Journal of epidemiology and population health最新文献

Background: Given the range of alarming social indicators in the French overseas territories, we aimed to study "deaths of despair", pooling deaths from suicide, alcohol, and drug-related deaths and to compare them with mainland France.

Methods: Standardized mortality rates obtained from death certificates between 2001 and 2022 were used for comparisons.

Results: Deaths of despair were generally lower than in mainland France, with Reunion Island as an exception. Suicide rates were consistently lower across all territories. However, alcohol-related deaths were notably higher in the overseas territories, particularly among men. The study found that deaths of despair were predominantly driven by suicide in mainland France, while in the overseas territories, they were split nearly equally between suicide and alcohol-related deaths. Drug-related deaths were negligible in the overseas territories. Between 2001 and 2022 deaths of despair declined notably because alcohol-related deaths declined.

Conclusions: The counter-intuitive finding that, with the exception of Reunion Island, despite all the social difficulties deaths of despair tend to be less frequent than in mainland France suggests that these small territories may have complex resilient features that limit the impact of poverty. While affordable rhum is locally produced populations drink less alcohol when compared to mainland France. However, the risk of dying from it remains a public health problem.

Introduction: Undocumented migrants in Latin America face life-threatening conditions during irregular border crossings, yet their mortality remains under-documented and structurally invisible in public health research. This study analyzes migrant deaths and assesses the methodological limitations in estimating mortality for those populations.

Methods: Cross-sectional data were drawn from the Missing Migrants Project, covering deaths and disappearances of Latin American migrants within the region from 2014 to 2022. The final sample included 1,817 documented fatalities with complete data on year and origin. The study analyzed spatial and temporal trends by region, migration route, country of origin, and cause of death. Data were grouped into three periods and tested for distributional differences using chi-square tests.

Results: From 1,817 deaths, nearly half occurred between 2020 and 2022. Regional patterns shifted over time, with a rising share of deaths in South America, particularly along the Darién Gap. Venezuelan and Haitian migrants accounted for the largest increases in deaths in recent years. Causes varied by route: drowning predominated in maritime crossings, while environmental exposure and violence were prevalent in jungle and borderland routes. Documentation improved over time, yet a large share of deaths remained unattributed to specific routes or causes.

Conclusions: Undocumented migrant mortality in Latin America is shaped by structural violence, fragile transit infrastructures, and inadequate data systems. Conventional demographic tools fail to capture these patterns due to missing denominators and fluid migration flows. Addressing these deaths requires new frameworks grounded in human rights, improved data systems, and expanded access to safe migration pathways.

Background: Medical debt is associated with poor mental and physical health outcome among US adults. Extant evidence also suggests an association between psychological distress and sugar-sweetened beverage (SSB) consumption. Building on these two strands of literature, this paper aimed to assess whether medical debt, defined as inability to pay medical bills, was associated with higher SSB consumption in US adults.

Methods: Using data on 26,559 adults from the 2022 National Health Interview Survey, we estimated two-part models to assess aggregate monthly frequency of SSB consumption. We used logistic regression to model the binary consumption decision (first part) and a generalized linear model (GLM) with log link and Poisson distribution to model the continuous frequency of consumption (second part). Adjustments were made for demographic, socioeconomic, and other known determinants of SSB consumption along with interview month fixed effects.

Results: Around 10.6% of the adults in our sample had medical debt and 6.4% were unable to pay at all. Those who had medical debt were more likely to consume SSBs at both external (i.e., whether consumed) and internal (how much if consumed) margins. On average, frequency of monthly SSB consumption was 4.07 (95% CI: 1.13-7.00) and 6.61 (95% CI: 2.74-10.49) units higher among adults with medical debt in general and those who were unable to pay, respectively, compared to that of adults who did not have problems paying medical bills.

Conclusions: These results suggest that US adults with medical debt were more likely to consume SSBs and warrants further research to identify strategies for curbing SSB consumption in this population.

Introduction: In France, medico-administrative data are collected through the Programme de Médicalisation des Systèmes d'Information (PMSI), which includes all discharge reports from public and private hospitals, covering more than 20 million hospital stays per year. In parallel, databases on rare diseases are a national priority but remain difficult to implement and maintain. We aimed to assess the validity of PMSI data to identify patients with congenital rare diseases, using congenital diaphragmatic hernia (CDH) as an example. We also aimed to explore the national epidemiological estimates provided by PMSI.

Methods: Using PMSI, we identified CDH patients treated in the neonatal intensive care units (NICU) of two French referral centers between 2010 and 2018 based on ICD-10 diagnostic codes. These centers have maintained a prospective database of CDH patients (CDHdb) for over 10 years. We compared PMSI data with CDHdb to assess the accuracy of PMSI in detecting CDH cases. A nationwide extraction was then performed to estimate the incidence and mortality of CDH in France.

Results: PMSI identified all 248 CDH patients listed in the CDHdb. However, 37 additional cases were found in PMSI but not in the CDHdb, including 24 neonatal deaths with confirmed CDH. Encoding errors were found in four cases (omphalocele, diaphragmatic eventration), and eight CDH cases were missing from the CDHdb. The sensitivity and specificity of PMSI were estimated at 100 % (98.5 %; 100 %) and 99.9 % (99.9 %; 100 %), respectively. At the national level, 1680 cases were identified, corresponding to an incidence of 2.33 per 10,000 live births, a male-to-female ratio of 1.40, and a 1-year mortality rate of 30.5 % (28.2 %; 32.9 %).

Discussion: PMSI appears to be a valid source for identifying CDH patients at birth, with national epidemiological estimates consistent with the literature. However, medico-administrative data require careful validation before being used for rare disease surveillance.

Conclusion: Our findings suggest that PMSI could be a valuable tool for studying and monitoring CDH patients-and potentially other congenital anomalies-on a nationwide scale.