Epidémiologique et de Surveillance Transport Travail Environnement (UMRESTTE UMR T9405), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut Français des Sciences et Technologies des Transports, de l'Aménagement et des Réseaux (IFSTTAR), Registre des cancers du Calvados, Institut de recherche en santé, environnement et travail (Irset), Université d'Angers (UA)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), EST-2009/1/65, French Agency for Food, Environmental and Occupational Health and Safety, La Fondation ARC pour la Recherche sur le Cancer, HAL-UPMC, Gestionnaire, Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Institut Pierre Louis d'Epidémiologie et de Santé Publique ( iPLESP ), Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre de recherche en épidémiologie et santé des populations ( CESP ), Université de Versailles Saint-Quentin-en-Yvelines ( UVSQ ) -Université Paris-Sud - Paris 11 ( UP11 ) -Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Université Paris Descartes - Paris 5 ( UPD5 ), Unité Mixte de Recherche Epidémiologique et de Surveillance Transport Travail Environnement ( UMRESTTE UMR T9405 ), Université Claude Bernard Lyon 1 ( UCBL ), Université de Lyon-Université de Lyon-Institut Français des Sciences et Technologies des Transports, de l'Aménagement et des Réseaux ( IFSTTAR ), Institut de recherche, santé, environnement et travail ( Irset ), Université d'Angers ( UA ) -Université de Rennes 1 ( UR1 ), and Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -École des Hautes Études en Santé Publique [EHESP] ( EHESP ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ) -Université des Antilles ( UA )

Subjects
medicine.medical_specialty, Epidemiology, Population, men, medicine.disease_cause, Asbestos, smoking, 03 medical and health sciences, 0302 clinical medicine, Environmental health, medicine, 030212 general & internal medicine, Lung cancer, education, education.field_of_study, business.industry, Incidence (epidemiology), Public health, Tobacco control, Cancer, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, occupational exposure, medicine.disease, 3. Good health, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, 030220 oncology & carcinogenesis, incidence, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, France, business
Abstract

International audience; 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. We analyzed data from a large French population-based case–control study (1976 lung cancers, 2648 controls). Detailed information on lifelong tobacco consumption and occupational exposures to various carcinogens was collected. We conducted inverse probability-weighted marginal structural models. A strong association was observed between education and lung cancer. 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 to 84) for men with a high school degree. The contribution of occupational exposures to asbestos and silica ranged from 15 % (10–20) for men with a high school degree to 20 % (13–28) for men with vocational secondary education. 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.

Published
2016
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