In reliability studies, the goal is to gain knowledge about a product's failure times or life expectancy. Precedence tests do not require large sample sizes and are used in reliability studies to compare the life-time distributions from two samples. Precedence tests are useful since they provide reliable results early in a life-test and the surviving units can be used in other tests. Ng and Balakrishnan (2010) proposed a precedence-type test based on the Kaplan-Meier estimator of the cumulative distribution function. A precedence-type test based on the Nelson-Aalen estimator of the cumulative hazard function has been proposed. This test was developed for both Type-II right censoring and progressive Type-II right censoring. Numerical results, including illustrative examples, critical values and a power study have been provided. The results from this test were compared with those from the test based on the Kaplan-Meier estimator.

In reliability studies, the goal is to gain knowledge about a product's failure times or life expectancy. Precedence tests do not require large sample sizes and are used in reliability studies to compare the life-time distributions from two samples. Precedence tests are useful since they provide reliable results early in a life-test and the surviving units can be used in other tests. Ng and Balakrishnan (2010) proposed a precedence-type test based on the Kaplan-Meier estimator of the cumulative distribution function. A precedence-type test based on the Nelson-Aalen estimator of the cumulative hazard function has been proposed. This test was developed for both Type-II right censoring and progressive Type-II right censoring. Numerical results, including illustrative examples, critical values and a power study have been provided. The results from this test were compared with those from the test based on the Kaplan-Meier estimator.

Resumo: No Brasil, existem poucos estudos sobre longevidade de vacas de corte, principalmente utilizando ferramentas de análise de sobrevivência na estimação de parâmetros genéticos. Todavia, os critérios para avaliar esta característica são vários, tal que em alguns destes nem todos os registros das vacas nos rebanhos podem ser levados em consideração, devido à metodologia de análise utilizada. Uma variável que é de fácil mensuração e já faz parte da maioria dos controles zootécnicos das fazendas é a idade da vaca ao último parto (IVUP). Neste trabalho, objetivo foi avaliar a longevidade das vacas nos rebanhos utilizando a variável IVUP, por meio da metodologia de análise de sobrevivência. Esta variável foi utilizada mediante um critério para analisar a longevidade produtiva de vacas nos rebanhos. O critério adotado foi a diferença entre a data em relação ao último parto de cada vaca e a data do último parto de cada fazenda. Se esta diferença foi superior a 36 meses, a vaca falhou e foi considerada descartada. Caso contrário, esta vaca foi censurada, indicando que esta ainda poderia ter futuras parições. O critério de 36 meses foi proposto por ser período suficiente para a ocorrência de um novo parto. A metodologia de análise de sobrevivência foi utilizada por considerar dados censurados e não censurados. As variáveis: estação e ano de nascimento de cada vaca, a fazenda e a idade ao primeiro parto foram utilizadas para as análises da variável IVUP. Um estudo prévio por meio de curvas de Kaplan-Meier e o modelo de Cox, utilizando a distribuição gama para os touros, desconsiderando o parentesco entre eles, foram realizados. O software Survival Kit foi empregado para estimação dos parâmetros genéticos, levando em consideração o parentesco entre os animais. Verificou-se que a IVUP apresentou herdabilidade de 0,25, e que seu uso permite avaliar a ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: In Brazil, there are few studies about stayability, especially using tools of survival analysis in the estimation of breeding values and heritability. The criteria for evaluating this characteristic are different, such that in some of these not all information in the herds of cows can be taken into consideration, because the method of analysis used. In addition, the definitions that consider the date of disposal of the animal affect the use of information obtained in practice, because until the cows come out of the flock may take years, thus the evaluation of their parents is impaired, since the goal is selection. A variable that is easy to measure and is already part of most controls husbandry farms are cow age at last birth (IVUP). This variable was used by one criterion to analyze the productive longevity of cows in herds. The criterion was the difference between the date from the last delivery date of each cow and the last part of each farm. If this difference was more than 36 months, the cow was considered failed and discarded. Otherwise, this cow was censored, indicating that this could still have further parities. The criterion of 36 months was proposed to be sufficient time for the occurrence of a new birth. The methodology of survival analysis was used. The variables season and year of birth of each cow, farm and age at first birth were used for analysis of variable IVUP. The objective of this study was to evaluate the performance of the variable IVUP through estimates of genetic and fixed effect, to study the longevity of cows in the herd. A previous study by Kaplan-Meier and Cox model using the gamma distribution for the bulls, disregarding the relationship between them, were performed. The Survival Kit software was used to estimate the genetic parameters, taking into account the relationship between the animals. It was found that the heritability of 0.25 for IVUP ... (Complete abstract click electronic access below) / Orientador: Danísio Prado Munari / Coorientador: Claudia Cristina Paro da Paz / Coorientador: Raysildo Barbosa Lobo / Banca: João Ademir de Oliveira / Banca: Henrique Nunes De Oliveira / Banca: Roberto Carvalheiro / Banca: Lenira El Faro Zadra / Doutor

Os estimadores para parÃmetros populacionais em amostras coletadas pelo mÃtodo de amostragem Respondent Driven Sampling (RDS) sÃo sensÃveis à presenÃa de observaÃÃes ignoradas e tendem a subestimar os parÃmetros populacionais. A ausÃncia de um quadro de amostragem bem definido para a coleta de amostras em populaÃÃes consideradas escondidas e/ou de acesso difÃcil fez com que o RDS se tornasse uma importante ferramenta de vigilÃncia comportamental e biolÃgica nessas populaÃÃes com maior risco para o HIV, em especial no Brasil. Considerado um mÃtodo de amostragem em cadeia de referÃncia, o RDS utiliza informaÃÃes sobre as conexÃes das redes sociais para obter estimadores contingentes assintoticamente imparciais das caracterÃsticas populacionais e a precisÃo desses estimadores. Estudo multicÃntrico de corte transversal para vigilÃncia epidemiolÃgica e comportamental em populaÃÃes de HSH com 18 anos ou mais foi realizado em dez cidades brasileiras (Manaus, Recife, Salvador, Campo Grande, BrasÃlia, Curitiba, ItajaÃ, Santos, Belo Horizonte e Rio de Janeiro) no ano de 2009 e, coleta, em cada municÃpio, uma amostra pelo RDS. Neste estudo, foi oferecido o teste rÃpido para diagnÃstico da infecÃÃo por HIV Ãqueles que aceitam participar de um prÃ-aconselhamento. Todos os participantes foram inquiridos sobre a realizaÃÃo de testes anti-HIV anteriores ao da pesquisa e sobre qual o diagnÃstico obtido. Com a simulaÃÃo de uma variÃvel dicotÃmica (exemplo: sorologia para HIV positiva ou negativa) sem observaÃÃes ignoradas na rede de recrutamento do Rio de Janeiro e posteriores exclusÃes de 18 recrutados, encontra-se que, a amostra com ignorados à avaliada com base em um nÃmero de observaÃÃes significativamente menor que o da amostra original e o parÃmetro em questÃo (prevalÃncia do HIV) à subestimado. Ainda, com a imputaÃÃo Ãnica das sorologias ignoradas, no contexto descritivo, observam-se, nas amostras com imputaÃÃo, marcadores biolÃgicos que indicam valores mais acurados. No estudo multicÃntrico, para o grupo de participantes que autorrelatou sorologia positiva ou negativa para o HIV e realizou teste rÃpido na pesquisa, observa-se para os autorrelatos elevada concordÃncia (0,88) e sensibilidade de 100% com o padrÃo-ouro teste rÃpido para diagnÃstico do HIV. Finalmente, estimando a prevalÃncia para o HIV nas amostras observadas por municÃpio e geral, e, com a proposta da imputaÃÃo pelo autorrelato do HIV positivo e posterior atribuiÃÃo de sorologia HIV +/- mediante trÃs propostas de imputaÃÃes: todos sÃo negativos, proximidade dos participantes na rede de recrutamento e pela regressÃo logÃstica. Encontra-se nas amostras coletadas a estimativa geral da prevalÃncia do HIV igual a 11,1% sendo, por municÃpio, a menor prevalÃncia em Santos (2,6%) e a maior no Rio de Janeiro (17,6%). Com as imputaÃÃes as prevalÃncias tendem a aumentar e as maiores estimativas sÃo encontradas com a imputaÃÃo por meio da regressÃo logÃstica em sete de nove municÃpios avaliados por essa metodologia. A estimativa geral do HIV pela regressÃo logÃstica à 14,2% sendo, por municÃpio, a menor prevalÃncia no Recife (5,2%) e a maior em BrasÃlia (23,7%). A imputaÃÃo da sorologia de infecÃÃo por HIV pela regressÃo logÃstica ocorre por municÃpio e por intermÃdio de um modelo com acurÃcia mÃnima igual a 70%. / The estimators for population parameters in samples collected by sampling Respondent Driven Sampling (RDS) are sensitive to the presence of observations ignored and tends to underestimate the population parameters. The absence of a clearly defined sampling frame for the collection of samples from populations considered hidden and/or difficult access made the RDS became an important tool for biological and behavioral surveillance in these populations at higher risk for HIV, especially Brazil. Considered a method of sampling in the reference chain, RDS uses information about the connections of social networks for specific asymptotically unbiased estimators of population characteristics and accuracy of these estimators. Multicenter cross-sectional epidemiological and behavioral surveillance for MSM populations in 18 years or more was conducted in 10 cities (Manaus, Recife, Salvador, Campo Grande, Brasilia, Curitiba, ItajaÃ, Santos, Belo Horizonte and Rio de Janeiro) in 2009 and collected in each municipality, a sample through RDS. This study offered the rapid test for diagnosis of HIV infection to those who agreed to participate in a pre-counseling. All participants were asked about testing for HIV prior to the research and about which the diagnosis obtained. By simulating a dichotomous variable (eg, HIV serology positive or negative) without comment ignored in recruiting network in Rio de Janeiro and later recruited 18 deletions, that is, the unknown sample is evaluated from a number of observations significantly smaller than the original sample and the parameter in question (HIV prevalence) is underestimated. Still, with the allocation of single serology ignored in the descriptive context, it is observed in samples with attribution, biological markers indicating that more accurate values. Multicentre study for the group of participants who self-reported positive or negative serology for HIV rapid test and performed the research notes to self-reports, high correlation (0.88) and 100% sensitivity with gold standard rapid test for HIV diagnosis. Finally, estimating the prevalence of HIV in the samples observed by county and general, and the proposed allocation of the self-reported HIV positive and HIV serology subsequent assignment of + / - through three proposed charges: are all negative, proximity of the participants in the network recruitment and by logistic regression. It is found in samples collected from the estimated overall HIV prevalence was equal to 11.1%, by municipality, the lower prevalence in Santos (2.6%) and highest in Rio de Janeiro (17.6%).With the charges tend to increase the prevalence and the highest estimates are found with the imputation logistic regression in 7 of 9 municipalities assessed by this methodology. The estimated overall HIV logistic regression is 14.2% and, by municipality, the lower prevalence in Recife (5.2%) and highest in Brasilia (23.7%). The allocation of serology for HIV by the Logistic Regression occurs by municipality and by a model with a minimum accuracy of 70%.

The Birnbaum-Saunders (BS) distribution is a positively skewed distribution and is a popular model for analyzing lifetime data. In this thesis, we first develop an improved method of estimation for the BS distribution and the corresponding inference. Compared to the maximum likelihood estimators (MLEs) and the modified moment estimators (MMEs), the proposed method results in estimators with smaller bias, but having the same mean squared errors (MSEs) as these two estimators. Next, the existence and uniqueness of the MLEs of the parameters of BS distribution are discussed based on Type-I, Type-II and hybrid censored samples. In the case of five-parameter bivariate Birnbaum-Saunders (BVBS) distribution, we use the distributional relationship between the bivariate normal and BVBS distributions to propose a simple and efficient method of estimation based on Type-II censored samples. Regression analysis is commonly used in the analysis of life-test data when some covariates are involved. For this reason, we consider the regression problem based on BS and BVBS distributions and develop the associated inferential methods. One may generalize the BS distribution by using Laplace kernel in place of the normal kernel, referred to as the Laplace BS (LBS) distribution, and it is one of the generalized Birnbaum-Saunders (GBS) distributions. Since the LBS distribution has a close relationship with the Laplace distribution, it becomes necessary to first carry out a detailed study of inference for the Laplace distribution before studying the LBS distribution. Several inferential results have been developed in the literature for the Laplace distribution based on complete samples. However, research on Type-II censored samples is somewhat scarce and in fact there is no work on Type-I censoring. For this reason, we first start with MLEs of the location and scale parameters of Laplace distribution based on Type-II and Type-I censored samples. In the case of Type-II censoring, we derive the exact joint and marginal moment generating functions (MGF) of the MLEs. Then, using these expressions, we derive the exact conditional marginal and joint density functions of the MLEs and utilize them to develop exact confidence intervals (CIs) for some life parameters of interest. In the case of Type-I censoring, we first derive explicit expressions for the MLEs of the parameters, and then derive the exact conditional joint and marginal MGFs and use them to derive the exact conditional marginal and joint density functions of the MLEs. These densities are used in turn to develop marginal and joint CIs for some quantities of interest. Finally, we consider the LBS distribution and formally show the different kinds of shapes of the probability density function (PDF) and the hazard function. We then derive the MLEs of the parameters and prove that they always exist and are unique. Next, we propose the MMEs, which can be used as initial values in the numerical computation of the MLEs. We also discuss the interval estimation of parameters. / Thesis / Doctor of Science (PhD)

Indiana University-Purdue University Indianapolis (IUPUI) / Introduction: The prevalence of diabetes mellitus (DM) is rapidly increasing among the aging United States population. This poses a challenge to dental providers since DM and multiple oral conditions have been identified as comorbidities. Hypertension (HTN) is associated with more poorly controlled DM and has been identified as contributing to RCT tooth loss in prior studies. Links have also been established between DM and the survival rate of root canal treated teeth, however, previous research has focused on institutional settings despite the majority of RCT being performed in private dental practices. This study will use data from private dental practices to evaluate the survival rate of RCT teeth in patients with DM and HTN. Materials and Methods: This retrospective study evaluated the survival rate of endodontic treated teeth among patients with DM and HTN using National Dental PBRN Practice data. Electronic dental records from 42 private dental practices in the United States over a period of 15 years with a minimum 2-year follow-up comprising 11,532 root canal treated teeth were analyzed. Kaplan-Meier survival curves were used to demonstrate the effects of HTN and DM on RCT tooth survival and Cox proportional hazards survival analysis was used to evaluate the DM and HTN effects after accounting for age, gender, insurance, year of treatment, tooth type, and crown and filling placement as covariates. Results: Patients with HTN only had significantly lower risk of failure than patients with both HTN and DM (p=0.003). Patients with neither HTN nor DM had significantly lower risk of failure than patients with both HTN and DM (p=0.020). Patients with DM only did not have significantly different risk of failure than patients with both HTN and DM (p=0.223). Patients with DM only did not have significantly different risk of failure than patients with HTN only (p=0.361). Patients with neither HTN nor DM did not have significantly different risk of failure than patients with HTN only (p=0.121) or patients with DM only (p=0.800). Conclusions: Patients with both DM and HTN have an increased chance of root canal treated tooth failure while patients with only DM or only HTN do not. Evaluation of severity of DM may be more important in determining RCT failure and studies utilizing laboratory values should be considered for future research.

對於生存時間的資料而言，通常我們所想要研究瞭解的是，至少存活到某特定時間點的機率，而這個機率亦即生存分析中的生存函數(survival function)。當有兩個不同的母體存在時，為了要知道這兩個母體的生存函數是否相同，在統計方法上，我們將進行一些檢定，常用的有Gehan-Wilcoxon和Cox-Mantel之兩樣本檢定，後來又有修飾型的Kolmogorov-Smirnov檢定。但是，前兩種檢定方法，只對此兩組生存函數呈現某特殊型式時，具有好的檢定力。因此，透過一些實證的研究，將上述檢定方法做有系統的整理，進而發展出一套簡單又有效率的檢定程序。再者，若檢定得此兩個母體之生存函數不相等時，如何利用Bootstrap方法，進一步對兩組生存函數之特定生存機率點或生存時間點所分別對應之生存時間或生存機率差距做推論與比較，本文將有詳細她說明；以提供研究人員更多有效的資訊，不再僅止於檢定虛無假設是否拒絕而已。最後，我們又藉由推廣上述Bootstrap方法，將其運用到檢定方法上，而另外發展出一種新的兩母體生存函數之檢定方法。 / When two different populations exist, we will take some tests by Cehan-Wilcoxon, Cox-Mantel or Modified Kolmogorov- Smirnov in satistical way. Therefore we develope a simple and efficient test process from arranging above test ways system- atically through some real study. How to use Bootstrap way to infer the difference of survival time or survival probability of specular point. We infer Bootstrap way on test work and then develope a new two populations survival function test way.

Made available in DSpace on 2014-07-22T13:16:48Z (GMT). No. of bitstreams: 2 Regina Elizabeth Müller.pdf: 4161979 bytes, checksum: 5df884fdb04b617145c35c1741e9b502 (MD5) license.txt: 1914 bytes, checksum: 7d48279ffeed55da8dfe2f8e81f3b81f (MD5) Previous issue date: 2011 / Fundação Oswaldo Cruz. Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira. Rio de Janeiro, RJ, Brasil. / Introdução: A cardiopatia reumática persiste como a principal doença cardiovascular adquirida em crianças e adultos jovens em todo o mundo, sendo responsável por altas taxas de morbimortalidade e evoluindo com frequência para a necessidade de cirurgia cardíaca valvar em pacientes na fase aguda ou crônica da doença. Objetivo: Estimar os fatores associados e o tempo desde o diagnóstico até a cirurgia cardíaca valvar em crianças e adolescentes portadores de cardiopatia reumática, em um centro cardiológico de referência terciária no Rio de Janeiro. Material e Métodos: estudo observacional longitudinal de base hospitalar, utilizando metodologia de análise de sobrevivência, para estimativa do tempo até a cirurgia, e modelo de regressão de Cox, para avaliar as razões de risco associadas segundo as covariáveis. A coorte foi composta por pacientes com 3 a 20 anos, cadastrados no Instituto Nacional de Cardiologia no Rio de Janeiro entre julho de 1986 e junho de 2006 e acompanhados até setembro de 2011. O diagnóstico da lesão valvar foi confirmado pelo exame Doppler-ecocardiográfico. As covariáveis, avaliadas no início do acompanhamento, foram reunidas em três dimensões: sociodemográfica (sexo, grupo etário, cor da pele, região de moradia e década do diagnóstico); clínica (apresentação clínica, classe funcional, número de surtos anteriores, profilaxia secundária, endocardite infecciosa e fibrilação atrial); e ecocardiográfica (lesão valvar por tipo e gravidade; diâmetro do átrio esquerdo, diâmetro sistólico do ventrículo esquerdo, função ventricular esquerda, hipertensão arterial pulmonar, e ruptura de cordoalha mitral). O banco de dados foi elaborado com o programa ACCESS 2000 e a análise estatística foi realizada pelo programa R versão 2.13.1. Foi considerado significativo o valor de - 0,05. Resultados: a coorte foi composta por 348 pacientes, 58% do sexo feminino, com idade mediana ao cadastro de 12,5 anos, e de 21,5 anos ao final do acompanhamento. O tempo médio de seguimento foi de 9,0 anos (2-21 anos). O evento cirurgia cardíaca ocorreu em 39% da amostra, com tempo mediano até a cirurgia de 22,3 anos. Na análise univariada todas as covariáveis das três dimensões (socioedemográfica, clínica e ecocardiográfica) apresentaram significância estatística e risco para realização de cirurgia cardíaca (hazard ratio>1), com exceção apenas da covariável região de moradia (p>0,5). Na análise multivariada, o modelo final incluiu as variáveis: década do diagnóstico, classe funcional, número de surtos anteriores, endocardite infecciosa, lesão valvar por tipo e gravidade, diâmetro do átrio esquerdo, diâmetro sistólico do ventrículo esquerdo e ruptura de cordoalha mitral. Conclusões: A realização da cirurgia cardíaca em pacientes com cardiopatia reumática está associada a fatores sociodemográficos, clínicos e ecocardiográficos. / Introduction: Rheumatic heart disease remains as the most common acquired heart disease in children and young adults all over the world, being responsible for high mortality and morbidity rates and often demanding valve surgery in the acute or chronic phase of the disease. Objective: To estimate the time from diagnosis until valve operation and the associated factors in children and young adults with rheumatic heart disease followed up in a tertiary center for cardiovascular care in Rio de Janeiro. Methods – It is a longitudinal observational study of a hospital based population, using survival analysis methodology for time estimation and Cox regression model for hazard risk evaluation of associated variables. Cohort was composed by 3 to 20 years old patients, registered in the National Institute of Cardiology (Instituto Nacional de Cardiologia), in Rio de Janeiro, between July 1986 and June 2006, and followed up until September 2011. Valve disease diagnosis was confirmed through Doppler echocardiography examination. Variables were evaluated at the patient´s first visit and separated in three dimensions: socio demographic (gender, age group, skin color, residence region, decade of diagnosis); clinic (disease status at presentation, functional class, number of previous rheumatic episodes, secondary prophylaxis, infectious endocarditis, atrial fibrillation); echocardiographic (valve lesion and severity, left atrium diameter, systolic left ventricle diameter, left ventricle function, pulmonary hypertension, rupture of mitral chordae). The database wasbased on the program ACCESS 2000 and statistical analysis was performed using the R Program version 2.13.1. For statistical analysis was considered as significant values for  value 0.05. Results – 348 patients were included in the cohort, 58% female. Median age at the register was 12.5 years, and 21.5 years at the end of follow up. Median follow-up time was 9.0 years (2 to 21 years). 39% underwent valve operation and the median time until surgery was 22.3 years. In the univariate analysis all the variables from the three dimensions (socio demographic, clinic and echocardiographic) presented statistical significance as hazard risk in predicting valve operation (hazard ratio>1), with only one exception, that was residence region (p>0.5). In the multivariate analysis the final model included the following variables: decade of diagnosis, functional class, number of anterior rheumatic episodes, infectious endocarditis, valve lesion and severity, left atrium diameter, systolic left ventricle diameter and rupture of mitral chordate. Conclusions: Valve surgery in patients with rheumatic heart disease is associated with socio demographic, clinic and echocardiographic factors.

Dans cette thèse, nous étudions des modèles définis par des équations de moments conditionnels. Une grande partie de modèles statistiques (régressions, régressions quantiles, modèles de transformations, modèles à variables instrumentales, etc.) peuvent se définir sous cette forme. Nous nous intéressons au cas des modèles avec un paramètre à estimer de dimension finie, ainsi qu’au cas des modèles semi paramétriques nécessitant l’estimation d’un paramètre de dimension finie et d’un paramètre de dimension infinie. Dans la classe des modèles semi paramétriques étudiés, nous nous concentrons sur les modèles à direction révélatrice unique qui réalisent un compromis entre une modélisation paramétrique simple et précise, mais trop rigide et donc exposée à une erreur de modèle, et l’estimation non paramétrique, très flexible mais souffrant du fléau de la dimension. En particulier, nous étudions ces modèles semi paramétriques en présence de censure aléatoire. Le fil conducteur de notre étude est un contraste sous la forme d’une U-statistique, qui permet d’estimer les paramètres inconnus dans des modèles généraux. / In this dissertation we study statistical models defined by condition estimating equations. Many statistical models could be stated under this form (mean regression, quantile regression, transformation models, instrumental variable models, etc.). We consider models with finite dimensional unknown parameter, as well as semiparametric models involving an additional infinite dimensional parameter. In the latter case, we focus on single-index models that realize an appealing compromise between parametric specifications, simple and leading to accurate estimates, but too restrictive and likely misspecified, and the nonparametric approaches, flexible but suffering from the curse of dimensionality. In particular, we study the single-index models in the presence of random censoring. The guiding line of our study is a U-statistics which allows to estimate the unknown parameters in a wide spectrum of models.

Le cancer du sein est actuellement dans les pays occidentaux le premier cancer chez la femme, en termes d’incidence et de mortalité (taux standardisés de 101,5 et 17.7 pour 100 000 personnes années en 2005 respectivement). De très nombreux facteurs de risque et facteurs pronostiques sont déjà connus et étudiés, plusieurs axes de recherche sont développés sur toutes les étapes de la maladie, mais l’influence des facteurs socio-économiques et géographiques, aux niveaux individuel et environnemental n’avait pas encore été étudiée en France sur le cancer du sein.L’objectif général de ce travail était d’explorer cette influence par différents moyens afin d’en tirer des connaissances et une application pratique dans la prévention du cancer du sein, qu’elle soit primaire, secondaire ou tertiaire.Dans notre première étude nous avons montré que les femmes d’un niveau socio-éducatif faible étaient moins à même d’avoir bénéficié d’au moins une mammographie dans les 6 ans ou d’au moins un suivi gynécologique dans les 3 ans précédant leur diagnostic de cancer du sein. Egalement elles ont un stade de diagnostic plus avancé que les femmes de niveau socio-éducatif plus élevé. Ces variables sont ensuite retrouvées comme facteurs pronostiques péjoratifs de la survie. Dans notre seconde étude nous avons montré que l’accès à un chirurgien spécialisé dans les interventions du cancer du sein, gage d’une meilleure survie, était influencé par le niveau socio-économique du lieu de résidence de la patiente, ainsi que par son éloignement géographique par rapport aux centres de traitement de référence du cancer, où travaillent les chirurgiens spécialisés. Dans notre troisième étude nous avons montré qu’à l’inverse de nombre de cancers, l’incidence du cancer du sein était plus élevée dans les zones socio-économiquement plus favorisées, et ce quelle que soit la classe d’âge de la patiente, phénomène pour lequel nous n’avons pas vraiment d’explication, surtout pour les femmes les plus jeunes. Enfin dans notre quatrième étude actuellement en cours, nous avons pour objectif d’étudier au niveau individuel, conjointement avec le nouvel indice de défavorisation européen adapté à la France, en quoi le degré de richesse économique et sociale et la proximité des services médicaux des patientes atteintes de cancer du sein joue sur le stade de la tumeur, l’accès et les modalités de traitement, et la survie. / In developed countries, breast cancer is currently the leading cancer in women in terms of incidence and mortality (standardized rate of 101.5 and 17.7 per 100,000 person-years in 2005, respectively). Many risk factors and prognostic factors have been studied and are well known. Research is under way with regard to every step in the development of breast cancer, but the impact of socio-economic and geographic factors, at the individual and environmental level with regard to the disease have never been studied in France.The general aim of this work was to explore the impact of these factors in different ways to build on our knowledge and to develop practical applications in the primary, secondary or tertiary prevention of breast cancer.In our first study, we showed that women with a low socio-educational level were less likely to have benefited from at least one mammography within the 6 years or at least one gynaecological consultation within the 3 years before the diagnosis of breast cancer. These women also had a more advanced tumour at diagnosis than did women with a higher socio-educational level. These variables also came to light as predictors of a poor prognosis in terms of survival. In our second study, we showed that access to a surgeon specialised in breast cancer surgery, which is associated with better survival, was influenced by the socio-economic level of the patient’s place of residence, as well as the distance between the patient’s home and reference centres for cancer treatment, where the specialised surgeons work. In our third study, we showed that in contrast to many cancers, the incidence of breast cancer was highest in the most socio-economically privileged areas, and this whatever the age of the patient. We have no explanation for this phenomenon, particularly with regard to the youngest age group of women. Finally, the aim of our fourth study, which is currently on-going, is to study at the individual level, using the new European deprivation index adapted to France, to what extent economic wealth and social standing, as well as the proximity of medical services for patients with breast cancer have an impact on tumour stage, access to treatment, treatment techniques and survival.