Rita Dévi ROCHEMONT

Non-communicable and chronic diseases, particularly cardiovascular disease, are one of the main causes of mortality. Numerous studies on the prevalence and risk factors of cardiovascular disease have been carried out throughout the world. In French Guyana, the emphasis is often placed on tropical and infectious diseases, in an Amazonian context that is unique to the region and has led to numerous publications in the field. However, the epidemiological transition is already well underway and cardiovascular disease is a major public health problem in French Guyana. Stroke and coronary heart disease are the main causes of premature mortality after accidents. As elsewhere, chronic renal failure is also an emerging public health problem in French Guyana. This French department is complex, with populations of diverse origins, often coming from poor countries and living in difficult conditions, while benefiting from the French healthcare system. However, there are pronounced inequalities in health. Diabetes and arterial hypertension are two major risk factors for cardiovascular complications, and underlie the very high incidence of chronic end-stage renal disease. In order to overcome the lack of data on these health problems in French Guyana, this work proposes to study descriptive and analytical epidemiology using data from the medical information systems programme (PMSI), data from the INDIA multicentre prospective cohort and data from the chronic renal failure register set up by the Agence de Biomédecine. The results of this work could help to optimise access to care and guide screening and therapeutic management in order to reduce the mortality and disability resulting from these diseases. This thesis shows the particular epidemiology of these diseases, with their high incidence and high lethality. It shows that there are social inequalities in health in French Guyana, as there are for other diseases, with the most vulnerable being sick at a younger age, with more serious conditions and higher mortality rates. Hypertension and diabetes are targets for preventive action, with a particular effort needed to reach the most vulnerable.

Non communicable chronic diseases, notably cardiovascular diseases are one of the main causes of death. Numerous studies have studied risk factors throughout the world. In French Guiana, most research themes focus on tropical infectious diseases. However, the epidemiologic transition is well underway, and cardiovascular diseases represent a major public health problem. Hence strokes and coronary syndrome are the main cause of premature death after accidents. As elsewhere, chronic renal failure also represents a rising problem in French Guiana. French Guiana is an overseas French Territory with a large Afro- caribbean population profile in terms of cultural and socioeconomic aspects with a French health system. Despite the universal healthcare system, there are frequent health inequalities. Diabetes and high blood pressure are 2 major risk factors for cardiovascular diseases and for end stage renal failure. In order to alleviate the lack of epidemiologic data, the present work aims to describe the epidemiology of these diseases in French Guiana using different data sources: the hospital's " programme médicalisé des systems d'information (PMSI) ", the data from the INDIA prospective cohort a collaboration between the clinical investigation center in Cayenne and Dijon hospital, and data from the end stage renal disease registry. These results will hopefully help improve access to care, and reduce mortality. The present thesis thus shows the particularities of the epidemiology of these highly incident and fatal diseases. It also shows the importance of health inequalities in French Guiana, as for other diseases, the more vulnerable populations become sick younger, with more severe diseases, and more deaths. Hypertension and diabetes are prime targets for preventive interventions, with special efforts to reach the most vulnerable social groups.