Background Identifying cancer cases in the French National Health Data System (SNDS) is essential for real-world oncology research, yet operational definitions remain heterogeneous and few algorithms have been validated. An initial ReDSiam review in 2017 mapped early practices. Since then, the use of SNDS data in oncology has expanded considerably, warranting an updated synthesis. Methods We conducted a scoping review following the PRISMA-ScR guidelines. A comprehensive MEDLINE search identified peer-reviewed studies using SNDS-based algorithms to detect cancer cases up to November 2024. A structured extraction grid captured algorithm characteristics, study applications and validation procedures. Results Among 233 included studies, publication volume increased sharply over time. Algorithms showed substantial heterogeneity in operational definition. Most studies focused on incident cancer detection using hospital data, while outpatient and long-term illness data were increasingly incorporated. Only 6% of studies reported validation against a gold standard, and validated algorithms remained limited to a few cancer sites. More recent publications more frequently provided code lists and supplementary materials, improving transparency. Conclusions The use of the SNDS in oncology has expanded substantially, but validated and standardised case-identification algorithms remain scarce. Strengthening validation efforts, improving access to reference data, ensuring regular algorithm updates and fostering collaboration between data producers, methodologists and clinicians are critical to enhance methodological consistency and reproducibility.

Abstract Background Blood biomarkers are increasingly used to support the diagnosis and monitoring of neurodegenerative diseases. However, their interpretation is complicated by physiological determinants, including age, sex, body-mass index, and renal function, and by differences in absolute concentrations between analytical methods. We aimed to develop population-based reference equations allowing individualized interpretation of the main blood biomarkers used in neurology. Methods In this cross-sectional study, we analysed plasma samples from cognitively unimpaired participants selected from the French CONSTANCES and Three-City population-based cohorts. Generalized additive models for location, scale, and shape were used to model neurofilament light chain (NfL), glial fibrillary acidic protein (GFAP), phosphorylated tau 181 (p-tau181), amyloid-β40, amyloid-β42, and their ratios according to age, sex, body-mass index, and renal function. The resulting equations provided individualized expected concentrations, percentiles, and Z-scores. Previously established disease-specific concentrations were converted into Z-score. Cross-calibration equations were developed for NfL measurements across analytical methods and sample matrices. Findings The final reference populations comprised 5123 participants for amyloid biomarkers and p-tau181 and 5122 for NfL and GFAP; median age was 52.3 years and half were women. Between ages 40 and 80 years, expected NfL and GFAP concentrations increased by an average of 2.6% and 2.2% per year, respectively. Renal function, body-mass index, and sex had additional biomarker-specific effects. Application of the equations to clinical cohorts preserved distinct disease-associated profiles: NfL Z-scores were increased across disorders characterised by neuroaxonal injury, whereas p-tau181 and GFAP showed its greatest increase in Alzheimer disease. NfL cross-calibration equations showed excellent agreement between methods and matrices, with intraclass correlation coefficients greater than 0.90. Interpretation This population-based multibiomarker framework enables blood biomarker concentrations to be interpreted relative to individuals with similar physiological characteristics. Publicly available equations, reference curves, and standardized Z-scores could improve individualized interpretation and comparability across biomarkers, laboratories, and clinical populations.

Introduction L’identification des personnes vivant avec le VIH dans le SNDS est essentielle pour la surveillance épidémiologique. L’algorithme de la cartographie CNAM combine ALD, hospitalisations, remboursements médicamenteux et actes de biologie. Nous proposons un algorithme optimisé pour améliorer la valeur prédictive positive. L’objectif de ce travail est de comparer les deux algorithmes. Méthodes L’algorithme optimisé reprend la logique CNAM mais exige ≥3 charges virales VIH-1 (code NABM : 4122) vs ≥1 et intègre des antirétroviraux récents. Les deux algorithmes ont été appliqués aux données SNDS de CONSTANCES (2007–2022, N=202 461). Les cas prévalents à l’inclusion dans CONSTANCES et incidents au cours du suivi ont été identifiés par les deux algorithmes, la concordance (kappa) a été testée et les parcours de soins comparés (comparaison de proportions sur échantillons partiellement appariés - test Z). Résultats À l’inclusion, 536 personnes étaient identifiées comme vivant avec le VIH par l’algorithme optimisé contre 655 par la CNAM (κ=0.90, IC95% [0.88-0.91]). L’algorithme optimisé identifiait 78 cas incidents et l’algorithme CNAM 271 (κ=0.44, IC95% [0.38-0.51]). Le parcours de soins spécifique différait significativement entre les deux algorithmes : parmi les cas prévalents, la population de l’algorithme optimisé avait plus souvent des ALD que la population identifiée par l’algorithme CNAM (92.2% vs 75.4%, p<0.001), des hospitalisations avec le code VIH (81.9% vs 67.0%, p<0.001) et des traitements spécifiques (88.6% vs 70.5%, p<0.001), la biologie VIH était moins fréquente (80.2% vs 85.3%, p<0.001). Pour les cas incidents, les écarts étaient beaucoup plus marqués (ALD 71.8% avec l’algorithme optimisé vs 20.6% avec l’algorithme CNAM, hospitalisations 44.9% vs 12.9%, traitement 67.9% vs 17.3%, tous p<0.001), tandis que la biologie était moins présente avec l’algorithme optimisé (51.3% vs 88.2%, p<0.001). Discussion/Conclusion Le critère « ≥1 charge virale » semble être susceptible de capter des mesures isolées non confirmées (faux positifs). À l’inverse, l’algorithme optimisé, en exigeant ≥3 mesures, semble limiter ce biais et renforcer la validité des analyses nécessitant une forte valeur prédictive positive.

Teacher shortages negatively impact economic costs, school-level collaboration, and student outcomes. Research on teacher attrition is often limited by cross-sectional designs and a focus on intentions to leave rather than actual departures. This prospective study examined socio-demographic, health, socio-economic, and psychosocial risk factors for attrition among 15,185 teachers from the French population-based CONSTANCES cohort (enrolled since 2012). We distinguished between intra-sectoral occupational changing and inter-sectoral leaving. We used Cox proportional hazards models to identify associated factors. During a median follow-up of 4.2 years, 275 (1.8%) teachers underwent intra-sectoral changes and 286 (1.9%) left the sector. Intra-sectoral mobility was associated with mid-career stage (aged ≥35), being male, teaching in primary school, no/low depressive symptoms, single-parent household, part-time work, and past financial difficulties. Leaving was associated with early-career stage (aged <35), having had several previous work experiences, high depressive symptoms, part-time work, constant strained relationships at work, and financial difficulties at inclusion. Gender-stratified analyses suggested nuances in risk factors between men and women. Our results highlight how intra-sectoral occupational changing is linked with career progression among mid-career teachers, while inter-sectoral leaving is associated with more negative life trajectories, particularly among women. To limit teacher attrition, key interventions at the workplace would include supporting teachers' mental health, improving working conditions in early years of the profession, mitigating tensions with students/families, and addressing potential economic challenges and work-life imbalance of the teaching workforce.

Background Integrating granular personal and clinical data with large-scale administrative records is a frontier in modern public health. In France, linking national epidemiological surveys with the National Health Data System (SNDS)—one of the world's most exhaustive administrative databases—offers a transformative "win-win" methodology to overcome self-reporting biases and loss to follow-up. Methods This paper analyzes the architectural and methodological frameworks of data linkage to SNDS in France, distinguishing between deterministic linkage (via the National Identification Number) and probabilistic approaches. We examine major national integrations, including the prospective Constances cohort, cross-sectional surveys or clinical cohorts, and administrative cohorts like EDP-Santé. Results Linkage significantly enhances data utility by cross-referencing objective healthcare consumption with socio-economic, environmental, and behavioral health determinants. Beyond data enrichment, this synergy provides a robust methodological platform for the validation of identification algorithms, allowing researchers to calculate sensitivity and specificity against clinical “Gold Standards.” We highlight how these linked datasets facilitate complex longitudinal studies on social health inequalities and care pathways that are unattainable through isolated sources. Conclusion Survey-SNDS linkage is a “win-win” process that has become the foundational standard for high-impact research in France. By maximizing the utility of national data assets, this methodology provides a replicable model for global real-world evidence (RWE) generation and public health policy evaluation.

BACKGROUND:Persistent Physical Symptoms (PPS) are disabling bodily symptoms lasting several months, irrespective of their underlying cause. They share mechanisms with functional disorders, characterized by a mismatch between reported symptoms and objective findings. Functional dyspnea-self-reported shortness of breath in the absence of identifiable cardiopulmonary disease-may represent an early marker of vulnerability to PPS. We investigated whether functional dyspnea assessed before the COVID-19 pandemic was associated with the incidence of PPS during the pandemic. METHODS:In this population-based study, we included participants from the French CONSTANCES cohort with normal spirometry and no known condition causing dyspnea at inclusion (2012-2019). Functional dyspnea was assessed at inclusion and incident PPS lasting more than 8 weeks were reported during the COVID-19 pandemic, regardless of SARS-CoV-2 infection. Multivariable logistic regression models adjusted for age, sex, body mass index, and educational level were used to estimate the associations. RESULTS:Among 17,326 participants (mean age 47.8 years; 54.3% women), 2230 (12.9%) reported functional dyspnea at inclusion. During the pandemic, 6687 participants (39.0%) reported at least one PPS. Functional dyspnea at inclusion was associated with a higher risk of incident PPS (OR 1.79, 95% CI [1.64-1.97], p < 0.001). Results were consistent across sensitivity analyses, including those accounting for SARS-CoV-2 infection. Depressive symptoms and self-rated health explained only a small proportion of the association. CONCLUSION:In this population-based cohort study, functional dyspnea may be a marker of future PPS, supporting the hypothesis of mechanisms common to all PPS, regardless of their type or origin.

BACKGROUND:With the increasing popularity of decorative tattooing, which entails the intradermal injection of inks that may contain carcinogens, investigating the related potential skin cancer risk is a public health priority. METHODS:We used data from the Cancer Risk Attributable with the Body Art of Tattooing study, nested in the French national cohort Consultants des Centres d'Examens de Santé (adults aged 18-69 years recruited in 2012-2018). Tattoo exposure was collected in 2020-2023. Skin cancers overall, cutaneous melanoma, and nonmelanoma skin cancer diagnosed during 2007-2021 were retrieved from national health insurance data. As exposure was collected after possible disease ascertainment, risks of skin cancer with prior tattoo exposure were assessed using logistic regression and Cox proportional hazards models in a retrospective cohort design. RESULTS:Among 111 074 participants, 1789 (1.6%) skin cancers were recorded (693 cutaneous melanoma, 1096 nonmelanoma skin cancer). No association was found between binary tattoo exposure (yes, no) and any skin cancer type. In the highest exposure category of tattoo body surface (>2 hand palms), 2 participants with skin cancer were observed among 1633 (0.1%) participants, yielding an odds ratio of 0.21 for overall skin cancer (95% confidence interval [CI] = 0.05 to 0.83; reference no tattoos); however, the corresponding Cox model was not statistically significant (hazard ratio [HR] = 0.26, 95% CI = 0.07 to 1.05). CONCLUSIONS:No overall association between tattoo exposure and skin cancer was observed. The inverse association in the highest exposure category is based on very few skin cancer diagnoses and should be interpreted with caution. Further studies with larger number of participants with skin cancer more detailed exposure assessment are warranted.

Radon exposure is an established risk factor for lung cancer, but its potential role in risks of other cancers remains unclear. A recent systematic review recommended more in-depth studies of specific cancer sites as potential long-term effects of radon exposure, especially during childhood. Here we investigated the association between lifelong residential radon exposure and the risks of various cancers, and the potential role of age at exposure. Study participants were selected from the French population-based CONSTANCES cohort recruited at adult age over the period 2012–2019. Radon exposure was reconstructed by linking lifelong residential histories with estimated municipality-level indoor radon concentrations. We fitted for each cancer site studied a time-dependent Cox proportional hazards model to assess the association between cumulative annual average residential radon exposure and the age at diagnosis of specific primary incident cancer, expressed as a Hazard Ratio per 1000 Bq.m− 3-years exposure and the corresponding 95

BACKGROUND:Besides the usual characterization of metabolic syndrome as a cluster of markers arbitrarily defined by thresholds, it is unclear to which extent these markers as continuous traits are correlated with each other in the general population. The present study aimed to explore these correlations across a wide array of biological, social and behavioral characteristics. METHODS:The cross-sectional analyses were performed in a large population-based French cohort (CONSTANCES) of 159,476 adults in whom blood glucose, low-density lipoproteins (LDL) and high-density lipoproteins (HDL), triglycerides, body mass index, waist and hip circumferences, systolic and diastolic blood pressures were measured at the time of recruitment between 2012 and 2021. Correlations between each pair of continuous marker distributions were assessed by calculating raw and partial correlation coefficients (r). RESULTS:The same pattern of partial correlations is observed with little variation in all groups of sex, age, individual and parental histories of cardiovascular disease, diagnosis of metabolic syndrome, social position, work environment, lifetime unemployment exposure, smoking, non-moderate alcohol consumption, leisure-time physical inactivity and diet quality. This pattern is composed of strong and expected intercorrelations between systolic and diastolic blood pressures (r ranging from 0.62 to 0.74), between body mass index and waist (r from 0.50 to 0.63) and hip (r from 0.58 to 0.70) circumferences and between waist and hip circumferences (r from 0.07 to 0.19). It also includes intercorrelations of systolic blood pressure with waist (r from 0.10 to 0.21) and hip (r from -0.07 to -0.12) circumferences and with blood glucose (r from 0.09 to 0.15), those of triglycerides with blood glucose (r from 0.07 to 0.16), LDL (r from 0.24 to 0.33), HDL (r from -0.20 to -0.29) and waist circumference (r from 0.07 to 0.15), and finally those of waist and hip circumferences with blood glucose (r from 0.09 to 0.17 and from -0.08 to -0.13) and HDL (r from -0.12 to -0.24 and from 0.08 to 0.18). CONCLUSIONS:These results show that metabolic syndrome markers are correlated with each other whatever the biological, social or behavioral characteristics of individuals. They suggest that it makes sense to systematically consider these markers all together rather than separately in terms of etiology, prevention and treatment of metabolic diseases and cardiovascular risk in the general population.

OBJECTIVES:Uncertainty exists as to what extent common risk factors are involved in the associations of unemployment with major health outcomes and mortality. DESIGN:A retrospective and prospective observational study. SETTING:A large population-based French cohort (CONSTANCES). PARTICIPANTS:99 430 adults at baseline who have been exposed to unemployment during their lifetime and 54 679 of them who were followed for 7 years after baseline. PRIMARY OUTCOME MEASURES:Testing the mediating roles of several risk factors at baseline in the associations of lifetime unemployment exposure with cardiovascular disease, cancer and mortality rates during a 7-year follow-up. Direct and indirect effects were calculated for each risk factor and all together using logistic regression models adjusted for major confounders including sex, age, parental histories of cardiovascular disease and cancer, social position and working conditions. RESULTS:Estimates (95% CIs) of the direct and indirect effects for smoking are 0.0083 (0.0044 to 0.0122), p<0.0001 and 0.0010 (0.0007 to 0.0014), p<0.0001 on cardiovascular disease rate; 0.0059 (0.0028 to 0.0089), p=0.0002 and 0.0007 (0.0004 to 0.0010), p<0.0001 on cancer rate; 0.0105 (0.0058 to 0.0151), p<0.0001 and 0.0010 (0.0005 to 0.0014), p<0.0001 on all-cause mortality. The figures for alcohol consumption are, respectively, 0.0076 (0.0034 to 0.0118), p=0.0004 and 0.0004 (0.0002 to 0.0005), p=0.0006; 0.0067 (0.0035 to 0.0100), p<0.0001 and 0.0004 (0.0002 to 0.0005), p<0.0001; 0.0114 (0.0064 to 0.0164), p<0.0001 and 0.0004 (0.0001 to 0.0006), p=0.0009. For depressive symptoms, 0.0084 (0.0040to 0.0128), p=0.0002 and 0.0007 (0.0002 to 0.0011), p=0.005; 0.0053 (0.0017 to 0.0089), p=0.004 and 0.0001 (-0.0002 to 0.0005), p=0.51; 0.0088 (0.0031 to 0.0144), p=0.002 and 0.0010 (0.0004 to 0.0015), p=0.0005. For leisure-time physical inactivity, 0.0083 (0.0044 to 0.0122), p<0.0001 and 0.0003 (0.0001 to 0.0005), p=0.0006; 0.0057 (0.0026 to 0.0088), p=0.0004 and 0.0002 (0.0001 to 0.0003), p=0.002; 0.0105 (0.0058 to 0.0152), p<0.0001 and 0.0004 (0.0002 to 0.0007), p<0.0001. For blood triglycerides, 0.0080 (0.0042 to 0.0119), p<0.0001 and 0.0005 (0.0004 to 0.0007), p<0.0001; 0.0057 (0.0026 to 0.0087), p=0.0003 and 0.0001 (-0.0001 to 0.0002), p=0.32; 0.0103 (0.0057 to 0.0149), p<0.0001 and 0.0002 (0.0000 to 0.0004), p=0.06. The figures for all risk factors when tested together were 0.0075 (0.0022 to 0.0128), p=0.005 and 0.0020 (0.0011 to 0.0027), p<0.0001; 0.0052 (0.0011 to 0.0093), p=0.01 and 0.015 (0.0009 to 0.0020), p<0.0001; 0.0102 (0.0035 to 0.0169), p=0.003 and 0.0022 (0.0011 to 0.0031), p<0.0001. CONCLUSIONS:These analyses show that common risk factors such as smoking, alcohol consumption, depressive symptoms, leisure-time physical inactivity and blood triglycerides mediate up to 10% of the associations of lifetime unemployment exposure with cardiovascular disease, cancer and mortality rates when tested separately and approximately 20% when tested all together. This highlights the existence of other major mediating pathways that have yet to be identified.

OBJECTIVES:Teachers' mental health, an important asset for society, may be impacted by security or health crises alongside more structural changes. Our primary aim was to assess 2012-2022 trends in depressive symptoms among French teachers compared to similar employees. We further examined concomitant trends in job dissatisfaction. METHODS:Within the ongoing French national CONSTANCES cohort, depressive symptoms were regularly assessed (up to four times between 2012 and 2022) using the Center for Epidemiologic Studies-Depression scale (CES-D, score 0-60). We used mixed models adjusted for sociodemographic factors to estimate mean parameters (95% CI) of CES-D variations between 2012 and 2022 among teachers (n=15 022) compared with other intermediate or managerial/professional occupations (n=21 361). We similarly studied changes in job dissatisfaction (score 1-8) from 2018 (first occurrence in questionnaires) to 2022. RESULTS:In 2012, teachers' CES-D was slightly lower on average compared with that of non-teachers (-0.66 point (-1.19 to -0.12)), but tended to increase more rapidly over the decade, particularly in the years concomitant to the COVID-19 pandemic (+0.14 point/year (0.01 to 0.27)). By 2022, the gap had closed. Job dissatisfaction followed a somewhat different pattern: slightly lower among teachers in 2018, it increased at first more rapidly compared with non-teachers, but then stabilised, in parallel with the waning of the pandemic. CONCLUSIONS:Our study highlights unfavourable long-term trends in the mental well-being of French teachers. Although clinical changes at individual levels would be mostly imperceptible, our findings concern a large population of key professionals, suggesting their growing needs for mental health support in the long run.

Objectif L’association entre syndrome d’apnées obstructives du sommeil (SAOS) et hypertension est connue, mais les effets des symptômes de SAOS sur le risque d’hypertension (HTA) incidente ne sont pas bien documentés. Le but de cette étude prospective était d’examiner si ronflement et somnolence en population générale sont associés à une HTA incidente. Méthodes Les données de la cohorte française CONSTANCES ont été analysées. Les participants normotendus, âgés de 18 à 69 ans, ont été inclus entre 2012 et 2016, et dépistés pour le ronflement, la fatigue matinale et la somnolence diurne en 2017 à l’aide des items du questionnaire de Berlin. Nous avons utilisé des modèles de Cox, ajustés pour plusieurs facteurs de confusion potentiels, y compris l’IMC, la pression artérielle de base, la durée du sommeil et les symptômes dépressifs, pour calculer les ratios de risque (HR) d’hypertension traitée incidente identifiée entre 2017 et 2020 par le truchement du système national des données de santé (SNDS). Résultats Parmi 34 727 sujets, la prévalence de ronflements habituels, de fatigue matinale et de somnolence diurne excessive (au moins 3 fois par semaine pour chaque symptôme) était respectivement de 23,6 %, 16,6 % et 19,1 %. Au cours d’un suivi médian de 3,1 ans (IQR [3,0 ; 3,5]), l’incidence de l’hypertension traitée était de 4,1 %. Le risque de développer une hypertension traitée de novo était plus élevé chez les participants ayant déclaré des ronflements habituels (HR ajusté [IC 95 %]=1,17, [1,03–1,32]), de la fatigue matinale (HR ajusté [IC 95 %]=1,22, [1,07–1,41]) ou une somnolence diurne excessive (HR ajusté [IC 95 %]=1,42, [1,24–1,62]), et augmentait avec la fréquence hebdomadaire des symptômes, suivant une relation dose-dépendante (p pour la tendance≤0,02 pour chaque symptôme). Conclusion Le ronflement auto-déclaré, la fatigue matinale et la somnolence diurne excessive sont associés à un risque accru de développer une hypertension. L’identification du ronflement et de la somnolence diurne pourrait constituer un outil de dépistage utile en santé publique dans les soins primaires pour la prévention de l’hypertension artérielle.

Very few quantitative data exist on tramadol metabolites, which hampers our understanding of their role in efficacy and safety of tramadol. We aimed to provide quantitative data on tramadol and its 5 main metabolites in a patient cohort and to determine whether metabolite ratios can be predictive of a CYP2D6 metabolism phenotype. We also aimed to investigate the influence of co-medications and patient profile (BMI, glycemia, lipid levels) on tramadol metabolite ratios. Overall, 37 patient samples from the CONSTANCES cohort contained tramadol and its 5 metabolites. Mean concentrations found tramadol at 343.2 +/- 223.2 mu g/L, M1 at 62.4 +/- 41.4 mu g/L, M2 at 210.0 +/- 272.3, M3 at 1.76 +/- 3.0 mu g/L, M4 at 1.8 +/- 2.8 mu g/L and M5 at 31.8 +/- 28.4 mu g/L. The most frequent CYP2D6 phenotype was extensive metabolizers (51.3%), followed by intermediate metabolizers (24.3%) and poor metabolizers (10.8%). CYP2D6-inhibiting co-medications impacted tramadol metabolism independently of CYP2D6 metabolism phenotype. Lipid parameters and glycemia were significantly associated with changes in tramadol metabolic ratios. Metabolic ratios are not sufficient to determine the CYP2D6 metabolic phenotype in patients. CYP2D6 inhibitors and obesity/NAFLD/diabetes impact tramadol metabolism. These factors are likely to impact the analgesic efficacy and safety profile of tramadol, justifying the need for further studies in this area.

Background:In 2022, the previously American Heart Association (AHA) life's simple 7 score (range 0 to 14) measuring cardiovascular health (CVH) has been updated by adding sleep health and providing more granularity to the score (range 0 to 100) to measure the so-called Life's Essential 8 (LE8) score. However, the distribution of the LE8 score in nationwide representative US and non-US populations is scarce. The present study quantifies LE8 score distribution and identifies determinants of high CVH (80-100 points) in French adults. Methods:CONSTANCES is a nationwide French cohort study that randomly recruited participants aged 18 to 69 years in 24 participating health examination centers in 21 French "départements" in different regions of France between 2012 and 2019. Design weights for age class, sex, socio economic status, and examination center/region were applied to represent the source population. LE8 score was quantified using inclusion data on eight CVH metrics. The prevalence estimates were age-standardized directly using the 2022 EU 28 population. Mixed effects multivariable linear and logistic regression models identified key LE8 score determinants. Results:The study included 191,335 participants free of prior cardiovascular disease, with an average age of 46.48 years (SD 13.41) and 54 % women, representing 45.17 million individuals aged 18-69 in France. The overall mean LE8 score was 66.11 (68.92 in women vs. 62.79 in men, p = 6.875e-7), 13.21 %, 76.81 %, and 9.43 % achieved high (≥ 80 points), moderate (50-79 points), and poor (< 50 points) LE8 levels, respectively. Diet had the lowest mean score (41.50), while blood glycemia had the highest mean score (95.50). Mixed effects multivariable regression models identified younger age, womanhood, high educational attainment, self-employment, or managerial positions, not living with a partner, fewer depressive symptoms, lower alcohol consumption, rural residence, less socioeconomic deprivation, and absence of CVD family history as predictors of higher LE8 scores. Conclusions:Only 13.21 % of adults in France achieved a high LE8 score (≥ 80 points), and disparities related to individual and contextual socio-demographic factors and mental health were identified. The findings further underscore the importance of timely implementation of effective and personalized primordial prevention strategies.

Introduction:Estimating hypertension incidence and improving screening in general population could enhance blood pressure control and decrease cardiometabolic risks. Identifying those likely to develop hypertension is essential. Our study focused on predicting onset hypertension and its incidence based on initial characteristics.Methods:We utilized data from the French prospective CONSTANCES cohort, including volunteers assessed twice over 5 years up to 31 December 2019, who were initially free from hypertension. Hypertension was defined as having a SBP at least 140 mmHg or DBP at least 90 mmHg during the second checkup or if antihypertensive medication was prescribed. We calculated annual incidence rates among subgroups and used machine learning models to identify predictors of hypertension. The impact of changes in BMI was analyzed using logistic regression.Results:Of the 11 112 participants (average age 47.5 +/- 12 years), 1929 (17.4%) developed hypertension within an average of 5.2 years, with 383 on medication. The incidence rate was 3.4 new cases per 100 person-years, rising with age and consistently higher in men (4.3 vs. 2.8). A blood pressure (BP) threshold of 130 mmHg predicted 70% of new cases. One-point BMI reduction significantly reduced hypertension risk by 16%, regardless of initial BMI and SBP levels.Conclusion:The study reports a notable hypertension incidence of 3.4 new cases per 100 person-years, particularly among those with SBP over 130 mmHg, highlighting the need for regular screening. Early diagnosis and control can mitigate hypertension's adverse effects, emphasizing the crucial role of preventive measures like BMI reduction.

OBJECTIVES:We hypothesise that women with type 2 diabetes and hypertension are less likely than comparable men to receive renin-angiotensin system (RAS)-inhibiting antihypertensive treatment, particularly as first-line therapy. This study's main aim is to investigate the delivery of RAS inhibitor treatments by sex and number of antihypertensive treatments used. DESIGN:Cross-sectional study in a cohort. SETTING:Constances cohort, France, 2012-2019. PARTICIPANTS:2541 participants with type 2 diabetes among the 196 477 individuals aged 18-69 included in the Constances cohort. OUTCOME MEASURES:Proportion of individuals treated with RAS inhibitors by sex and number of antihypertensive treatments dispensed. Factors associated with the use of RAS inhibitors. RESULTS:Among 2541 diabetics, 1742 (68.6%) had received at least one antihypertensive treatment during the year preceding inclusion-a percentage that did not differ significantly between men and women (p=0.07). In analyses stratified by the number of antihypertensive classes, RAS inhibitors were delivered significantly less often to women than men for single-drug therapy (OR 0.46, 95% CI 0.25 to 0.81; p=0.008) and two-drug therapy (0.35, 95% CI 0.16 to 0.75, p=0.007) but not in regimens of three or more drugs (0.29, 95% CI 0.05 to 1.56; p=0.15). In the multivariate analysis, women received RAS inhibitors significantly less often than men (0.41, 95% CI 0.27 to 0.62; p<0.001). CONCLUSIONS:Women with type 2 diabetes are less likely than men to receive a prescription for RAS inhibitors, although this drug class is recommended as first-line therapy in this population.