A Prospective Comparative Study of Health Inequalities and the Epidemiology of Stroke in French Guiana and Dijon, France
BackgroundIn French Guiana poverty is widespread and specialized care is lacking. We aimed to compare strokes between precarious and non-precarious patients within French Guiana and to compare the epidemiology of ischemic strokes and their outcomes between French Guiana and mainland France.MethodsA...
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Frontiers Media S.A.
2022-05-01
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| Series: | Frontiers in Public Health |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fpubh.2022.849036/full |
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| author | Devi Rita Rochemont Emmanuelle Mimeau Caroline Misslin Martine Papaix-Puech Bertrand de Toffol Nadia Sabbah Emmanuel Delmas Yannick Bejot Isabelle Fournel Isabelle Fournel Mathieu Nacher Mathieu Nacher |
| author_facet | Devi Rita Rochemont Emmanuelle Mimeau Caroline Misslin Martine Papaix-Puech Bertrand de Toffol Nadia Sabbah Emmanuel Delmas Yannick Bejot Isabelle Fournel Isabelle Fournel Mathieu Nacher Mathieu Nacher |
| author_sort | Devi Rita Rochemont |
| collection | DOAJ |
| description | BackgroundIn French Guiana poverty is widespread and specialized care is lacking. We aimed to compare strokes between precarious and non-precarious patients within French Guiana and to compare the epidemiology of ischemic strokes and their outcomes between French Guiana and mainland France.MethodsA multicenter prospective cohort examined the influence of social inequalities on stroke characteristics. Consecutive patients aged > 18 years admitted for an acute ischemic stroke, confirmed by neuroimaging were eligible. Exclusion criteria were a history of symptomatic stroke, presence of other short-term life-threatening diseases and inability to contact patients by telephone during follow-up. Social deprivation was measured using the EPICES score, which is based on a multidimensional questionnaire.ResultsOverall, 652 patients with ischemic stroke were included. The patients in French Guiana were 7 years younger, were more frequently male, of sub-Saharan ancestry, they had a low level of education, and were more often precarious (67.7%) than the patients included in Dijon (39.2%). The origin of the ischemic stroke was predominantly lacunar for patients included in French Guiana and cardioembolic for patients included in Dijon, with greater severity for patients included in Dijon. The proportion of patients with known pre-stroke hypertension, diabetes, or a history of Transient Ischemic Accident was greater in French Guiana than in Dijon. In contrast, hypercholesterolemia, atrial fibrillation, and history of Myocardial Infarction were more frequently found in patients included in Dijon than in patients included in French Guiana. Fibrinolysis was less frequent in French Guiana than in Dijon, 24% of patients arriving early enough receiving thrombolysis in French Guiana vs. 45% in Dijon, P < 0.0001. However, after adjustment for patient characteristics, the effect of the center on the use of fibrinolysis disappeared. When comparing precarious and non-precarious patients within French Guiana, the main difference was the younger age and the lower mortality of precarious patients—notably immigrants.ConclusionPrecariousness was widespread in French Guiana. Within French Guiana, despite a younger age among foreigners than French patients, the risk factors, mechanisms, and outcomes were homogenous across socioeconomic strata. The observed differences between the two contrasted French territories suggested that, beyond health inequalities, the epidemiology of cardiovascular risk factors may differ between French Guiana and mainland France. |
| first_indexed | 2024-12-12T05:13:14Z |
| format | Article |
| id | doaj.art-dd1ae75f421e4314b999e3b7ba598ccb |
| institution | Directory Open Access Journal |
| issn | 2296-2565 |
| language | English |
| last_indexed | 2024-12-12T05:13:14Z |
| publishDate | 2022-05-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Public Health |
| spelling | doaj.art-dd1ae75f421e4314b999e3b7ba598ccb2022-12-22T00:36:51ZengFrontiers Media S.A.Frontiers in Public Health2296-25652022-05-011010.3389/fpubh.2022.849036849036A Prospective Comparative Study of Health Inequalities and the Epidemiology of Stroke in French Guiana and Dijon, FranceDevi Rita Rochemont0Emmanuelle Mimeau1Caroline Misslin2Martine Papaix-Puech3Bertrand de Toffol4Nadia Sabbah5Emmanuel Delmas6Yannick Bejot7Isabelle Fournel8Isabelle Fournel9Mathieu Nacher10Mathieu Nacher11CIC Inserm 1424, Centre d'investigation Clinique, Centre Hospitalier de Cayenne, Cayenne, French GuianaService d'accueil des Urgences, Centre Hospitalier de Cayenne, Cayenne, French GuianaService de Médecine, Centre Hospitalier de l'Ouest Guyanais, Saint-Laurent-du-Maroni, French GuianaService des Urgences, Centre Hospitalier de Kourou, Kourou, French GuianaService de Neurologie, Centre Hospitalier de Cayenne, Cayenne, French GuianaService de Diabétologie, Centre Hospitalier de Cayenne, Cayenne, French GuianaCentre d'investigation Clinique – Épidémiologie Clinique, CIC Inserm 1432, Centre d'investigation Clinique, CHRU de Dijon, Dijon, FranceRegistre des AVC de Dijon, EA7460, Service de Neurologie, Université de Bourgogne, CHRU Dijon, Dijon, FranceRegistre des AVC de Dijon, EA7460, Service de Neurologie, Université de Bourgogne, CHRU Dijon, Dijon, FranceUFR des Sciences de Santé, Université de Bourgogne, Dijon, FranceCIC Inserm 1424, Centre d'investigation Clinique, Centre Hospitalier de Cayenne, Cayenne, French Guiana0Département Formation Recherche (DFR) Santé, Université de Guyane, Cayenne, French GuianaBackgroundIn French Guiana poverty is widespread and specialized care is lacking. We aimed to compare strokes between precarious and non-precarious patients within French Guiana and to compare the epidemiology of ischemic strokes and their outcomes between French Guiana and mainland France.MethodsA multicenter prospective cohort examined the influence of social inequalities on stroke characteristics. Consecutive patients aged > 18 years admitted for an acute ischemic stroke, confirmed by neuroimaging were eligible. Exclusion criteria were a history of symptomatic stroke, presence of other short-term life-threatening diseases and inability to contact patients by telephone during follow-up. Social deprivation was measured using the EPICES score, which is based on a multidimensional questionnaire.ResultsOverall, 652 patients with ischemic stroke were included. The patients in French Guiana were 7 years younger, were more frequently male, of sub-Saharan ancestry, they had a low level of education, and were more often precarious (67.7%) than the patients included in Dijon (39.2%). The origin of the ischemic stroke was predominantly lacunar for patients included in French Guiana and cardioembolic for patients included in Dijon, with greater severity for patients included in Dijon. The proportion of patients with known pre-stroke hypertension, diabetes, or a history of Transient Ischemic Accident was greater in French Guiana than in Dijon. In contrast, hypercholesterolemia, atrial fibrillation, and history of Myocardial Infarction were more frequently found in patients included in Dijon than in patients included in French Guiana. Fibrinolysis was less frequent in French Guiana than in Dijon, 24% of patients arriving early enough receiving thrombolysis in French Guiana vs. 45% in Dijon, P < 0.0001. However, after adjustment for patient characteristics, the effect of the center on the use of fibrinolysis disappeared. When comparing precarious and non-precarious patients within French Guiana, the main difference was the younger age and the lower mortality of precarious patients—notably immigrants.ConclusionPrecariousness was widespread in French Guiana. Within French Guiana, despite a younger age among foreigners than French patients, the risk factors, mechanisms, and outcomes were homogenous across socioeconomic strata. The observed differences between the two contrasted French territories suggested that, beyond health inequalities, the epidemiology of cardiovascular risk factors may differ between French Guiana and mainland France.https://www.frontiersin.org/articles/10.3389/fpubh.2022.849036/fullischemic strokerisk factorsthrombolysishealth inequalitiesepidemiologyFrench Guiana |
| spellingShingle | Devi Rita Rochemont Emmanuelle Mimeau Caroline Misslin Martine Papaix-Puech Bertrand de Toffol Nadia Sabbah Emmanuel Delmas Yannick Bejot Isabelle Fournel Isabelle Fournel Mathieu Nacher Mathieu Nacher A Prospective Comparative Study of Health Inequalities and the Epidemiology of Stroke in French Guiana and Dijon, France Frontiers in Public Health ischemic stroke risk factors thrombolysis health inequalities epidemiology French Guiana |
| title | A Prospective Comparative Study of Health Inequalities and the Epidemiology of Stroke in French Guiana and Dijon, France |
| title_full | A Prospective Comparative Study of Health Inequalities and the Epidemiology of Stroke in French Guiana and Dijon, France |
| title_fullStr | A Prospective Comparative Study of Health Inequalities and the Epidemiology of Stroke in French Guiana and Dijon, France |
| title_full_unstemmed | A Prospective Comparative Study of Health Inequalities and the Epidemiology of Stroke in French Guiana and Dijon, France |
| title_short | A Prospective Comparative Study of Health Inequalities and the Epidemiology of Stroke in French Guiana and Dijon, France |
| title_sort | prospective comparative study of health inequalities and the epidemiology of stroke in french guiana and dijon france |
| topic | ischemic stroke risk factors thrombolysis health inequalities epidemiology French Guiana |
| url | https://www.frontiersin.org/articles/10.3389/fpubh.2022.849036/full |
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