Management of rare diseases of the Head, Neck and Teeth: results of a French population-based prospective 8-year study

Abstract

Background: In the last ten years, national rare disease networks have been established in France, including national centres of expertise and regional ones, with storage of patient data in a bioinformatics tool. The aim was to contribute to the development and evaluation of health strategies to improve the management of patients with rare diseases. The objective of this study has been to provide the first national-level data concerning rare diseases of the head, neck and teeth and to assess the balance between demand and supply of care in France. Methods: Centres of expertise for rare diseases record a minimum data set on their clinical cases, using a list of rare Head, Neck and Teeth diseases established in 2006. The present analysis focuses on 2008 to 2015 data based on the Orphanet nomenclature. Each rare disease RD "case" was defined by status "affected" and by the degree of diagnostic certainty, encoded as: confirmed, probable or non-classifiable. Analysed parameters, presented with their 95% confidence intervals using a Poisson model, were the following: time and age at diagnosis, proportions of crude and standardized RD prevalence by age, gender and geographical site. The criteria studied were the proportions of patients in Paris Region and the "included cases geography", in which these proportions were projected onto the other French Regions, adjusting for local populations.Results: In Paris Region, estimated prevalence of these diseases was 5.58 per 10,000 inhabitants (95% CI 4.3-7.1). At December 31st 2015, 11,342 patients were referenced in total in France, of whom 7294 were in Paris Region. More than 580 individual clinical entities (ORPHA code) were identified with their respective frequencies. Most abnormalities were diagnosed antenatally. Nearly 80% of patients recorded come to Paris hospitals to obtain either diagnosis, care or follow up. We observed that the rarer the disease, the more patients were referred to Paris hospitals. Conclusions:A health network covering a range of aspects of the rare diseases problematic from diagnostics to research has been developed in France. Despite this, there is still a noticeable imbalance between health care supply and demand in this area.

Consideration of oral health in rare disease expertise centres: a retrospective study on 39 rare diseases using text mining extraction method

“…This is easily explained by the multiplication of hospital stays, the multiplication of practitioners met in hospital, with different knowledge and sensitivity to oral medicine. One hypothesis that may explain this is that patients treated in the AnDDi-Rares and TETECOU have severe craniofacial features and need paediatric surgery very early [ 13 , 14 ]. Indeed, access to a dental care adapted to their rare pathology often appears to be deficient [ 1 , 15 ].…”

10 years of CEMARA database in the AnDDI-Rares network: a unique resource facilitating research and epidemiology in developmental disorders in France

“…The first French RD initiative, CEMARA, has been collecting information on RD epidemiology and related medical activities from RCRD and CERD on a national-level since 2007. To date, the data entered in CEMARA has already been used by some networks for RD [ 18 ]. Other publications have also been facilitated by CEMARA’s infrastructure [ 19 ].…”

“…Interestingly, when compared with the data obtained for the Head and Neck Network, in which nearly 80% of patients are required to visit Paris hospitals to obtain diagnosis, care or follow up [ 18 ], the distribution of RCRD/CERD within the AnDDI-Rares network (Additional file 2 : Figure S1A) has optimized the distance patients must travel to obtain specialist care for RD.…”

Correlation between quality of life and burden of family caregivers of infants with cleft lip and palate

“…Rarer and more complex diseases require more specialist advice. Lack of information about the patient and resource deficits in some centers may have adverse impacts on the patients' quality of life and on the heavy economic and social burden borne by patients and their families (27) .…”