OBJECTIVE:To assess whether early antihypertensive treatment after Hypertensive Disorders of Pregnancy (HDP) influences subsequent development of cardiovascular complications. DESIGN AND SETTING:Population-based nationwide cohort of health data set in France. POPULATION:108 906 women with HDP (excluding pre-existing Chronic Hypertension (CH)) who delivered between 2010 and 2014, with 35 878 (33%) receiving at least one antihypertensive treatment in the month after giving birth. METHODS:Traditional Cox model, estimated 10-year cardiovascular risk. Extended Cox Step Function model and Restricted Mean Survival Time evaluated time trends. MAIN OUTCOME MEASURES:New-onset CH, heart failure, coronary, cerebrovascular, peripheral artery diseases and 2 composite events (one including CH, the other excluding it) over 10 years following giving birth. RESULTS:Women receiving early postnatal antihypertensive treatment had a higher long-term risk of complications over 10 years than non-treated women (CH: aHR = 3.067, 95% CI [2.996-3.139]; composite event including CH: aHR = 3.025 [2.956-3.096]; composite event excluding CH: aHR = 1.451 [1.305-1.614]). Treated women had events earlier than non-treated women, presenting a higher risk at the beginning of the postpartum period. The 10-year absolute risk for CH remained high in both groups: 44% for treated women and 18% for non-treated women. CONCLUSION:Our study shows that women receiving early postpartum antihypertensive treatment are at higher long-term cardiovascular risk, with 44% of them having CH within 10 years. Besides, approximately 1 in 5 women non-treated in the postpartum period subsequently developed CH, demonstrating that many high-risk women are not being identified in the peripartum period and may be missing opportunities for timely intervention.

Objectives Lung cancer surgery is associated with significant postoperative morbidity (15%–40%) and mortality (2%–5%), with considerable interhospital variability. This study conducts the first national longitudinal analysis of performance trajectories in lung cancer surgery using advanced trajectory modelling approaches to understand temporal dynamics of quality evolution across hospitals.Methods We included all adult patients (French national hospital database, n=56 299; 148 hospitals) who underwent lung resection for primary lung cancer in 2020–2024. The primary outcome was severe complications including major postoperative complications and 30-day mortality. Annual logistic regression models incorporating clinical and procedural variables calculated risk-adjusted rates (RAR) for each hospital. Hospitals were classified using funnel plots corrected for overdispersion. Hidden Markov Models estimated transition probabilities between performance categories, while group-based multitrajectory models identified subgroups of hospitals sharing similar evolution profiles, stratified by activity volume (low, <43; medium, 43-100; high, >100 procedures/year).Results Predictive models demonstrated excellent stable discrimination (mean area under the ROC curve=0.890). Markov models revealed strong performance inertia (persistence probabilities ≥78%). Trajectory analysis identified a complex non-linear relationship between volume and quality. Medium-volume hospitals showed optimal improvement trajectories (45.4–45.8% RAR reduction). Conversely, some low-volume centres experienced catastrophic deterioration (843% RAR increase), while paradoxically, a subgroup of high-volume hospitals also showed concerning performance degradation (151% increase).Discussion This study demonstrates heterogeneous performance trajectories in French lung cancer surgery, challenging the assumption that high-volume alone guarantees quality and suggesting organisational complexity challenges.Conclusion This study shows the value of implementing systematic outcome monitoring using existing administrative data to target quality improvement interventions and reduce inter-hospital performance variations.

The extent to which gestational diabetes mellitus (GDM) influences the risk of kidney disease remains unknown. We investigated the associations between GDM and incidence of kidney disease, including CKD and AKI. This nationwide population-based cohort study included 1,441,317 parous women in France during 2012–2013. We used Cox regression to investigate the: 1 ) association of GDM with incident hospitalization for AKI or CKD, 2) timing to postpartum GDM-related kidney disease, and 3 ) GDM recurrence and the incidence of kidney disease. Over a 10-year period, women with a history of GDM (n=103,122 [7.2%]) had a 46% higher risk of CKD (aHR: 1.46, 95% CI: 1.36, 1.55) and a 18% higher risk of AKI (aHR: 1.18, 95% CI: 1.11, 1.25), compared to those without a history of GDM. Accounting for post-partum incident hypertension and type 2 diabetes attenuated effect estimates - 10% for CKD (aHR: 1.10. 95% CI: 1.02, 1.19) and 1% for AKI (aHR: 1.01, 95% CI: 0.95, 1.08). The elevated risk of kidney disease was apparent at one-year post-partum and more pronounced among women with two or more GDM episodes than among those with one GDM episode. GDM was mainly associated with an increased risk of CKD; which is present early in the post-partum and higher among women with repeated GDM.

KEY POINTS:In this large cohort, over 10 years, women with a history of gestational diabetes mellitus exhibited a high risk for overall kidney disease. This risk was already apparent in the early postpartum and more pronounced with two or more gestational diabetes mellitus episodes. Accounting for the history of gestational diabetes mellitus among women may help prevent kidney disease. BACKGROUND:The extent to which gestational diabetes mellitus (GDM) influences the risk of kidney disease remains unknown. We investigated the associations between GDM and incidence of kidney disease, including CKD and AKI. METHODS:This nationwide population-based cohort study included 1,441,317 parous women in France during 2012-2013. We used Cox regression to investigate the ( 1 ) association of GDM with incident hospitalization for AKI or CKD, ( 2 ) timing to postpartum GDM-related kidney disease, and ( 3 ) GDM recurrence and the incidence of kidney disease. RESULTS:Over a 10-year period, women with a history of GDM ( n =103,122 [7.2%]) had a 46% higher risk of CKD (adjusted hazard ratio [aHR], 1.46; 95% confidence interval [CI], 1.36 to 1.55) and a 18% higher risk of AKI (aHR, 1.18; 95% CI, 1.11 to 1.25), compared with those without a history of GDM. Accounting for postpartum incident hypertension and type 2 diabetes attenuated effect estimates-10% for CKD (aHR, 1.10; 95% CI, 1.02 to 1.19) and 1% for AKI (aHR, 1.01; 95% CI, 0.95 to 1.08). The elevated risk of kidney disease was apparent at 1 year postpartum and more pronounced among women with two or more GDM episodes than among those with one GDM episode. CONCLUSIONS:GDM was mainly associated with an increased risk of CKD, which is present early in the postpartum and higher among women with repeated GDM.

BACKGROUND:Marginal ulcers (MUs) are one of the most common late complications after gastric bypass. In France, the absence of reliable epidemiological data has precluded the formulation of recommendations concerning dosage or total duration of treatment and the establishment of an endoscopic monitoring strategy. OBJECTIVES:The aim of this study was to describe the frequency and time to onset of MUs following gastric bypass surgery in a nationwide database and to assess risk factors for developing this complication. SETTING:We conducted a population-based study. Patients were included using the French Hospital Discharge Database. METHODS:All patients who underwent gastric bypass between January 2015 and December 2021 were included and followed up for 1 year. Ulcer diagnosis was based on upper gastrointestinal endoscopy (including day care) or revision surgery. Patients with undocumented clinical suspicion of ulcer were excluded. RESULTS:A total of 83,450 patients were included. The incidence of ulcers in the year following surgery was 2.11%, with 25% occurring in the first month. The significant factors identified in multivariable analysis were history of Helicobacter pylori infection (adjusted hazard ratio [aHR]: 1.25 [1.07-1.45]), men (aHR: 1.46 [1.31-1.63]), history of ulcers (aHR: 1.51 [1.16-1.97]), smoking (aHR: 1.91 [1.57-2.33]), and postoperative complications (aHR = 6.89 [6.22-7.61]). Increased body mass index and previous bariatric surgery appeared to be protective. CONCLUSIONS:Among French adult patients who had gastric bypass surgery, 2.11% developed a MU within the first year postoperatively. History of bariatric surgery seems well accounted for. However, greater emphasis should be placed on smoking cessation and the consideration of postoperative complications that may arise during the follow-up period.

Child maltreatment (CM) is a widespread and underreported public health concern with long-term health and wellbeing outcomes. In Europe, access to timely, effective support remains limited. Inadequate responses exacerbate long-term outcomes and influence life course trajectories, with substantial societal and economic costs. The EU-funded SERENA project aims to improve access to health and social care (HSC) services for individuals who experience CM throughout Europe by enhancing detection and interventions, limiting consequences, and reducing societal burdens. SERENA takes an early life course approach, and will examine HSC pathways before and after CM detection, assess related health and wellbeing outcomes, and evaluate the societal costs of CM. Two scoping reviews will examine quantitative and qualitative evidence on barriers and facilitators to access to HSC for children who experience CM, and their service pathways. A mixed methods study will combine quantitative analyses of nationwide longitudinal administrative HSC data from seven countries, supplemented by aggregated child protection data from 26 countries, with qualitative analyses of interviews with adult survivors of CM and HSC professionals in three countries. Examination of HSC pathways will enable us to identify the settings and stages where interventions can be targeted to improve outcomes for children with CM. We will also examine societal costs by analysing direct medical expenses, educational costs, and productivity losses in four countries. An interdisciplinary, participatory synthesis involving stakeholders and adult survivors of CM will assess services, define priority actions, and inform recommendations. SERENA, a consortium of 22 partners across Europe, represents the first multi-country, large-scale, cross-sectoral longitudinal initiative to comprehensively examine CM and HSC service use. By addressing critical evidence gaps, SERENA will provide operationally and economically viable recommendations to enhance service access and public health responses in Europe, with findings that are transferable to diverse international contexts.

BACKGROUND:Coronary revascularization is a key treatment for coronary artery disease (CAD). Over the past 15years, several randomized trials have shown that it failed to improve life expectancy in most patients with stable CAD. AIM:To compare trends in the use of coronary revascularization from 2012 to 2018 in France and the United States (US). METHODS:Administrative databases were used in both countries to identify patients ≥35years of age, hospitalized for CAD or congestive heart failure (CHF) undergoing coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI), as identified from the International Classification of Diseases coding system. Independent correlates of the use of coronary revascularization were also investigated. RESULTS:In France, from 2012 to 2018, coronary revascularization increased by 13.3% among patients aged 35-64years and by 24.6% among those aged ≥65years. In contrast, in the US, it decreased by 16.3% and 19.6%, respectively. These trends were mainly related to the use of PCI: +15.8% and +28.8% in France versus-17.6% and-20.4% in the US. These divergent trends could not be explained solely by changes in the number of hospitalizations for CAD/CHF. In both countries and for both periods, use of revascularization was independently related to age, number of medical diagnoses, sex and income. CONCLUSION:Divergent trends in the use of coronary revascularization were observed in France and the US that could not be explained by trends in the number of CAD/CHF hospitalizations, nor by differences in the correlates of its use.

Background Mental disorders represent a major public health challenge, exerting significant pressure on health systems and societies worldwide. Addressing persistent knowledge gaps in their epidemiology and adequate care requires robust population-based data. This article illustrates how a large-scale health claims database can advance research on mental disorders and inform public health decision-making, using the French national health data system (SNDS) as an example. Methods We conducted a thematic mapping of studies that used the SNDS to investigate mental disorders from a public health perspective. Relevant studies were identified through the collective expertise of the Mental Disorders Working Group within the ReDSiam network, a national expert group dedicated to developing and validating algorithms for use within the SNDS. Sources included presentations at the group meetings, scientific conferences, and existing literature. Results First, the SNDS, particularly when combined with prospective cohorts, enables large-scale research on factors associated with the onset of mental disorders, ranging from early-life exposures to adverse life events. Second, it supports the comprehensive epidemiological surveillance of these conditions by facilitating the development of refined detection algorithms and enabling the monitoring of temporal and spatial trends. Third, it allows advanced analyses of care trajectories for individuals with mental disorders, adopting a whole-system approach capturing pathways across services. Conclusion The SNDS offers unprecedented opportunities to advance public health research on mental disorders. Despite limitations, notably regarding clinical and socio-economic information, ongoing methodological advances and broader data integration will further strengthen its contribution to guiding prevention and care strategies in France.

Minimally invasive surgical approaches have gained widespread adoption, yet comparative evidence integrating multiple hierarchical endpoints remains limited. Our objective was to compare the surgical approaches for lung cancer resection (thoracotomy, VATS, robot-assisted surgery) using a four-level hierarchical composite endpoint of postoperative morbidity and mortality, and the Win Ratio (WR) method, which respects the clinical priority of outcomes, and offers a novel framework for such comparisons. A nationwide retrospective cohort study including all patients undergoing pulmonary resection for lung cancer were included (N = 62,670; 169 hospitals, French National Hospital Discharge Database 2020–2024). The primary endpoint was a four-level hierarchical composite: 90-day mortality > Dindo–Clavien complication score > 30-day readmission > length of stay. Inverse probability of treatment weighting (IPTW) was used for confounding adjustment. WR and Net Benefit (NB) were reported. Both minimally invasive approaches demonstrated statistically significant superiority over thoracotomy: VATS vs. thoracotomy WR = 1.47[1.44–1.50] (p < 0.0001, NB = 18.4%); robot-assisted vs. thoracotomy WR = 1.52[1.47–1.56] (p < 0.0001, NB = 20.1%). The comparison between robot-assisted surgery and VATS showed a modest advantage for the robotic approach (WR = 1.03[1.00–1.06], p = 0.025, NB = 1.5%) which is clinilly marginal. Dindo–Clavien complication was the main driver of differences. Results were robust across multiple sensitivity analyses, including alternative hierarchies, IPTW truncation thresholds, and restriction to lobectomies. This large-scale Win Ratio analysis suggests that minimally invasive approaches (VATS and robot-assisted surgery) are associated with better short-term postoperative outcomes compared with thoracotomy for lung cancer resection, mainly due to a reduction in the severity of complications rather than a fall in mortality.These findings should be interpreted with caution given the observational design and the potential for residual confounding by unmeasured clinical factors.

BACKGROUND:Cardiovascular disease (CVD) is the leading cause of mortality in women. We investigated the associations between gestational diabetes (GD) and the incidence of various CVD outcomes. METHODS:This nationwide population-based cohort study included 1 436 468 parous women in France during 2012 to 2013. We used Cox regression to (1) quantify the association of GD with incident hospitalization for chronic hypertension as well as overall and type-specific CVD, (2) investigate the timing to GD-related CVD onset in the postpartum period, and (3) assess the impact of the recurrence of GD on CVD incidence. RESULTS:Women with a history of GD (n=101 814) had a 97% increased relative risk of chronic hypertension (hazard ratio [HR], 1.97 [95% CI, 1.89-2.06]) and a 31% higher overall CVD risk (HR, 1.31 [95% CI, 1.22-1.41]) compared with those without such history. There were increased risks of specific CVDs associated with GD (versus no GD), including increased coronary heart disease (HR, 1.71 [95% CI, 1. 50-1.94]), heart failure (HR, 1.41 [95% CI, 1.21-1.65]), and stroke (HR, 1.16 [95% CI, 1.06-1.28]) risks. The elevated risk was apparent as early as 1 year postpartum for chronic hypertension and CVD outcomes, and the elevated CVD risk was more pronounced among women with ≥2 pregnancies complicated by GD during the study period than in those with 1 GD episode. CONCLUSIONS:GD was associated with increased risks of overall and specific CVD, as well as the risk of incident chronic hypertension. The elevated CVD risk was present early in postpartum and persisted over time, and was higher with repeated GD.

Background: Robot-assisted surgery (RAS) is a major innovation in the treatment of lung cancer, offering advantages in surgical precision and reducing postoperative complications. However, its impact on 90-day mortality remains controversial due to methodological biases in comparative studies. This study uses machine learning methods to improve propensity score estimation and reduce selection bias. Methods: We used the French national hospital database (PMSI) to identify patients who underwent lung resection for cancer between 2019 and 2023. Four models were applied for propensity score estimation: logistic regression, Random Forest, Gradient Boosting Machine (GBM), and XGBoost. Group balancing was achieved through propensity score weighting and matching, followed by logistic regression analysis to estimate the effect of RAS on 90-day mortality. Results: Among the 30,988 patients included, 5717 (18.5%) underwent robot-assisted surgery, while 25,271 (81.5%) underwent thoracotomy. RAS patients had a lower prevalence of comorbidities and earlier-stage tumors. XGBoost was the most effective model for propensity score estimation, with an AUC ROC of 0.9984 and a Brier Score of 0.0119. The adjusted analysis showed a significant reduction in 90-day mortality in the RAS group (OR = 0.39, 95% CI: 0.34–0.45) with weighting and (OR = 0.58, 95% CI: 0.48–0.70) with matching. Conclusions: The application of machine learning to adjust for selection bias allowed for better control of confounding factors in the analysis of the effect of RAS on 90-day mortality. Our results suggest a potential benefit of robotic surgery compared to thoracotomy, although further studies are needed to confirm these findings.

Background Although long-term effects of COVID-19 such as dyspnea are frequent, the mechanisms are often poorly understood. The endothelial effects of COVID-19, like venous or arterial thrombosis, are also well documented. Thus the incidence of Chronic Thromboembolic Pulmonary Hypertension (CTEPH) following COVID-19 is an issue with many implications, particularly for screening in patients with long COVID. Methods From the French National Hospital Discharge database (March 2020–December 2021), we included all adults hospitalised for pulmonary embolism (PE). To study the hospital incidence of CTEPH, we excluded patients with previous pulmonary hypertension diagnoses. Then, in the two years following the admission for PE, we compared the hospital incidence of CTEPH between PE patients with COVID-19 (Covid-PE) and without (Non-Covid-PE). We also studied in-hospital mortality. Results Among the 136 505 patients included, 1.68% were diagnosed with CTEPH in the following two years with a significant difference between Covid-PE and Non-Covid-PE (0.77% versus 1.82%, p<0.0001). Two-year in-hospital mortality was significantly lower in Covid-PE than in Non-Covid-PE (4.82% versus 13.34%, p<0.0001). These results were confirmed by multivariate analyses. Among Covid-PE, we found no difference in the hospital incidence of CTEPH between 2020 and 2021, while post initial discharge in-hospital mortality was significantly higher in 2020 compared to 2021. Conclusion When investigating chronic dyspnea in patients hospitalised for COVID-19 associated with PE, the risk of CTEPH should not be considered higher than for other PE. COVID-19 associated with hospitalised PE should not be considered an additional harmful factor if not associated with initial in-hospital mortality.

Background. Given the complexity of lung cancer surgery, this study aims to provide an overview of hospitals authorised to perform lung cancer surgery in France, and to assess their performance focusing on severe post-operative complications and 30-day in-hospital mortality based on the Clavien–Dindo classification (grade > 2). Methods. We included all patients (n = 64,304) who underwent pulmonary resection for lung cancer from the French hospital database (2019–2023). To quantify variations within regions, we used the ratio of the 90th to the 10th decile of the standardised outcome rate of the hospitals. We used a hierarchical logistic regression model to estimate the adjusted odds ratio (aOR) according to the number of annual procedures. We then used the results of this modelling to see how the standardised rate estimate might evolve after simulating a new organisation of hospitals authorised to perform this surgery. Results. A total of 18,151 patients (28%) had severe complications (Clavien–Dindo > 2). Compared to hospital performing less than 100 procedures/year, the risk of severe complications was significantly reduced for hospitals performing between 101 and 250 procedures/year (aOR = 0.83 [0.77–0.89]) and more than 250 procedures/year (aOR = 0.85 [0.77–0.93]). A simulation of hospital reorganisation, using 100 procedures/year as the threshold value, showed that 477 severe complications could have been prevented over the period. Conclusions. This study shows inequalities in performance indicators between hospitals in each French region. The influence of the volume of activity raises questions about the need to restructure the offer of care for complex surgeries, such as lung cancer surgery.

With the growing availability of large healthcare databases for clinical science, mitigating unmeasured confounding has emerged as a major issue in pharmacoepidemiologic studies. Extensions of causal inference methods to high-dimensional settings could help address this problem, but studies comparing their performance in real-world databases are still lacking. This study aims to compare the ability to reduce the measured and indirectly measured confounding of three causal inference methods adapted to a real-world high-dimensional database using a machine learning LASSO algorithm: G-computation (GC), Targeted Maximum Likelihood estimation (TMLE) and Propensity Score with overlap or stabilized inverse probability treatment weighting. This large-scale empirical study was based on the French National Healthcare Claims Database (SNDS), consisting of 2,172,702 pregnancies ≥ $$ \ge $$  22 weeks of gestation over the period 2011-2014. We used a set of 42 negative and 13 positive reference drugs related to prematurity risk. For each reference drug, the logarithm of the odds ratio for prematurity and its 95% confidence interval were estimated using each method. The proportions of false positive and true positive associations were calculated and compared between the methods. All methods yielded fewer false positives than a crude model based on a minimal set of adjusted covariates. TMLE produced the lowest proportion of false positives (45.2%), followed by GC (47.6%). GC yielded the highest proportion of true positives (92.3%). Our results confirm the interest of causal inference methods exploiting the wealth of data in healthcare databases, especially GC in terms of performance and ease of implementation.

Background Although long-term effects of coronavirus disease-2019 (COVID-19) such as dyspnoea are frequent, the mechanisms are often poorly understood. The endothelial effects of COVID-19, such as venous or arterial thrombosis, are also well documented. Thus, the incidence of chronic thromboembolic pulmonary hypertension (CTEPH) following COVID-19 is an issue with many implications, particularly for screening in patients with long COVID. Methods From the French National Hospital Discharge database (March 2020 to December 2021), we included all adults hospitalised for pulmonary embolism (PE). To study the hospital incidence of CTEPH, we excluded patients with previous pulmonary hypertension diagnoses. Then, in the 2 years following the admission for PE, we compared the hospital incidence of CTEPH between PE patients with COVID-19 (COVID-PE) and without (non-COVID-PE). We also studied in-hospital mortality. Results Among the 136 505 patients included, 1.68% were diagnosed with CTEPH in the following 2 years with a significant difference between COVID-PE and non-COVID-PE (0.77% versus 1.82%; p<0.0001). The 2-year in-hospital mortality was significantly lower in COVID-PE than in non-COVID-PE (4.82% versus 13.34%; p<0.0001). These results were confirmed by multivariate analyses. Among COVID-PE, we found no difference in the hospital incidence of CTEPH between 2020 and 2021, while after the initial discharge, in-hospital mortality was significantly higher in 2020 compared with 2021. Conclusion When investigating chronic dyspnoea in patients hospitalised for COVID-19 associated with PE, the risk of CTEPH should not be considered higher than for other PE. COVID-19 associated with hospitalised PE should not be considered an additional harmful factor if not associated with initial in-hospital mortality.

Objectives Child physical abuse (CPA) is a global public health problem associated with lifelong negative consequences, yet reliable epidemiologic data are lacking. We did a multinational cohort study to analyse trends in CPA hospitalisations between 2013 and 2021. Method We used medico-administrative databases to identify children aged one month to five years hospitalised in Denmark, England, France, Ireland, and Wales. Analysing data on more than 12 million hospitalisations, we identified CPA using a validated algorithm based on International Classification of Diseases-10 codes (ICD-10 codes). We calculated the number, proportion, and incidence rate of children hospitalised for CPA, and the number and proportion of total hospitalisations for CPA, by year and age group (<1 and <5). We assessed the distribution of ICD-10 codes used to identify CPA, in each country. Results The pooled incidence rate of infants <1 year hospitalised for CPA was stable over time (around 42/100,000 per year), ranging on average from 33 to 48/100,000 between countries. Average incidence rates for infants were highest in England and lowest in Wales. The pooled proportion of infant CPA hospitalisations was around 0.17% per year (range 0.15–0.21%), increasing significantly during the COVID-19 pandemic in 2020 (0.21%). In children <5, the incidence rate (around 18/100,000 per year) and proportion of CPA hospitalisations (around 0.11% per year, range 0.10–0.14%) were lower than in infants but also increased in 2020 (0.14%). There were national differences in the distribution of ICD-10 codes used to record CPA and differences in year-on-year trends between countries. Conclusions This study is, to our knowledge, the first large-scale analysis examining trends in CPA hospitalisations in more than two European countries. We demonstrated that comparing temporal trends in CPA hospitalisations between countries is feasible, implying that hospital data are one of several valuable sources of information for surveillance of CPA.

In national hospital databases, certain prognostic factors cannot be taken into account. The main objective was to estimate the performance of two models based on two databases: the Epithor clinical database and the French hospital database. For each of the two databases, we randomly sampled a training dataset with 70% of the data and a validation dataset with 30%. The performance of the models was assessed with the Brier score, the area under the receiver operating characteristic (AUC ROC) curve and the calibration of the model. For Epithor and the hospital database, the training dataset included 10,516 patients (with resp. 227 (2.16%) and 283 (2.7%) deaths) and the validation dataset included 4507 patients (with resp. 93 (2%) and 119 (2.64%) deaths). A total of 15 predictors were selected in the models (including FEV1, body mass index, ASA score and TNM stage for Epithor). The Brier score values were similar in the models of the two databases. For validation data, the AUC ROC curve was 0.73 [0.68–0.78] for Epithor and 0.8 [0.76–0.84] for the hospital database. The slope of the calibration plot was less than 1 for the two databases. This work showed that the performance of a model developed from a national hospital database is nearly as good as a performance obtained with Epithor, but it lacks crucial clinical variables such as FEV1, ASA score, or TNM stage.

While much work has shown a link between the global SARS-CoV-2 pandemic and poor mental health, little is known about a possible association between hospitalization with SARS-CoV-2 infection and subsequent hospitalization for self-harm. Analyses performed on the French national hospital database between March 2020March 2021 in 10,084,551 inpatients showed that hospitalization with SARS-CoV-2 infection was not associated with hospitalization for self-harm in the following year. However, hospitalization with SARS-Cov-2 was related to an increased risk of self-harm in patients with a suicidal episode at the inclusion (aHR=1.56 [1.14-2.15]), suggesting an effect of SARS-CoV-2 in patients with a recent history of self-harm.