Background Systemic Lupus Erythematosus (SLE) is a chronic auto-immune disease that can be severe and life threatening. The overall mortality rate has improved significantly over the past 50 years but is still high as compared with the general population. Objectives The aim of the study is to analyze the mortality profile related to SLE in France. Methods For the 2000-2009 period, data collected in the French Epidemiological Center for the Medical Causes of Death (CépiDc, Inserm) database and corresponding to death certificates of adults (n=1593) on which SLE was listed as an underlying (n=637) or non-underlying cause (n=956) of death were analyzed using multiple cause-of-death analysis. Gender, age, sex-ratio, standardized mortality rates as well as the respective weight and frequency of the various causes of death were assessed, both at national and regional level. The observed/expected death ratio (O/E ratio) was calculated for the main causes of death. Results Mean age at death was 63.5±17.3 years. Sex-ratio was 3.5 (1238 female and 355 male). The mean standardized mortality rate was 3.2 per 106 people. For SLE as an underlying cause, the main non-underlying causes of death were cardiovascular diseases (49.5%), infectious diseases (24.5%) and renal failure (23.2%). For SLE as a non-underlying cause of death, the most common underlying causes of death were cardiovascular diseases (35.7%), neoplasms (13.9%) and infectious diseases (10.3%). The overall death O/E ratio was >1 for infectious and cardiovascular diseases and renal failure (especially for people <40 years of age for the 2 last causes), but was <1 for neoplams. Digestive neoplasms, hematologic malignancies, and lung neoplasms were the most frequent cancers reported. Considering each type of cancer individually, an O/E ratio of <1 (age and gender-adjusted) was found for lung cancer, digestive neoplasms, and gynecological neoplasms, but not for hematologic malignancies. There were no differences between the Mediterranean area and the rest of France concerning the causes of death. In overseas departments, the standardized mortality rate was higher (10.8/106 people) and the mean age of death was earlier. Conclusions For the 2000-2009 period, cardiovascular diseases are the most important cause of death associated to SLE in France with a significant excess of mortality compared to general population. It is therefore essential to improve the early identification of SLE patients at high risk for cardiovascular events in order to optimize therapeutic and preventive interventions in this population and improve survival in SLE. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.2400

AIMS:To compare the 5-year mortality (overall and cause-specific) of a cohort of adults pharmacologically treated for diabetes with that of the rest of the French adult population.METHODS:In 2001, 10 000 adults treated for diabetes were randomly selected from the major French National Health Insurance System database. Vital status and causes of death were successfully extracted from the national registry for 9101 persons. We computed standardized mortality ratios.RESULTS:Over 5 years, 1388 adults pharmacologically treated for diabetes died (15% of the cohort, 32.4/1000 person-years). An excess mortality, which decreased with age, was found for both genders [standardized mortality ratio 1.45 (1.37-1.52)]. Excess mortality was related to: hypertensive disease [2.90 (2.50-3.33)], ischaemic heart disease [2.19 (1.93-2.48)], cerebrovascular disease [1.76 (1.52-2.03)], renal failure [2.14 (1.77-2.56)], hepatic failure [2.17 (1.52-3.00)] in both genders and septicaemia among men [1.56 (1.15-2.09)]. An association was also found with cancer-related mortality: liver cancer in men [3.00 (2.10-4.15)]; pancreatic cancer in women [3.22 (1.94-5.03)]; colon/rectum cancer in both genders [1.66 (1.28-2.12)]. Excess mortality was not observed for breast, lung or stomach cancers.CONCLUSIONS:Adults pharmacologically treated for diabetes had a 45% increased risk of mortality at 5 years, mostly related to cardiovascular complications, emphasizing the need for further prevention. The increased risk of mortality from cancer raises questions about the relationship between cancer and diabetes and prompts the need for improved cancer screening in people with diabetes.

Background: Worldwide, cardiovascular diseases and cancer account for ∼40% of deaths. Certain reports have shown a progressive decrease in mortality. Our main objective was to assess mortality trends related to myocardial infarction (MI), heart failure (HF) and pulmonary embolism (PE). Methods: MI, HF and PE were studied as cause of death based on the analysis of death certificates in Canada (C), England and Wales (E), France (F) and Sweden (S). We also used a multiple cause approach. Age-standardized death rates (SDR) were calculated. Results: The SDR for MI, HF or PE as the underlying cause of death, all decreased during the last decade. The decrease in SDR secondary to MI exceeded that for HF or PE. Concerning multiple cause of death, a greater decrease was also found for MI, compared with HF or PE. Conclusions: We confirm the beneficial trends in SDR with MI, HF or PE both as underlying or multiple causes in the studied countries. For HF and PE, multiple cause approach seems more accurate to describe the burden of these two pathologies. Our study also suggests that more efforts should be dedicated to HF and PE in order to achieve similar trends than in MI.

Las medidas de la línea de implantación pilosa frontal de la mujer española caucásica no han sido descritas, y tampoco si existe relación entre estas medidas y los niveles hormonales androgénicos, producción sebácea e hidratación.Estudio observacional, prospectivo, descriptivo y analítico en 103 mujeres sanas españolas caucásicas premenopáusicas, pertenecientes a la plantilla sanitaria de nuestro hospital a las que se les midió la línea de implantación pilosa frontal, los niveles de sebo y la hidratación de la capa córnea, y en 50 voluntarias de este grupo se determinaron, además, los niveles hormonales androgénicos 3-5 días después de terminar la menstruación.La edad media de nuestras pacientes fue de 29,7 años. El pico de viuda se objetivó en el 94,17% de las pacientes. Las dimensiones medias del pico de viuda en nuestro grupo fueron de 1,01 cm de alto y 2,13 cm de ancho. Los niveles medios hormonales fueron los que habitualmente consideramos como normales en el laboratorio de nuestro hospital, excepto la 17-hidroxi-progesterona, que alcanzó valores medios de 1,39 ng/ml (rango: 0,6-5,9; N: 0,15-1,10). El PSA fue de 0,04 ng/ml (rango: 0,02-0,08; N: 0,00-0,02).Las medidas de las líneas de implantación pilosa frontal de la mujer caucásica española han sido distintas de las descritas para la mujer americana. El conocimiento de este patrón de distribución de la línea de implantación pilosa frontal normal puede ayudar en el caso de que la paciente con una alopecia androgenética femenina de patrón masculino, una alopecia frontal fibrosante u otra cicatricial ya estable desee corregir quirúrgicamente su problema mediante trasplante capilar.Anterior hairline measurements and their possible relationship with androgen levels, sebum production, and skin hydration have not been reported in white Spanish women.This was a prospective descriptive and analytical observational study conducted on 103 healthy premenopausal white Spanish women recruited from the health staff of Hospital Universitario Virgen Macarena in Seville, Spain. Measurements were made of anterior hairline implantation, sebum levels, and the degree of hydration of the stratum corneum. Androgen levels were also determined in 50 volunteers from this group 3 to 5 days after the end of the menstrual cycle.The mean age of the women was 29.7 years. A widow's peak was observed in 94.17% of the group. The mean dimensions of the widow's peak were a height of 1.01 cm and width of 2.13 cm. The mean hormone levels were within normal limits for our hospital's laboratory with the exception of 17-hydroxyprogesterone, with a mean level of 1.39 ng/mL (range, 0.6-5.9 ng/mL; normal limits, 0.15-1.10 ng/mL). The mean prostate specific antigen level was 0.04 ng/mL (range 0.02-0.08 ng/mL; normal limits, 0.00-0.02 ng/mL).The hairline measurements of the white Spanish women in this study differ from those reported in American women. Knowledge of this normal pattern of anterior hairline implantation can be important in the evaluation of women with female androgenetic alopecia with male pattern, frontal fibrosing alopecia, or other established scarring alopecia seeking a surgical solution by hair transplantation.

Background. - Monitoring the time trends in socioeconomic inequalities in mortality by cause is a key public health issue. The aim of this study was to compare methods to measure social inequalities in cause-specific mortality in the French population aged 25-55 years. More specifically, it compares bias and precision related to the use of occupational class declared at the last census (linked data) to the one declared at the time of death on the death certificate (unlinked data).Methods. - We used a representative sample of 1% of the French population. Causes of death were obtained by direct linkage with the French national death registry. Occupational class was classified into eight categories. Taking professionals and managers as the reference, relative risks of mortality by cause and their 95% confidence intervals were estimated using Poisson models for the 1983-1989, 1991-1997, and 2000-2006 periods. The relative risks were calculated with both linked data and exhaustive unlinked data.Results. - Over the 2000-2006 period, occupational classes declared at census and on the death certificate were consistent for half of the deaths. Relative risks for manual workers were found to be similar between the two approaches over the 1983-1989 and 1991-1997 periods, and higher for the unlinked approach over the 2000-2006 period. Over the latter period, the order and magnitude of relative risks varied similarly by occupational class and cause of death for both approaches. Confidence intervals obtained from linked data were wide.Conclusion. - Occupational class derived from the death certificate must be used with caution as a measure for epidemiological purposes and the available linked data do not allow accurate estimates of social inequalities in cause-specific mortality. Other solutions should be considered in order to improve the follow-up of social inequalities in mortality. This would require the collection of educational level on the death certificate or the linkage of the cause of death database with other exhaustive and informative databases. (C) 2013 Elsevier Masson SAS. All rights reserved.

Le modèle le plus simple et le plus général qui permette de discuter les déplacements chimiques ESCA, dont le sens physique est trés clair, permet de discuter également les moments dipolaires et les polarisabilités. Soixane huit déplacements chimiques ESCA attributés à C1s, N1s, O1s ou F1s dans quarante e un composés diversement substitutes (−F, −Cl, −Br, −OH, −NH2), saturés ou non (aldéhydes, cétones, acides) ont été calculés à partir de la répartition des charges impliquée par ce modèle; les écarts quadratiques movens avec l'expérience sont respectivement: ±1.1 eV pour C, ±1.6 eV pour N, ±0.8 eV pour O ±0.7 eV pour F.Inversement il permet d'obtenir une répartition des charge à partir des données ESCA, et celà même pour des molécules aromatiques: les moments dipolaires calculés pour douze de ces molécules fluorées sont en excellent accord avec les moments dipolaires expérimentaux. D'autres résultats ont pu être obtenus à titre prévisionnel pour des molécules n'ayant pas encore fait l'objet de déterminations expérimentales définitives, même lorsque ces molécules contiennent des atomes lourds.The simplest and most general model for interpreting ESCA chemical shifts, the physical meaning of which is very clear, also allows the discussion of dipole moments and polarisabilities. Sixty-eight ESCA chemical shifts of C1s, N1s, O1s and F1s in 41 differently-substituted compounds (−F, −Cl, −Br, −OH, −NH2), saturated or unsaturated (aldehydes, ketones, acids), have been calculated with this model from electric charge distribution; the mean quadratic deviations are respectively ±1.1 eV for C, ±1.6 eV for N, ±0.8 eV for 0, ±0.7 eV for F.With this model, electric charge repartitions can be deduced from ESCA data, even for aromatic molecules. The calculated electric dipole moments for 12 fluorinated aromatic molecules agree very well with experimental results. Other data have been calculated for molecules for which experimental data are not yet available, including examples where heavy atoms are present.

Les données de mortalité, par le peu d’ambiguïté de leur définition, leur compréhension par l’ensemble des acteurs, et l’exhaustivité de leur enregistrement, constituent une pierre angulaire de la statistique en santé publique en France et dans la plupart des pays industrialisés. Cet article décrit le processus de production des données et les principaux types d’analyses possibles. La production des données se décompose en différentes étapes : la certification par le médecin sur support papier ou électronique (à l’aide d’une application web), la transmission des données à l’Inserm, la saisie et le codage de l’information. Le codage de l’information vise à suivre les recommandations de l’OMS formulées dans la Classification internationale des maladies ([CIM], 10e révision utilisée depuis 2000). Il est effectué à l’aide d’un logiciel de codage automatique, nommé Iris, développé au sein d’un consortium international. Le codage consiste en premier lieu à attribuer un code de la CIM à toutes les entités nosologiques rencontrées sur le certificat, puis à choisir la cause initiale de décès. Cette dernière est la principale information utilisée pour les exploitations statistiques. Trois principaux types d’analyses se dégagent dans la littérature : l’exploitation des données présentes sur le certificat de décès uniquement, les analyses écologiques (études d’associations entre des variables mesurées à l’échelle de groupes) et les analyses à partir de données chaînées individuellement à d’autres bases de données. Ces différentes analyses permettent de traiter de nombreuses problématiques en santé publique. Plusieurs évolutions dans le processus de production sont en cours de mise en œuvre : le déploiement de la certification électronique, l’automatisation accrue du traitement de l’information contenue sur les certificats et le chaînage pérenne et complet de l’information avec les données de l’assurance maladie et d’hospitalisation. Elles pourraient prochainement élargir encore le champ des exploitations possibles des données de causes de décès.Mortality data, by the unambiguity of their definition and understanding by all stakeholders, and completeness of registration, are a cornerstone of public health statistics in France and in most industrialized countries. This article describes the data production process, and the main types of possible analyses. Data production is composed of different stages: death certification by a medical doctor on paper or electronic (using a web application) format, data transmission to Inserm, capture and coding of information. The encoding of the information follows the WHO recommendations of the International Classification of Diseases ([ICD], 10th revision used since 2000). It is carried out using an automatic coding software, called Iris, developed in an international consortium. The coding aims, first, at assigning an ICD code to all nosologic entities encountered on the certificate, and then at selecting the underlying cause of death. The latter is the main information used for statistical analyses. Three main types of analysis emerge in the literature: the exploitation of data on the death certificate only, ecological analyses (studies of associations between variables measured across groups) and analysis from data individually linked to other databases. Many public health issues can be addressed with these various analyses. Several developments in the production process are being implemented: the deployment of electronic certification, increased automation of the death certificate information processing and durable and complete record linkage with health insurance and hospitalisation data. They could soon be deeply expanding the scope of possible uses of causes of death data.

Étude de vie réelle portant sur les facteurs pronostiques de radiodermite aiguë dans une cohorte monocentrique de 200 patientes traitées par irradiation conformationnelle adjuvante d'un cancer du sein avec ou sans modulation d'intensité.Deux cent patientes atteintes d'un cancer du sein localisé traité par irradiation adjuvante ont été incluses consécutivement. Chez chacune des patientes, les caractéristiques cliniques, tumorales, les modalités d'irradiation ainsi que le grade maximal de radiodermite aiguë pendant le traitement et à 6 semaines de la fin de la radiothérapie, ont été recueillis rétrospectivement. L'objectif était d'identifier les facteurs de risque de survenue d'une radiodermite aiguë de grade ≥ 2.En analyse unifactorielle, les facteurs de risque significatifs de survenue d'une radiodermite de grade ≥ 2 étaient un indice de masse corporelle (IMC) plus élevé (p < 0,001), un volume cible prévisionnel (PTV) plus élevé (p < 0,001) et un normofractionnement (p = 0,002). En analyse multifacorielle, les facteurs de risque significatifs de survenue d'une radiodermite de grade ≥ 2 étaient un IMC supérieur à 30 (odds ratio [OR] = 9,31 ; p = 0,04), le phototype clair (OR = 0,04 ; p = 0,02) et une histologie autre que le carcinome canalaire infiltrant (CCI) ou le carcinome lobulaire infiltrant (CLI) (OR = 0,07 ; p = 0,04).Aucune radiodermite de grade 3 n'a été observée, et la fréquence de survenue d'une radiodermite de grade 2 était inférieure à celles relevées dans la littérature. L'analyse multifactorielle a montré que l'IMC, le phototype et l'histologie étaient à risque de radiodermite aiguë de grade ≥ 2 après une irradiation adjuvante d'un cancer de sein. La radiothérapie conformationnelle avec modulation d'intensité (RCMI) n'était pas associée à une diminution de radiodermite de grade ≥ 2.Real life study of prognostic factors of acute radiodermatitis in a monocentric cohort of 200 patients with breast cancer treated with RT3D or IMRT for adjuvant radiotherapy.This study comprises 200 patients with breast cancer treated with adjuvant radiotherapy, included consecutively. For each patient, their clinical and tumoral characteristics and the irradiation schedule was retrospectively collected. The severity of acute radiodermatitis was also collected, during the treatment and 6 weeks after the end of irradiation. The objective was to identify risk factors for acute radiodermatitis grade ≥ 2.The univariate analysis found that a more important BMI (p < 0.001), a more important volume of PTV (p < 0.001) a normofractionated schedule (p = 0.002) were statistically associated to a greater risk of occurrence of grade ≥ 2 acute radiodermatitis. The multivariate analysis found BMI > 30 (OR = 9.31, p = 0.04), light phototype (OR = 0.04, p = 0.02) and histology other than invasive breast carcinomas (OR = 0.07, p = 0.04) to be statistically associated to the occurrence of grade ≥ 2 acute radiodermatitis.In this monocentric retrospective study, with a prospective collection of the severity of acute radiodermatitis, no grade 3 radiodermatitis has been observed and the frequency of occurrence of grade 2 radiodermatitis was lower than previously published. In contrast to previously published results, IMRT was not associated to a lower risk of grade ≥ 2 acute radiodermatitis. Multivariate analysis found BMI, phototype, and histology to be risk factors of grade ≥ 2 acute radiodermatitis.

Les événements indésirables graves associés aux soins (EIGAS) correspondent à des prises en charge non optimales ayant des conséquences graves et inattendues et qui dans 40 % des cas seraient évitables. Ils sont souvent précédés d'événements porteurs de risque (« presque accident »). Le dernier rapport d'activité de la démarche d'accréditation des spécialités à risques confirme la nécessité de déclarer et de gérer les événements indésirables graves afin d'en identifier les causes récurrentes et de mettre en œuvre des actions collectives (locales ou nationales) pour mieux les détecter et limiter leur impact. Cette étude a souligné la prédominance des causes systémiques liées au travail en équipe et à la communication. Le décret de décembre 2016 fait obligation à tous les professionnels de santé de déclarer sur une plateforme nationale de déclaration. Cet article propose une mise au point concernant les définitions et l'évaluation des événements indésirables associés aux soins qu'ils soient graves ou non.Serious adverse events associated with care correspond to non-optimal care with serious and unexpected consequences and which in 40% of cases would be preventable. They are often preceded by risk-bearing events ("near accident"). The last activity report of the accreditation procedure for specialties at risk confirms the need to declare and manage serious adverse events in order to identify recurring causes and to implement collective actions (local or national) to better detect them and limit their impact. This study highlighted the predominance of systemic causes related to teamwork and communication. The decree of December 2016 requires all health professionals to declare on a national reporting platform. This article provides an update on the definitions and evaluation of adverse events associated with healthcare, whether serious or not.

La rapidité des changements socio-économiques survenus en Polynésie française depuis 30 ans fait de ce Territoire un terrain de choix pour l'étude de l'évolution de la mortalité en révélant une rapide et remarquable transition épidémiologique. Mais la répartition de la population en petits groupes humains dispersés pose un problème statistique de mesure de la mortalité. Le taux brut de mortalité a continûment décru passant de 17,5‰ en 1945-49 à 5,3‰ au cours des 5 dernières années. Mais les différents taux de mortalité infantile, malgré leur recul, restent encore supérieurs á ceux de la France métropolitaine. L'évolution contrastée des causes de décès permet de classer la Polynésie française dans le groupe des petits pays en voie de développement accéléré et la range encore loin derrière ses 'modèles de référence' comme la France métropolitaine, ou les pays développés du Pacifique Sud, Australie et Nouvelle-Zélande.De surcroît, d'importantes inégalités régionales demeurent entre Tahiti et les archipels périphériques, principalement parmi les causes de décès. Globalement les îles lointaines demeurent significativement plus frappées par les décès dûs aux maladies infectieuses et parasitaires, en accord avec le modèle de la Transition Epidémiologique, tandis que l'île de Tahiti qui concentre 70% de la population apparaît comme le lieu d'un cumul des pathologies infectieuses et dégénératives, notamment de surcharge et de société. L'opposition centre/périphérie, entre une métropole et un Territoire d'Outre-Mer se répète à l'échelle locale entre milieux urbain et rural.The fast pace of social and economic changes which have occured in French Polynesia over the last 30 years, have made this territory a choice ground for studying trends in mortality by revealing a fast and outstanding epidemiological transition. However, the breakdown of the population in small scattered human groups raises the statistical problem of measuring mortality. The crude mortality rate has decreased steadily from 17.5/1000 in 1945–1949 to 5.3/1000 over the last five years. However, the various infant mortality rate, in spite of their decline, is still exceeding those of Metropolitan France. The contrasted trends in the causes of mortality provides a means to classify French Polynesia in the group of small fast developing countries but still ranks it far behind its 'reference models' such as Metropolitan France or the developed countries in the South Pacific, Australia and New Zealand.Moreover, there are significant regional disparities which still exist between Tahiti and the outlying archipelagoes, mainly among causes of death. As a whole, distant islands remain significantly more affected by deaths resulting from infectious and parasitic diseases, in line with the model of epidemiological transition, where as the islands of Tahiti with 70% of the total population appears as a place of cumulation of infectious and degenerative diseases, in particular of overloading and cultural problems. The centre/periphery opposition between a metropolitan country and an overseas territory repeats itself at the local level between urban and rural environments.

Grâce à la biologie moléculaire, on assiste actuellement à une double révolution dans le traitement de l'hémophilie: la possibilité de pouvoir traiter des patients sans utiliser des produits dérivés du sang et la perspective de guérir un jour les hémophiles. Après quelques rappels sur l'hémophilie et les traitements actuellement disponibles, nous envisagerons l'apport du génie génétique dans le traitement, puis dans la guérison des hémophiles.

Deaths occurring in the context of acquired haemophilia (AH) may be related to inter-connected causes and mechanisms including bleeding, specific or older patient co-morbidities or iatrogenic complications. However, their magnitude remains unknown. This study aimed to determine the respective weight and frequency of the various causes of death in AH. Multiple-cause analysis based on death certificates data is used in this purpose. Over a 10-year period (2000-2009), 121 deaths with AH as a cause were registered in France. All the deaths were of adults (extremes: 47 and 99 years; mean age: 80.7 years). The average number of causes per death certificate was 4.7. AH was the underlying cause of death (UCD) in 69.4% of the cases, and was more frequent in the older subjects. In contrast, before age of 75 years, AH was more often a contributing cause of death. No postpartum or obvious thromboembolism-related deaths were registered. Haemorrhagic shock was the most frequent direct cause of death (DCD), followed by infectious events, cardiac dysfunction, metabolic and nutritional disorders with muscle wasting and decubitus complications, and cancers (52.9%, 26.4%, 7.5%, 5.8% and 4.1%, respectively). However, when AH was not reported as an UCD, infections become the first DCD (32.4%) followed by bleeding events (16.2%). Best prophylactic and curative strategies for infections are particularly required to improve the prognosis in AH. Moreover, as several of its DCD correspond also to steroids side effects, best tolerated immunosuppressant regimen with steroid-sparing agents adjoining are particularly awaited in AH population.

For many years in France, premature mortality (i.e., deaths before 65 years of age) and avoidable deaths have routinely been used to monitor the health of the population and help to elaborate policies in this area. This paper aims, to account for, the utility of another indicator of premature mortality, which makes it possible to take into account the impact of deaths and the years of life lost (YLL).Mortality data for France in the years 2000–2002 were obtained from the Center for Epidemiology of the Medical Causes of Death. Premature mortality was defined by death rates before 65. For the calculation of YLL, the mortality norm chosen was French life expectancy for the years 2001–2003. To study the spatial distribution of these indicators, standardized ratios were calculated for each department, taking France as the reference population.For all genders and indicators considered, ranking the causes emphasizes three main groups of diseases that are clearly distinguished from the others: cardiovascular diseases, malignant neoplasms, and injuries. The rank of causes varies appreciably depending on the indicator used. The spatial representation of standardized ratios of expected YLL and deaths before 65 shows a strong north–south trend.The concept of premature mortality is difficult to define and debate continues on the age limit to use for its quantification. The choice of an indicator depends to a large degree on how it is to be used. The simple analysis of deaths before 65 years of age currently used to describe premature mortality in France describes its frequency. The use of a summary measure such as YLL allows us to quantify the impact of premature mortality by giving different weights to deaths depending on the age at death. YLL, therefore, seems to be an indicator that is particularly well adapted to decision-making in public health, depending on the preferred choices and values.Depuis de nombreuses années, les décès avant 65 ans sont utilisés en routine en France, ainsi que dans d'autres pays, afin de suivre l'état de santé de la population et de contribuer à l'élaboration des politiques publiques dans ce domaine. L'objectif de cet article est de rendre compte de l'utilité potentielle d'un autre indicateur de mortalité permettant de prendre en compte l'impact des décès prématurés, les années espérées de vie perdues (AEVP).Les données de mortalité concernent les années 2000 à 2002 en France métropolitaine. La mortalité prématurée est définie par les taux de décès avant l'âge de 65 ans. Pour le calcul des AEVP, les espérances de vie par sexe et âges utilisées comme références sont issues de la table de mortalité 2001–2003 française. Afin, de permettre d'étudier la distribution géographique des indicateurs définis ci-dessus, les ratios standardisés sont calculés par département en prenant la France métropolitaine comme population de référence.Quels que soient le sexe et l'indicateur considérés, le classement des causes fait ressortir trois grands groupes de pathologies qui se détachent fortement des autres : les maladies de l'appareil circulatoire, les tumeurs et les causes externes. La hiérarchie des différentes causes obtenue varie sensiblement selon l'indicateur utilisé. La représentation spatiale des ratios standardisés d'AEVP et de décès avant 65 ans fait apparaître une même différenciation nord–sud en France.La notion de mortalité prématurée est difficile à définir et les discussions persistent sur la limite d'âge à utiliser pour la quantifier. Le choix de l'indicateur à utiliser dépend fortement de l'utilisation que l'on souhaite en faire. L'analyse des décès avant 65 ans, utilisée actuellement pour décrire la mortalité prématurée en France, permet de décrire sa fréquence. L'utilisation d'un indicateur tel que les AEVP permet de quantifier l'impact de la mortalité prématurée en pondérant de façon plus importante les décès intervenant à des âges jeunes. Les AEVP semblent donc un indicateur particulièrement adapté dans une visée d'aide à la décision en santé publique, en fonction des choix et valeurs que l'on souhaite privilégier.

AMIEHS, avoidable mortality in the European Union : towards better indicators for the effectiveness of health systems

Background. - This article describes the gradual establishment between 1995 and 2009 of the collection of medical causes of death in Algeria by the National Institute of Public Health (INSP).Methods. - The registration of these causes is based on the WHO certificate's model. The codes and rules of the International Classification of Diseases (ICD10) were used for coding.Results. - Initial results for 2007 show that causes of death have been gathered by INSP for 36.5% of the deaths registered by the civil registrar. Among these causes, cardiovascular diseases occupy the first place. Distributions are different by gender and age.Conclusion. - This study is a first step towards the knowledge of the causes of death in Algeria. (C) 2010 Elsevier Masson SAS. All rights reserved.