Mortality with Alzheimer's disease and dementia in France, 2006.

BACKGROUND: Alzheimer's and related diseases have become a major public health issue in all developed countries, particularly with the aging of the population. Given the potential burden of these pathologies, the French government launched a third National Alzheimer's Strategic Plan 2008-2012 in 2008. The aim of the study was to provide French data on the mortality statistics of Alzheimer's and related diseases by age, gender, and geographical area. METHODS: Analyses were based on the number of deaths from Alzheimer's disease (AD) and dementia, extracted from the 2000-2006 French National Mortality Registry (Inserm-Centre d'épidémiologie sur les causes médicales de décès [CépiDc]). Underlying and multiple causes of death were taken into account. Gender, age, area of residence, and place of death were noted for all subjects deceased with AD or dementia. Mortality rates were standardized on the truncated 60+ French 2006 population. Mortality rates were also estimated by 5-year age groups. Causes of death in demented and nondemented people were compared by estimating an age-adjusted relative-risk ratio. RESULTS: In France, in 2006, AD or dementia was reported as the underlying cause or a multiple cause of death on 45,597 death certificates. Among these death certificates, 70% were women and the mean age at death was 85.9 years. Age-standardized mortality rates were 341/100,000 person-years for men and 333/100,000 person-years for women. Age-specific mortality rates increased with age and were higher in women than in men over 90 years of age. The analysis of the changes in mortality rates showed an overall increase of 11.3% between 2000 and 2006. The most frequent underlying cause when AD or dementia was mentioned as an associated cause were cardiovascular diseases (40.5%), neoplasms (11.9%), and endocrine diseases (8.5%). CONCLUSION: The analysis of mortality data on AD and dementia provides insight into the burden of these diseases in France. If carried out regularly, these analyses can provide trend analyses of mortality rates.

Acute childhood leukaemia and residence next to petrol stations and automotive repair garages: the ESCALE study (SFCE).

BACKGROUND: The association between acute childhood leukaemia and residing next to petrol stations and automotive repair garages was analysed in a national registry-based case-control study carried out in France in 2003-2004. METHODS: Population controls were frequency matched with cases on age and gender. Data were collected by standardised telephone interview with the mothers. The latter were asked to report the proximity of their homes to petrol stations, automotive repair garages and other businesses from the conception of the index child to the diagnosis (for cases) or interview (for controls). Odds ratios were estimated using unconditional regression models adjusted for age, gender, number of children under 15 years of age in the household, degree of urbanisation and type of housing. RESULTS: 765 cases of acute leukaemia and 1681 controls were included. Acute leukaemia was significantly associated with residence next to petrol stations or automotive repair garages (OR 1.6, 95% CI 1.2 to 2.2) and next to a petrol station (OR 1.9, 95% CI 1.2 to 3.0). The OR showed no tendency to increase with duration of exposure. The results were not modified by adjustment for potential confounding factors including urban/rural status and type of housing. CONCLUSIONS: The results support the findings of our previous study and suggest that living next to a petrol station may be associated with acute childhood leukaemia. The results also suggest that the role of low-level exposure to benzene in acute childhood leukaemia deserves further evaluation.

The growing incidence of type 1 diabetes in children: the 17-year French experience in Aquitaine.

BACKGROUND: While the incidence of type 1 diabetes in children has increased in various parts of the world, in France, no actual figures have been available since 1997. OBJECTIVE: The aim of this study was to determine whether or not the pattern of increase in the incidence of type 1 diabetes in children aged less than 15 years varies with age at onset in Aquitaine (France) over a 17-year period. PATIENTS AND METHODS: From 1988 to 1997, all newly diagnosed cases of type 1 diabetes were confirmed by registration into the French Registry of Incidence of Diabetes. Subsequently, all cases registered from 1998 to 2004 were collected within paediatric centres in Aquitaine as part of their hospital-based prospective records. RESULTS: In the overall population, the age- and gender-adjusted incidence rate increased from 8.86 per 100,000 per year (95% CI: 6.27-11.45) in 1988 to 13.47 per 100,000 per year (95% CI: 10.29-16.65) in 2004, indicating an annual increase in incidence of 3.34% (95% CI: 3.33-3.34). Median age at diabetes onset for cases in the first registration period (1988-1996) was significantly higher than that in the second registration period (1997-2004): 10.04 years (range: 6.64-12.53) versus 8.83 years (range: 5.48-11.73), respectively (P=0.01). The annual increase in incidence rate was highest in the youngest children and varied significantly with age (0-4 years: 7.59%; 5-9 years: 4.06%; 10-14 years: 1.28%). CONCLUSION: These results indicate a doubling of the incidence of type 1 diabetes in children every 30 years in Aquitaine, with an even steeper increase among younger children, thus underscoring the need for appropriate adaptation of the system of healthcare provision.