Theme 3: Socio-territorial inequalities and chronic diseases

Our group is interested in these various impacts, focusing on the vulnerabilities that chronic diseases can represent, particularly chronic kidney disease, at all stages up to dialysis and transplantation.

Chronic kidney disease is on the rise due to an aging population, an increase in other chronic diseases such as diabetes and cardiovascular disease, and environmental factors that have not been studied extensively. In 2023, they ranked ninth in terms of mortality from noncommunicable diseases, and projections place them fifth in 2040 (Foreman Lancet 2018).

These diseases, such as diabetes and cardiovascular disease, are particularly common in socially disadvantaged populations and are steadily increasing in countries in the Global South.

These diseases require chronic treatment, which can be expensive and inaccessible to some, but also exposes patients to potentially serious side effects, particularly in cases of co-medication and/or heat waves.

The cost of treating kidney failure through dialysis or transplantation is skyrocketing, making these treatments inaccessible to the most vulnerable patients in certain countries and placing a heavy burden on social security budgets (more than $4.5 billion per year for 100,000 patients with kidney failure in France). Finally, these treatments, particularly dialysis, are very energy-intensive and have a significant environmental impact, which must be taken into account in order to find solutions to reduce this impact.

Our group is therefore interested in the individual or combined effects of these diseases, social status and/or health literacy, medications, and climatic events.

This work is based on clinical data from local or regional databases (eHOP), national databases (SNDS, ABM’s REIN registry), or qualitative and/or quantitative clinical studies. Collaborative work with organizations such as the ABM (Agence de la Biomédecine), the CNAM (Caisse Nationale d’Assurance Maladie) or learned societies such as the SFNDT (Société Francophone de Néphrologie, Dialyse et Transplantation) will also enable us to target specific populations.

The aim of this work is to assist in the drafting and implementation of clinical and organizational recommendations for healthcare professionals and health policymakers.

• Care pathways for chronic kidney patients undergoing dialysis or transplantation and vulnerability to heat waves and air pollution
• Impact of health literacy on therapeutic education for solid organ transplant patients
• Calculation of the carbon cost of drugs and transportation for chronic dialysis patients
• Impact of in utero exposure to immunosuppressive drugs on the health of the unborn child and the developing adult (funded by the SFNDT Epidemiology and Public Health Commission)
• Evaluation of the arrival of SGLT2 inhibitors in SNDS data: monitoring of medical recommendations, adverse effects, and impact of heat waves

• Adaptation of treatments in the event of heat waves and co-medications.
• Adaptation of therapeutic education according to health literacy levels.
• Recommendations for adapting medications and transportation for dialysis patients to reduce carbon costs (collaboration with the SFNDT’s “green nephrology” working group).
• Recommendations for monitoring pregnancies and children after in utero exposure to medications

These projects are carried out in collaboration with all the researchers in the team and from different areas of focus, requiring a multidisciplinary approach involving multiple clinical, epidemiological, sociological, quantitative, and qualitative approaches.

Strong collaborations with the Arenes team at EHESP have long existed with members of the team and are also necessary for the successful completion of these projects.