Place of residence and distance to medical care influence the diagnosis of hepatitis C: a population-based study.
Fiche publication
Date publication
mars 2006
Auteurs
Membres identifiés du Cancéropôle Est :
Dr JOOSTE Valérie
Tous les auteurs :
Monnet E, Collin-Naudet E, Bresson-Hadni S, Minello A, Di Martino V, Carel D, Jooste V, Gagnaire A, Evrard P, Obert-Clerc B, Miguet JP, Hillon P
Lien Pubmed
Résumé
BACKGROUND/AIMS: In France, geographic access to medical care may affect the diagnosis of hepatitis C. The aims of this study were to compare the detection rates of hepatitis C in urban and rural areas after adjusting for distance to medical care, and evaluating the impact of the place of residence on patients' clinical characteristics. METHODS: Between 1994 and 2001, 1938 newly detected cases were recorded in a French population of 1,005,817 inhabitants. Age and sex-adjusted detection rates for 10(5) inhabitants were estimated for urban and rural areas and for classes of distance to the nearest practitioner. RESULTS: Detection rates were lower in rural than in urban areas [14.1, (95CI: 12.5-15.7) versus 24.7, (95CI: 23.5-26.0)] and decreased as the distance to the general practitioner increased [27.0, (95CI: 25.5-28.4) versus 13.7, (95CI: 12.1-15.3) for a cutoff value of 1.5 km]. In multivariate analyses, detection rates were only influenced by the distance to general practitioner. Hepatocellular carcinoma at diagnosis was more frequent among rural than among urban patients (adjusted OR = 2.28, 95CI: 0.97-5.39, P = 0.059). CONCLUSIONS: A poorer geographic access to care explained the lower detection of hepatitis C in rural areas. Hepatocellular carcinoma was more frequent in rural patients. It may result from later detection and/or involvement of environmental factors on hepatocarcinogenesis.
Référence
J Hepatol. 2006 Mar;44(3):499-506