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A new efficient method to monitor precocious puberty nationwide in France


Clinical precocious puberty (PP) is a disease, reputed to be on the increase and suspected to be linked to endocrine disrupting chemicals (EDC) exposure. Population-based epidemiological data are lacking in France and scarce elsewhere. We accessed the feasibility of monitoring PP nationwide in France in this context, using a nationwide existing database, the French National Health Insurance Information System. Here, we present the method we used with a step-by-step approach to build and select the most suitable indicator. We built three indicators reflecting the incidence of idiopathic central precocious puberty (ICPP), the most frequent form of PP, and we compared these indicators according to their strengths and weaknesses with respect to surveillance purposes.

Conclusion: Monitoring ICPP in France proved feasible using a Drug reimbursement indicator. Our method is cost efficient and highly relevant in public health surveillance. Our step-by-step approach proved helpful to achieve this project and could be proposed for assessing the feasibility of monitoring health outcomes of interest using existing data bases.

What is known:
Precocious puberty (PP) is suspected to be related to EDC exposure and it is believed to be on the increase in France and in others countries.
Very few epidemiologic data on PP are currently available in the world at the national scale.
What is new:
This is the first study describing a method to monitor the most frequent form of PP, idiopathic central PP (ICPP) nationwide in a cost-efficient way, using health insurance databases.
This cost-effective method will allow to estimate and monitor the incidence of ICPP in France and to analyze spatial variations at a very precise scale, which will be very useful to examine the role of environmental exposures, especially to EDCs.

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Central nervous system


Central precocious puberty


Endocrine disrupting chemicals


Gonadotropin-releasing hormone


International Classification of Disease


Idiopathic central precocious puberty


Long-term disease


Precocious puberty


Peripheral precocious puberty


Predictive positive value


French National Health Insurance Information System


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The authors are grateful to Agnès Lefranc, Nathalie Velly, Javier Nicolau, Marjorie Boussac, and Edwige Bertrand for their specific help.


No specific funding was sought for this study. It was fully funded by Santé publique France. Access to the SNIIRAM databases received authorizations from the institute of health data (Institut des données de santé) and the French data protection authority (Commission nationale de l’informatique et des libertés). The first author was habilitated by Santé publique France to access the data.

Author information

AR and JLM contributed to the design of the study. JL and JCC provided medical expertise and ALT statistical expertise. AR extracted and analyzed the data. JLM provided medical and environmental expertise and AR administrative database expertise. Both drafted the manuscript. All authors approved the final version submitted.

Correspondence to Annabel Rigou.

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The authors declare that they have no conflict of interest.

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Communicated by Mario Bianchetti

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Rigou, A., Le Moal, J., Léger, J. et al. A new efficient method to monitor precocious puberty nationwide in France. Eur J Pediatr 177, 251–255 (2018). https://doi.org/10.1007/s00431-017-3012-y

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  • Precocious puberty
  • Environmental health
  • Child health
  • Epidemiological methods
  • Surveillance
  • EDC