Survie en cas de cancer dans le canton de Vaud : rapport statistique descriptif : cas incidents 1974-1980

On présente les résultats de survie pour 22 localisations choisies. Les collectifs étudiés comprennent environ 80% de l'ensemble des cas nouveaux (incidents) recensés par le Registre vaudois des tumeurs entre 1974 et 1980 dans le canton de Vaud. Chaque type ou groupe de tumeurs est décrit en fonction du sexe, de l'âge, du type histologique et de l'expérience de survie globale brute ou corrigée jusqu'à cinq ans. De plus, des analyses de survie plus détaillées, notamment par sous-localisation ou type morphologique sont rapportées pour le côlon, les poumons, les mélanomes cutanés, les testicules et les leucémies. Les taux corrigés à cinq ans sont confrontés, dans un tableau synthétique, avec ceux de Genève, de Finlande, de Norvège, de Nouvelle-Zélande et du SEER (Surveillance, Epidemiology and End Results) pour les blancs des USA.

Obésité en Suisse: percentiles d'indice de masse corporelle (IMC) d'une population d'enfants et d'adolescents nés en 1980 à Lausanne et écart avec les normes suisses (1955)

OBJECTIVES: The objective of this study is to calculate the percentiles of BMI of a cohort of 1,203 children and adolescents, representing the 95% of the pupils of the school, born in 1980 followed longitudinally between 5 and 16 years. We compare these percentiles with those of the first swiss study, calculated on a cohort born in 1954-1956. METHODS: The percentiles were calculated with the method of Cole, on the basis of weight and height measured during the controls by the school health service, at a non-periodic mean interval of 14 months. RESULTS: The gap between the BMI percentiles of the two cohorts is near zero for the third percentiles, weak but progressively growing with age up to two units of BMI for the 50th percentiles. For the percentiles 97 the difference, straight away present at five years, grows regularly up to 11 years, and remains thereafter for the girls at 4.3 units of BMI, while growing more up to 6.8 units of BMI at 15 years for the boys. The percentages of children and adolescents of the present study with overweight, in accordance with the thresholds of Cole, constant for the girls at 14%, increase for the five to 11.5 years old boys from 13.4% to 17.6% for the 11.5 to 16 years old. The percentage of obesity is 2.7% for the girls, and increase for the same categories for the boys from a percentage of 1.7% to 2.3% for the boys. CONCLUSIONS: The changes during this quarter of century are important, especially for the boys. We can postulate thereafter a very early change in the energy balance. A chronic increase of the food supply, linked or not with a decrease of the physical activity, would be an explanation.

Trends in cancer mortality in Brazil, 1980-2004.

Scanty information, limited to selected areas of the country, is available on cancer mortality in Brazil. Age-standardized (world population) mortality rates between 1980 and 2004, derived from the WHO database, were computed for all cancers and 24 major cancer sites in Brazil. Joinpoint regression analyses were used to identify the significant changes in trends and estimate annual percent change (APC) in rates. Total cancer mortality rates increased over the last decade in men (APC = 0.5) to reach 101.2/100 000, and in women (APC = 0.3) to reach 71.3/100 000. In men, upward trends were observed for cancers of the oral cavity and pharynx with a rate of 5.9/100 000 in 2000-2004, intestines (whose rate, however was low, i.e. 7.6), prostate (12.2), and leukemias (3.4). Male lung cancer increased until 1993 (APC = 1.39) and decreased thereafter (APC = -0.29), with a relatively low rate of 16.2/100 000 in 2000-2004. In women, there were steady upward trends for cancers of the lung (APC = 2.3), reaching 6.2/100 000 in 2000-2004, and leukemias (2.5). Breast cancer mortality leveled off at around 10/100 000 in the last decade, whereas declines were observed for cancers of the uterus, whose rate (8.3) however, remained comparatively high. Declines were observed for stomach cancer in both sexes, with rates of 11.1 in men and 4.6 in women. In conclusion, the key issues of cancer mortality in Brazil are the high rates of head and neck cancers in men and (cervix) uterine cancer in women, that is, in principle cancers that are largely avoidable through prevention, screening, and early diagnosis.

Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: a comparative risk assessment.

BACKGROUND: High blood pressure, blood glucose, serum cholesterol, and BMI are risk factors for cardiovascular diseases and some of these factors also increase the risk of chronic kidney disease and diabetes. We estimated mortality from cardiovascular diseases, chronic kidney disease, and diabetes that was attributable to these four cardiometabolic risk factors for all countries and regions from 1980 to 2010. METHODS: We used data for exposure to risk factors by country, age group, and sex from pooled analyses of population-based health surveys. We obtained relative risks for the effects of risk factors on cause-specific mortality from meta-analyses of large prospective studies. We calculated the population attributable fractions for each risk factor alone, and for the combination of all risk factors, accounting for multicausality and for mediation of the effects of BMI by the other three risks. We calculated attributable deaths by multiplying the cause-specific population attributable fractions by the number of disease-specific deaths. We obtained cause-specific mortality from the Global Burden of Diseases, Injuries, and Risk Factors 2010 Study. We propagated the uncertainties of all the inputs to the final estimates. FINDINGS: In 2010, high blood pressure was the leading risk factor for deaths due to cardiovascular diseases, chronic kidney disease, and diabetes in every region, causing more than 40% of worldwide deaths from these diseases; high BMI and glucose were each responsible for about 15% of deaths, and high cholesterol for more than 10%. After accounting for multicausality, 63% (10·8 million deaths, 95% CI 10·1-11·5) of deaths from these diseases in 2010 were attributable to the combined effect of these four metabolic risk factors, compared with 67% (7·1 million deaths, 6·6-7·6) in 1980. The mortality burden of high BMI and glucose nearly doubled from 1980 to 2010. At the country level, age-standardised death rates from these diseases attributable to the combined effects of these four risk factors surpassed 925 deaths per 100 000 for men in Belarus, Kazakhstan, and Mongolia, but were less than 130 deaths per 100 000 for women and less than 200 for men in some high-income countries including Australia, Canada, France, Japan, the Netherlands, Singapore, South Korea, and Spain. INTERPRETATION: The salient features of the cardiometabolic disease and risk factor epidemic at the beginning of the 21st century are high blood pressure and an increasing effect of obesity and diabetes. The mortality burden of cardiometabolic risk factors has shifted from high-income to low-income and middle-income countries. Lowering cardiometabolic risks through dietary, behavioural, and pharmacological interventions should be a part of the global response to non-communicable diseases. FUNDING: UK Medical Research Council, US National Institutes of Health.

National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2·7 million participants.

BACKGROUND: Data for trends in glycaemia and diabetes prevalence are needed to understand the effects of diet and lifestyle within populations, assess the performance of interventions, and plan health services. No consistent and comparable global analysis of trends has been done. We estimated trends and their uncertainties in mean fasting plasma glucose (FPG) and diabetes prevalence for adults aged 25 years and older in 199 countries and territories. METHODS: We obtained data from health examination surveys and epidemiological studies (370 country-years and 2·7 million participants). We converted systematically between different glycaemic metrics. For each sex, we used a Bayesian hierarchical model to estimate mean FPG and its uncertainty by age, country, and year, accounting for whether a study was nationally, subnationally, or community representative. FINDINGS: In 2008, global age-standardised mean FPG was 5·50 mmol/L (95% uncertainty interval 5·37-5·63) for men and 5·42 mmol/L (5·29-5·54) for women, having risen by 0·07 mmol/L and 0·09 mmol/L per decade, respectively. Age-standardised adult diabetes prevalence was 9·8% (8·6-11·2) in men and 9·2% (8·0-10·5) in women in 2008, up from 8·3% (6·5-10·4) and 7·5% (5·8-9·6) in 1980. The number of people with diabetes increased from 153 (127-182) million in 1980, to 347 (314-382) million in 2008. We recorded almost no change in mean FPG in east and southeast Asia and central and eastern Europe. Oceania had the largest rise, and the highest mean FPG (6·09 mmol/L, 5·73-6·49 for men; 6·08 mmol/L, 5·72-6·46 for women) and diabetes prevalence (15·5%, 11·6-20·1 for men; and 15·9%, 12·1-20·5 for women) in 2008. Mean FPG and diabetes prevalence in 2008 were also high in south Asia, Latin America and the Caribbean, and central Asia, north Africa, and the Middle East. Mean FPG in 2008 was lowest in sub-Saharan Africa, east and southeast Asia, and high-income Asia-Pacific. In high-income subregions, western Europe had the smallest rise, 0·07 mmol/L per decade for men and 0·03 mmol/L per decade for women; North America had the largest rise, 0·18 mmol/L per decade for men and 0·14 mmol/L per decade for women. INTERPRETATION: Glycaemia and diabetes are rising globally, driven both by population growth and ageing and by increasing age-specific prevalences. Effective preventive interventions are needed, and health systems should prepare to detect and manage diabetes and its sequelae. FUNDING: Bill & Melinda Gates Foundation and WHO.

La fragilité des liens nationaux. La reconfiguration de l'élite de pouvoir en Suisse, 1980-2010

Pendant la majeure partie du XXe siècle, la forte cohésion des élites économiques helvétiques s'est appuyée sur leurs interrelations très denses au sein des conseils d'administration, leurs liens étroits avec les champs politique et militaire ainsi que sur leur appartenance à des institutions de socialisation et de légitimation nationales. Au cours des trente dernières années, sous l'effet de la globalisation économique et de la financiarisation, ces élites ont connu de profonds changements. En combinant analyse de réseau et analyse des correspondances multiples des dirigeants des 110 plus grandes entreprises helvétiques en 1980, 2000 et 2010, nous mettons en évidence ces transformations, en montrant notamment le fort déclin des réseaux d'interconnexions entre conseils d'administration, la redéfinition des rapports à l'État ainsi que la modification des curricula de formation et des carrières des élites. Cette reconfiguration de l'élite du pouvoir traditionnelle est révélatrice de la remise en cause du cadre national dans l'organisation et les processus de légitimation des élites économiques suisses.