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Article Dans Une Revue Journal of Hepatology Année : 2006

Place of residence and distance to medical care influence the diagnosis of hepatitis C: a population-based study.

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.

Dates et versions

hal-00465338 , version 1 (19-03-2010)

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Elisabeth Monnet, Estelle Collin-Naudet, Solange Bresson-Hadni, Anne Minello, Vincent Di Martino, et al.. Place of residence and distance to medical care influence the diagnosis of hepatitis C: a population-based study.. Journal of Hepatology, 2006, 44 (3), pp.499-506. ⟨10.1016/j.jhep.2005.11.044⟩. ⟨hal-00465338⟩
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