Age at death during the Covid-19 lockdown in French metropolitan regions: a non parametric quantile regression approach.

BACKGROUND: Lockdowns have been implemented to limit the number of hospitalisations and deaths during the first wave of 2019 coronavirus disease. These measures may have affected differently death characteristics, such age and sex. France was one of the hardest hit countries in Europe with a decreasing east-west gradient in excess mortality. This study aimed at describing the evolution of age at death quantiles during the lockdown in spring 2020 (17 March-11 May 2020) in the French metropolitan regions focusing on 3 representatives of the epidemic variations in the country: Bretagne, Ile-de-France (IDF) and Bourgogne-Franche-Comté (BFC). METHODS: Data were extracted from the French public mortality database from 1 January 2011 to 31 August 2020. The age distribution of mortality observed during the lockdown period (based on each decile, plus quantiles 1, 5, 95 and 99) was compared with the expected one using Bayesian non-parametric quantile regression. RESULTS: During the lockdown, 5457, 5917 and 22 346 deaths were reported in Bretagne, BFC and IDF, respectively. An excess mortality from + 3% in Bretagne to + 102% in IDF was observed during lockdown compared to the 3 previous years. Lockdown led to an important increase in the first quantiles of age at death, irrespective of the region, while the increase was more gradual for older age groups. It corresponded to fewer young people, mainly males, dying during the lockdown, with an increase in the age at death in the first quantile of about 7 years across regions. In females, a less significant shift in the first quantiles and a greater heterogeneity between regions were shown. A greater shift was observed in eastern region and IDF, which may also represent excess mortality among the elderly. CONCLUSIONS: This study focused on the innovative outcome of the age distribution at death. It shows the first quantiles of age at death increased differentially according to sex during the lockdown period, overall shift seems to depend on prior epidemic intensity before lockdown and complements studies on excess mortality during lockdowns.

Estimated incidence of erythema migrans in five regions of France and ecological correlations with environmental characteristics.

BACKGROUND: While several studies conducted on Lyme borreliosis (LB) risk in the United States showed an association with environmental characteristics, most of European studies considered solely the effect of climate characteristics. OBJECTIVES: The aims of this study were to estimate incidence of erythema migrans (EM) in five regions of France and to analyze associations with several environmental characteristics of the place of residence. METHODS: LB surveillance networks of general practitioners (GPs) were set up for a period of 2 years in five regions of France. Participating GPs reported all patients with EM during the study period. Data were pooled according to a standardized EM case definition. For each area with a participating GP, age-standardized incidence rates and ratios were estimated. Associations with altitude, indicators of landscape composition, and indicators of landscape configuration were tested with multivariate Poisson regression. RESULTS: Standardized estimated incidence rates of EM per 10(5) person-years were 8.8 [95% confidence interval (CI)=7.9-9.7] in Aquitaine, 40.0 (95% CI 36.4-43.6) in Limousin, 76.0 (95% CI 72.9-79.1) in the three participating départements of Rhône-Alpes, 46.1 (95% CI 43.0-49.2) in Franche-Comté, and 87.7 (95% CI 84.6-90.8) in Alsace. In multivariate analysis, age-adjusted incidence rates increased with the altitude (p<0.0001) and decreased with forest patch density (p<0.0001). CONCLUSION: The marked variations in EM risk among the five regions were partly related to differences in landscape and environmental characteristics. The latter may point out potential risk areas and provide information for targeting preventive actions.

A recent increase in the incidence of male urethritis in France.

BACKGROUND: At-risk sexual behaviors appear to have increased recently in France, possibly because of the reassuring efficacy of highly active antiretroviral treatments. The objective of this study was to assess the pattern of change. GOAL: The goal was to analyze trends in the incidence of male urethritis, a marker of at-risk sexual behavior, between 1989 and 2000. STUDY DESIGN: The general practitioners of the Sentinelles Network reported, through an online computer system, all cases of male urethritis they diagnosed, together with the patients' age, presence of discharge, sexual preference, history of sexually transmitted disease, prescriptions, and results of microbiologic findings. RESULTS: After falling markedly between 1989 and 1995, the incidence of urethritis increased slightly in 1996 and then stabilized. The percentage of homosexual/bisexual men was higher among the cases than in the general population. Homosexual/bisexual men were younger than heterosexual men with urethritis; they were more likely to have a discharge and a history of sexually transmitted disease and had more sex partners. The main causative organisms were chlamydiae (18%) and Neisseria gonorrhoeae (13%). CONCLUSION: The increasing incidence of urethritis in France calls for a readjustment of preventive strategies.