The absence of certain workplace policies, such as paid sick leave, confers a population-attributable risk of 5 million additional cases of ILI in the general population and 1.2 million cases among Hispanics. Federal mandates for sick leave could have significant health impacts by reducing morbidity from ILI, especially in Hispanics.

Previous studies that explored the impact of misspecification of cross-classified data structure as strictly hierarchical are limited to random intercept models. This study examined the effects of misspecification of a two-level, cross-classified, random effect model (CCREM) where both the level-1 intercept and slope were allowed to vary randomly. Results suggest that ignoring one of the crossed factors produced considerably underestimated standard errors for: 1) the regression coefficients of the level-1 predictor; 2) the inappropriately modeled predictor associated with the misspecified crossed factor; and 3) and their interaction. This misspecification also resulted in a significant inflation of the level-1 residual variances and the intercept and slope variance components across the levels of the remaining crossed factor in hierarchical linear model.

Bladder cancer incidence is investigated in the department of Bouches-du-Rhône to provide answers to the population reporting an excess of cancer cases in industrial areas. The study aimed to describe the geographical variations of bladder cancer incidence among men and detect potential spatial clusters without point source specification. Incident cases diagnosed between 2013 and 2016 were extracted from the departmental observatory of cancers REVELA13. Age-standardized incidence ratios (SIRs) were calculated for each commune and bayesian smoothed risk estimate based on the Besag, York and Mollie model were computed for incidence mapping. Morans’I, Potthoff-Whittinghill and Tango statistic tests were used to investigate global clustering and the spatial scan statistic of Kulldorf (SaTScan) was used to investigate local clustering. Analyses were adjusted on a French deprivation index, access to health-care services and population density. During the study period, 1 735 cases of bladder cancers were diagnosed among men. The study found a spatial heterogeneity (p < 0.01) and aggregation (p < 0.01) but no spatial autocorrelation (p = 0.09). Bayesian smoothed SIRs were not related to the confounding factors studied. An over-incidence was observed in the communes located in the South East of the department including Marseille, the biggest city of the study area. SaTScan algorithms detected two significant high-risk clusters in the same area (RR = 1.50 and 1.38). Introduction of each confounding factors in spatial scan detection, changed slightly the shape of clusters and/or the value of the relative risk but not the location. None high-risk cluster was detected in the communes of the industrial area. Spatial analysis provides a first answer to the population concerning an excess of risk of bladder cancer at commune level. However, more analysis should be led to identify etiological factors or common environmental exposure. Key messages Geographic disparities exist in bladder cancer incidence among men at a commune level in the department of Bouches-du-Rhône. Spatial analysis show excess of risk of bladder cancer in the south-east of the department including the urban area of Marseille.

While the incidence of bladder cancer begins to decline in men it increases in women related to tobacco smoking. The study aimed to describe bladder cancer among women in the department of Bouches-du-Rhône and assess their spatial distribution in order to detect potential spatial clusters. Cancer incidence data were obtained from the departmental observatory of cancers REVELA13. The characteristics of the cases registered were compared to those describe at the national level. Age-standardized incidence ratios (SIRs) were calculated for each commune and bayesian smoothed risk estimate based on the Besag, York and Mollie model were computed for incidence mapping. The spatial scan statistic (SaTScan) was used to investigate local cluster. Spatial analyses were adjusted on various confounding factors as a French deprivation index, access to health-care services and population density. During the period 2013-2016, 395 cases of bladder cancers were diagnosed in women. Departmental incidence was significantly higher (3.3 cases per 100.000 inhabitants) than the national incidence (2.3). Compared to men, bladder cancers among women were diagnosed at a more advanced stage of the disease (p < 0.01). SIRs geographical variations were related to access of care but none of the communes showed any significant excess of cases. However, one significant cluster including nine districts of the biggest city (Marseille) and one neighbouring commune (RR = 1.76) was detected in the south east of the department. Spatial studies of bladder cancer in women rarely find over-incidence or clusters due to lack of power. However, this study has shown that geographical disparities exist in particular because of a lesser access to a specialist. Regarding the high prevalence of smoking among women in the south of France, practitioners need to think about bladder cancer in women with urinary signs. Key messages We identify for the first time a cluster of bladder cancers in women in France. Practitioners need to think about bladder cancers in women with urinary signs because this cancer will become a public health issue in the future.