French Census Research Articles

Increase of tuberculosis incidence in Ile-de-France region and the role of recent migration

Abstract Background In metropolitan France and in the Ile-de-France region, the incidence of tuberculosis has globally decreased since the year 2000 and has stabilized from 2011 to 2015. This study analysed the evolution of tuberculosis in the Ile-de-France region between 2015 and 2017. Methods We analysed tuberculosis cases reported in Ile-de-France from 2015 to 2017; 2015 was considered as the baseline year. Incidence rates of reported tuberculosis cases were estimated using French census data for the corresponding year for the denominator. Age-standardized rates were estimated for each of the 8 departments of the region based on the Ile-de-France region population. Foreigners’ population was based on the 2015 French census data. Differences in incidence and proportions were tested with the CHI2 statistic (STATA® v14.0). Results The incidence of tuberculosis increased in the Ile-de-France region from 14.6 to 15.8/100 000 pop. between 2015 and 2017 (+8.2%, p < 0.01). In this region, all department’s incidence were above 10/100 000 pop. in 2017. Sub-regional disparities were observed, with an important increase of the incidence in Paris, from 13,5 to 16.8/100 000 pop. between 2015 and 2017 (p < 0,01). The incidence rates among foreigners increased from 44.6 to 51.7/100 000 pop. (p < 0.01) and the proportion of tuberculosis cases among foreigners who arrived in France less than 2 years ago increased from 23% to 32% (p < 0.01), between 2015 and 2017. The incidence rates of tuberculosis cases increased particularly in men, foreigners, and recent migrants. Conclusions The incidence of tuberculosis increased in the Ile-de-France region in 2016 and 2017, particularly in newly arrived migrants. This situation requires actions to better detect and manage tuberculosis in this specific population. Key messages The incidence of tuberculosis increased in the Ile-de-France region. The incidence of tuberculosis increased in vulnerable population in relation with recent migration.

Gluten-free diet in French adults without coeliac disease: sociodemographic characteristics, motives and dietary profile.

The number of people avoiding gluten is growing in many Western countries. However, little information is available on their sociodemographic and dietary profiles. We aimed to describe sociodemographic, behavioural and dietary profiles of participants avoiding gluten in the NutriNet-Santé cohort. Participants of the NutriNet-Santé cohort - excluding coeliac patients - who completed a questionnaire about food exclusions, with complete data on sociodemographic characteristics and dietary intake were included (n 20 456). Food group consumptions and nutrient intakes according to self-reported avoidance of gluten were estimated using ANCOVA adjusted for age, sex and daily energy intake. Based on principal component analysis, three dietary patterns (DP) were identified. Association between DP and avoidance of gluten was investigated using multivariate logistic regression. All data were weighted on the French census. A total of 10·31 (95 % CI 9·90, 10·73) % of the participants declared avoiding gluten, of which 1·65 % totally. They were more likely to be women, older persons, non-smokers, to have a lower educational level and declared more food intolerances. They had higher consumption of fruit, vegetables and lower consumption of dairy products, salty/sweet and fatty foods and alcohol. After adjustments on confounders, a healthy dietary pattern was positively associated with total gluten avoidance (ORQuintile5vsQuintile1 = 14·44, 95 % CI 8·62, 24·19). Our study highlighted that, in this population, individuals who avoid gluten from their diet tend to have a diet more favourable to health. These results can serve as a basis for future studies investigating the potential consequences of a gluten-free diet in non-coeliac population.

Measles and rubella seroprevalence in a population of young adult blood donors, France 2013.

As part of the evaluation of the French plan for the elimination of measles and rubella, we conducted a seroprevalence survey in 2013, aimed at updating seroprevalence data for people 18-32 years old. A secondary objective was to estimate measles incidence in this population during the 2009-2011 outbreak, and thus estimate the exhaustiveness of measles mandatory reporting. We used a cross-sectional survey design, targeting blood donors 18-32 years old, living in France since 2009, who came to give blood in a blood collecting site. We included 4647 people in metropolitan France, 806 people in Réunion Island and 496 in the French Caribbean. A further 3942 individuals were interviewed in the south-east region of metropolitan France to estimate the exhaustiveness of measles mandatory reporting. One of the main findings of this survey is that the proportion of people 18-32 years old susceptible to both measles and rubella infections remained high in France in 2013, 9.2% and 5.4%, respectively, in metropolitan France, even after the promotion campaigns about vaccination catch-up during and following the major measles epidemic in 2009-2011. Applying our results to French census data would suggest that around 1 million people aged 18-32 years old are currently susceptible to measles in France, despite this age group being one of the vaccination targets of the national measles elimination plan. Another important finding is that only an estimated 45% of the true number of cases in this age group was actually notified, despite notification being mandatory.

Does Country Context Matter? Sub‐Saharan and North African Immigrants’ Labour Market Outcomes in France and Spain

AbstractEuropean debates on immigrant integration focus on employment because of its implications for assimilation. Although studies show that Sub‐Saharan African immigrants are most disadvantaged across Europe, cross‐national analyses do not examine labour force participation (LFP) or control for selection into the labour force before estimating employment, calling these results into question. Furthermore, studies rarely discuss visible minority status or gender making it unclear whether (1) country‐context matters for African LFP and employment and (2) visible minority status matters differently by gender. I use French and Spanish census data to determine whether Sub‐Saharan Africans are most disadvantaged in new and traditional receiving countries. My results indicate that country‐context matters, but previous employment findings likely reflect variation in LFP. Despite smaller penalties to migration characteristics in Spain, Sub‐Saharan African men are the only group significantly less likely to be employed in Spain, indicating that they experience unique barriers to job access.

L’effet d’une politique d’État sur les migrations DOM-métropole. Les enseignements des recensements de 1962 à 1999

Cet article propose de nouvelles perspectives d’analyse de la démographie de quatre départements français d’outre-mer (DOM : Guadeloupe, Guyane, Martinique et La Réunion). Quels sont les effets des politiques publiques de population, portées notamment par le Bureau pour la migration des DOM (Bumidom, 1963–1981) et ses successeurs, sur les migrations vers la métropole ? Les recensements de 1968 à 1999 permettent de mesurer l’ampleur et la structure de ces flux migratoires au cours du temps, ainsi que leur poids dans la population des natifs des DOM. S’appuyant sur des régressions en différences de différences, cette analyse permet de mesurer l’effet des politiques menées par le Bumidom. Elle montre que cet organisme a favorisé la croissance des migrations, également alimentées par les inégalités socioéconomiques entre les DOM et la métropole. Alors que l’offre d’enseignement supérieur dans les DOM et la part de bacheliers ne progressent pas au même rythme, les aspirations scolaires peuvent également être motrices des migrations. La comparaison des ultramarins restés dans les DOM avec ceux partis en métropole révèle que, depuis 1968, ces derniers sont caractérisés par un niveau d’études plus élevé.

Can Public Housing Decrease Segregation? Lessons and Challenges From Non-European Immigration in France : Can Public Housing Decrease Segregation?

Recent decades have seen a rapid increase in the share of non-European immigrants in public housing in Europe, which has led to concern regarding the rise of ghettos in large cities. Using French census data over three decades, we examine how this increase in public housing participation has affected segregation. While segregation levels have increased moderately, on average, the number of immigrant enclaves has grown. The growth of enclaves is being driven by the large increase in non-European immigrants in the census tracts where the largest housing projects are located, both in the housing projects and the surrounding nonpublic dwellings. As a result, contemporary differences in segregation levels across metropolitan areas are being shaped by the concentration of public housing within cities, in particular the share of non-European immigrants in large housing projects constructed before the 1980s. Nevertheless, the overall effect of public housing on segregation has been ambiguous. While large projects have increased segregation, the inflows of non-European immigrants into small projects have brought many immigrants into census tracts where they have previously been rare and, thus, diminished segregation levels.

Place of registration and place of residence: the non-linear detrimental impact of transportation cost on electoral participation

The French case offers a very valuable opportunity for testing the impact of transportation costs on the individual decision of turnout, because in France, voters can be registered in a municipality other than their residential municipality. Voters with a non-residential registration have to travel great distances in order to cast their ballots compared to voters with a residential registration. Our empirical analysis, based on a unique dataset extracted from the French Census database, uses a selection model to estimate the probability of voting of an individual voter with a non-residential electoral registration and assesses the impact of the distance to the voting municipality on this probability. The analysis shows that distance and in fine the cost of voting have a highly significant impact on electoral turnout: at the median distance (22 km), a 1% increase in distance induces a reduction of 0.01% in turnout in the first round of the 2012 French presidential election and 0.007% in the second round. Moreover, the impact of distance is non-linear: an increase in distance for voters with a short distance to travel is more detrimental to turnout than the same increase for voters who travel great distances. The results are robust to several checks, ranging from analyzing other elections to changes in the estimation method. This analysis provides new insights in the issue of voting cost and its impact on electoral turnout.

French Immigration—Demography Meets Politics: A Review Essay

French Immigration—Demography Meets Politics: A Review Essay

Can Public Housing Decrease Segregation? Lessons and Challenges from Non-European Immigration in France

Recent decades have seen a rapid increase in the share of non-European immigrants in public housing in Europe, which has led to concern regarding the rise of ghettos in large cities. Using French census data over three decades, we examine how this increase in public housing participation has affected segregation. While segregation levels have increased moderately, on average, the number of immigrant enclaves has grown. The growth of enclaves is being driven by the large increase in non-European immigrants in the census tracts where the largest housing projects are located, both in the housing projects and the surrounding nonpublic dwellings. As a result, contemporary differences in segregation levels across metropolitan areas are being shaped by the concentration of public housing within cities, in particular the share of non-European immigrants in large housing projects constructed before the 1980s. Nevertheless, the overall effect of public housing on segregation has been ambiguous. While large projects have increased segregation, the inflows of non-European immigrants into small projects have brought many immigrants into census tracts where they have previously been rare and, thus, diminished segregation levels.

Ability of ecological deprivation indices to measure social inequalities in a French cohort

BackgroundDespite the increasing interest in place effect to explain health inequalities, there is currently no consensus on which kind of area-based socioeconomic measures researchers should use to assess neighborhood socioeconomic position (SEP). The study aimed to evaluate the reliability of different area-based deprivation indices (DIs) in capturing socioeconomic residential conditions of French elderly women cohort.MethodsWe assessed area-based SEP using 3 DIs: Townsend Index, French European Deprivation Index (FEDI) and French Deprivation index (FDep), among women from E3N (Etude épidémiologique auprès des femmes de la Mutuelle Générale de l’Education Nationale). DIs were derived from the 2009 French census at IRIS level (smallest geographical units in France). Educational level was used to evaluate individual-SEP. To evaluate external validity of the 3 DIs, associations between two well-established socially patterned outcomes among French elderly women (smoking and overweight) and SEP, were compared. Odd ratios were computed with generalized estimating equations to control for clustering effects from participants within the same IRIS.ResultsThe analysis was performed among 63,888 women (aged 64, 47% ever smokers and 30% overweight). Substantial agreement was observed between the two French DIs (Kappa coefficient = 0.61) and between Townsend and FEDI (0.74) and fair agreement between Townsend and FDep (0.21). As expected among French elderly women, those with lower educational level were significantly less prone to be ever smoker (Low vs. High; OR [95% CI] = 0.43 [0.40–0.46]) and more prone to being overweight (1.89 [1.77–2.01]) than women higher educated. FDep showed expected associations at area-level for both smoking (most deprived vs. least deprived quintile; 0.77 [0.73–0.81]) and overweight (1.52 [1.44–1.62]). For FEDI opposite associations with smoking (1.13 [1.07–1.19]) and expected association with overweight (1.20 [1.13–1.28]) were observed. Townsend showed opposite associations to those expected for both smoking and overweight (1.51 [1.43–1.59]; 0.93 [0.88–0.99], respectively).ConclusionFDep seemed reliable to capture socioeconomic residential conditions of the E3N women, more educated in average than general French population. Results varied strongly according to the DI with unexpected results for some of them, which suggested the importance to test external validity before studying social disparities in health in specific populations.

Does the edge effect impact on the measure of spatial accessibility to healthcare providers?

BackgroundSpatial accessibility indices are increasingly applied when investigating inequalities in health. Although most studies are making mentions of potential errors caused by the edge effect, many acknowledge having neglected to consider this concern by establishing spatial analyses within a finite region, settling for hypothesizing that accessibility to facilities will be under-reported. Our study seeks to assess the effect of edge on the accuracy of defining healthcare provider access by comparing healthcare provider accessibility accounting or not for the edge effect, in a real-world application.MethodsThis study was carried out in the department of Nord, France. The statistical unit we use is the French census block known as ‘IRIS’ (Ilot Regroupé pour l’Information Statistique), defined by the National Institute of Statistics and Economic Studies. The geographical accessibility indicator used is the “Index of Spatial Accessibility” (ISA), based on the E2SFCA algorithm. We calculated ISA for the pregnant women population by selecting three types of healthcare providers: general practitioners, gynecologists and midwives. We compared ISA variation when accounting or not edge effect in urban and rural zones. The GIS method was then employed to determine global and local autocorrelation. Lastly, we compared the relationship between socioeconomic distress index and ISA, when accounting or not for the edge effect, to fully evaluate its impact.ResultsThe results revealed that on average ISA when offer and demand beyond the boundary were included is slightly below ISA when not accounting for the edge effect, and we found that the IRIS value was more likely to deteriorate than improve. Moreover, edge effect impact can vary widely by health provider type. There is greater variability within the rural IRIS group than within the urban IRIS group. We found a positive correlation between socioeconomic distress variables and composite ISA. Spatial analysis results (such as Moran’s spatial autocorrelation index and local indicators of spatial autocorrelation) are not really impacted.ConclusionOur research has revealed minor accessibility variation when edge effect has been considered in a French context. No general statement can be set up because intensity of impact varies according to healthcare provider type, territorial organization and methodology used to measure the accessibility to healthcare. Additional researches are required in order to distinguish what findings are specific to a territory and others common to different countries. It constitute a promising direction to determine more precisely healthcare shortage areas and then to fight against social health inequalities.

Diverse Approaches to Implement and Monitor River Restoration: A Comparative Perspective in France and Germany.

River restoration is a main emphasis of river management in European countries. Cross-national comparisons of its implementation are still rare in scientific literature. Based on French and German national censuses, this study compares river restoration practices and monitoring by analysing 102 French and 270 German projects. This comparison aims to draw a spatial and temporal framework of restoration practices in both countries to identify potential drivers of cross-national similarities and differences. The results underline four major trends: (1) a lag of almost 15 years in river restoration implementation between France and Germany, with a consequently higher share of projects in Germany than in France, (2) substantial similarities in restored reach characteristics, short reach length, small rivers, and in "agricultural" areas, (3) good correspondences between stressors identified and restoration measures implemented. Morphological alterations were the most important highlighted stressors. River morphology enhancement, especially instream enhancements, were the most frequently implemented restoration measures. Some differences exist in specific restoration practices, as river continuity restoration were most frequently implemented in French projects, while large wood introduction or channel re-braiding were most frequently implemented in German projects, and (4) some quantitative and qualitative differences in monitoring practices and a significant lack of project monitoring, especially in Germany compared to France. These similarities and differences between Germany and France in restoration application and monitoring possibly result from a complex set of drivers that might be difficult to untangle (e.g., environmental, technical, political, cultural).

L’importance de la recherche épidémiologique psychiatrique sur les populations migrantes en France

The association between migration status, ethnic minority position and mental disorders is well established in many European countries. In France, although near 25% of the population is a first or second-generation migrant, epidemiological studies on their mental health are scarce. One reason for this is the lack of ethnic statistics in the French census, which contributes to the invisibility of immigrants’ descendants in quantitative investigation. Nevertheless, recent studies have been showing evidence of higher incidence and prevalence rates of mental illness, especially of psychosis, in this population (including internal migrants from the French overseas departments). Besides, psychosocial factors of vulnerability of mental illness in the French society are observed among migrant groups and their decedents. They experience more inequities in health and living conditions, social trajectories and access to resources than non-migrants. They also report day-to-day experience of discrimination interactions and experience of racism (related to skin color and origin). Therefore, more studies are needed to better know to what extent migration and ethnicity are associated to mental disorders in France and to better identify the correlates and the ethnic groups at higher risk in the French context.

Perception of different formats of front-of-pack nutrition labels according to sociodemographic, lifestyle and dietary factors in a French population: cross-sectional study among the NutriNet-Santé cohort participants

ObjectiveFour formats for a front-of-pack (FOP) nutrition label are currently considered in France: the Nutriscore (or 5-Colour Nutrition Label, developed by a public research team), the SENS (supported by retailers),...

Undercount of young children and young adults in the new French census

Undercount of young children and young adults in the new French census

Small-area spatiotemporal analysis of heatwave impacts on elderly mortality in Paris: A cluster analysis approach

BackgroundHeat-waves have a substantial public health burden. Understanding spatial heterogeneity at a fine spatial scale in relation to heat and related mortality is central to target interventions towards vulnerable communities. ObjectivesTo determine the spatial variability of heat-wave-related mortality risk among elderly in Paris, France at the census block level. We also aimed to assess area-level social and environmental determinants of high mortality risk within Paris. MethodsWe used daily mortality data from 2004 to 2009 among people aged >65 at the French census block level within Paris. We used two heat wave days' definitions that were compared to non-heat wave days. A Bernoulli cluster analysis method was applied to identify high risk clusters of mortality during heat waves. We performed random effects meta-regression analyses to investigate factors associated with the magnitude of the mortality risk. ResultsThe spatial approach revealed a spatial aggregation of death cases during heat wave days. We found that small scale chronic PM10 exposure was associated with a 0.02 (95% CI: 0.001; 0.045) increase of the risk of dying during a heat wave episode. We also found a positive association with the percentage of foreigners and the percentage of labor force, while the proportion of elderly people living in the neighborhood was negatively associated. We also found that green space density had a protective effect and inversely that the density of constructed feature increased the risk of dying during a heat wave episode. ConclusionWe showed that a spatial variation in terms of heat-related vulnerability exists within Paris and that it can be explained by some contextual factors. This study can be useful for designing interventions targeting more vulnerable areas and reduce the burden of heat waves.

Assessment of the spatial accessibility to health professionals at French census block level.

BackgroundThe evaluation of geographical healthcare accessibility in residential areas provides crucial information to public policy. Traditional methods - such as Physician Population Ratios (PPR) or shortest travel time - offer only a one-dimensional view of accessibility. This paper developed an improved indicator: the Index of Spatial Accessibility (ISA) to measure geographical healthcare accessibility at the smallest available infra-urban level, that is, the Îlot Regroupé pour des Indicateurs Statistiques.MethodsThis study was carried out in the department of Nord, France. Healthcare professionals are geolocalized using postal addresses available on the French state health insurance website. ISA is derived from an Enhanced Two-Step Floating Catchment Area (E2FCA). We have constructed a catchment for each healthcare provider, by taking into account residential building centroids, car travel time as calculated by Google Maps and the edge effect. Principal Component Analyses (PCA) were used to build a composite ISA to describe the global accessibility of different kinds of health professionals.ResultsWe applied our method to studying geographical healthcare accessibility for pregnant women, by selecting three types of healthcare provider: general practitioners, gynecologists and midwives. A total of 3587 healthcare providers are potentially able to provide care for inhabitants of the department of Nord. On average there are 92 general practitioners, 22 midwives and 21 gynecologists per 100,000 residents. The composite ISA for the three types of healthcare provider is 39 per 100,000 residents. A comparative analysis between ISA and physician-population ratios indicates that ISA represents a more even distribution whereas the physician-population ratios show an ‘all-or-nothing’ approach.ConclusionISA is a multidimensional and improved measure, which combines the volume of services relative to population size with the proximity of services relative to the population’s location, available at the smallest feasible geographical scale. It could guide policy makers towards highlighting critical areas in need of more healthcare providers, and these areas should be earmarked for further knowledge-based policy making.

Socioeconomic Segregation in Large Cities in France and the United States.

Past cross-national comparisons of socioeconomic segregation have been undercut by lack of comparability in measures, data, and concepts. Using IRIS data from the French Census of 2008 and the French Ministry of Finance as well as tract data from the American Community Survey (2006-2010) and the U.S. Department of Housing and Urban Development Picture of Subsidized Households, and constructing measures to be as similar as possible, we compare socioeconomic segregation in metropolitan areas with a population of more than 1 million in France and the United States. We find much higher socioeconomic segregation in large metropolitan areas in the United States than in France. We also find (1) a strong pattern of low-income neighborhoods in central cities and high-income neighborhoods in suburbs in the United States, but varying patterns across metropolitan areas in France; (2) that high-income persons are the most segregated group in both countries; (3) that the shares of neighborhood income differences that can be explained by neighborhood racial/ethnic composition are similar in France and the United States; and (4) that government-assisted housing is disproportionately located in the poorest neighborhoods in the United States but is spread across many neighborhood income levels in France. We conclude that differences in government provision of housing assistance and levels of income inequality are likely important contributing factors to the Franco-U.S. difference in socioeconomic segregation.

Counting the Population or Describing Society? A Comparison of English and Welsh and French Censuses.

Data collected at household level in censuses are used for a wide range of purposes including practical planning and academic analysis of changing social conditions. Comparability is a core demographic value, and to understand the limits of the comparability of census data across time and space, it is important to recognise if, how and why, concepts and definitions change between censuses. This paper examines definitions of the household in censuses in England and Wales (E&W) and France from 1960 to 2012 in order to investigate how census definitions have changed and to examine the drivers of such changes. Two research methods were used: (1) longitudinal analyses of census documentation since the 1960s and (2) in-depth interviews with key informants oriented around respondents’ roles in the collection and/or use of household data from censuses and surveys. We identify two contrasting national approaches to the data collection exercise that is called a census, which reflect political and institutional differences. These differences call into question the comparability of some aspects of census data across national boundaries, despite increased harmonisation of approaches to data collection. By comparing the evolution of the definitions of the “household” in censuses, we develop insight into the diversity of the priorities of census commissioners and designers, and consider the broader implications of this for producing comparable data.

Association Between Prenatal Exposure To Traffic-Related Air Pollution And Preterm Birth In The Pelagie Mother-Child Cohort, Brittany, France. Does The Urban-Rural Context Matter ?

Introduction: In urban settings, evidence that exposure to ambient air pollution during pregnancy may influence preterm birth (PTB) has accumulated. Conversely, this relation has hardly been investigated in rural areas where individuals' characteristics (demographic, socioeconomic and psychosocial factors) and environmental co-exposures may differ. We therefore examined the association between prenatal exposure to traffic-related air pollution and PTB among pregnant women from the PELAGIE mother-child cohort (Brittany, France, 2002-2006) living in urban and rural settings (1550 and 959 women, respectively). Methods: Women's residences were classified as either urban or rural using the French census bureau rural-urban continuum code. Nitrogen dioxide (NO2) concentrations at home addresses were estimated from adjusted land-use regression models. Associations between NO2 concentrations and PTB were assessed using logistic regressions. Results: Prevalence of PTB (3%) was similar among women living in urban and in rural settings. Better socioeconomic characteristics and health behaviours but more single-parent family situations were observed among urban women. NO2 exposure was on average 20.8 ± 6.6 µg.m-3 for women residing in urban areas and 18.8 ± 5.6 µg.m-3 for their rural counterparts. An increased risk of PTB was associated with the two highest terciles of NO2 concentration in urban areas (OR (16.43 -21.18 µg.m-3): 2.46, 95% CI: 1.06-5.81; OR(> 21.18 µg.m-3): 2.35, 1.02-5.42, respectively) but not in rural areas. Discussion: Our study conducted in a region with interspersed urban-rural areas, are in line with previous findings suggesting an increased risk of PTB associated with higher NO2 concentrations for women living in urban areas. The absence of association among their rural counterparts for whom exposure levels were similar, suggest that environmental mixtures and psychosocial inequalities might play a role in this heterogeneity.