Background To encourage Covid-19 vaccination, France introduced during the Summer 2021 a ‘Sanitary Pass’, which morphed into a ‘Vaccine Pass’ in early 2022. While the sanitary pass led to an increase in Covid-19 vaccination rates, spatial heterogeneities in vaccination rates remained. To identify potential determinants of these heterogeneities and evaluate the French sanitary and vaccine passes’ efficacies in reducing them, we used a data-driven approach on exhaustive nationwide data, gathering 141 socio-economic, political and geographic indicators. Methods We considered the association between vaccination rates and each indicator at different time points: before the sanitary pass announcement (week 2021-W27), before the sanitary pass came into force (week 2021-W31) and 1 month after (week 2021-W35) and the equivalent dates for the vaccine pass (weeks 2021-W49, 2022-W03 and 2022-W07). Results The indicators most associated with vaccination rates were the share of local income coming from unemployment benefits, overcrowded households rate, immigrants rate and vote for an ‘anti-establishment’ candidate at the 2017 Presidential election. These associations increase over time. Consequently, living in a district below the median of such indicator decreases the probability to be vaccinated by about 30% at the end of the studied period, and this probability gradually decreases by deciles of these indicators. Conclusions Our analysis reveals that factors related to poverty, immigration and trust in the government are strong determinants of vaccination rate, and that vaccination inequities tended to increase after the introduction of the French sanitary and vaccination passes.
Aims Heart failure (HF) in young adults is uncommon, and changes in its incidence and prognosis in recent years are poorly described. Methods and results The incidence and prognosis of HF in young adults (18–50 years) were characterized using nationwide medico-administrative data from the French National Hospitalization Database (period 2013–2018). A total of 1,486 877 patients hospitalized for incident HF were identified, including 70 075 (4.7%) patients aged 18–50 years (estimated incidence of 0.44‰ for this age group). During the study period, the overall incidence of HF tended to decrease in the overall population but significantly increased by ∼0.041‰ in young adults (P < 0.001). This increase was notably observed among young men (from 0.51‰ to 0.59‰, P < 0.001), particularly those aged 36–50 years. In these young men, ischaemic heart disease (IHD) was the most frequently reported cause of HF, whereas non-ischaemic HF was mainly observed in patients ≤ 35 years old. In contrast to non-ischaemic HF, the incidence of IHD increased over the study period, which suggests that IHD-related HF is progressively affecting younger patients. Concordantly, young HF patients presented with high rates of traditional IHD risk factors, including obesity, smoking, hypertension, dyslipidaemia, or diabetes. Lastly, the rates of re-hospitalization (for HF or for any cause) within two years after the first HF event and in-hospital mortality were high in all groups, indicating a poor-prognosis population. Conclusion Strategies for the prevention of HF risk factors should be strongly considered for patients under 50 years old.
The French sanitary pass led to an increase in vaccination rates in France, but local heterogeneities in vaccination rates remain. To identify potential determinants of these heterogeneities and how the French sanitary pass influenced them, we used a data-driven approach on exhaustive nationwide data, gathering 181 socio-economic and geographic factors. Our analysis reveals that, both before and after the introduction of the French sanitary pass, factors with the largest impact are related to poverty, with the most deprived areas having greater than 10 times the odds of being among the districts with lower vaccination rates.
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