Cluster analysis of social and environment inequalities of infant mortality. A spatial study in small areas revealed by local disease mapping in France.

Cindy Padilla 1, 2, 3, * Severine Deguen 2 Benoit Lalloue 1, 2, 4 Olivier Blanchard 1, 2 Charles Beaugard 5 Florence Troude 5 Denis Zmirou Navier 2 Verónica Vieira 6
* Auteur correspondant
1 EHESP - École des Hautes Études en Santé Publique [EHESP]
2 Irset - Institut de recherche, santé, environnement et travail
3 ADEME
4 IECL - Institut Élie Cartan de Lorraine
5 AASQA - Association agréée Surveillance Qualité de l'air
6 Department of Environmental Health
Abstract : Mapping spatial distributions of disease occurrence can serve as a useful tool for identifying exposures of public health concern. Infant mortality is an important indicator of the health status of a population. Recent literature suggests that neighborhood deprivation status can modify the effect of air pollution on preterm delivery, a known risk factor for infant mortality. We investigated the effect of neighborhood social deprivation on the association between exposure to ambient air NO2 and infant mortality in the Lille and Lyon metropolitan areas, north and center of France, respectively, between 2002 and 2009. We conducted an ecological study using a neighborhood deprivation index estimated at the French census block from the 2006 census data. Infant mortality data were collected from local councils and geocoded using the address of residence. We generated maps using generalized additive models, smoothing on longitude and latitude while adjusting for covariates. We used permutation tests to examine the overall importance of location in the model and identify areas of increased and decreased risk. The average death rate was 4.2‰ and 4.6‰ live births for the Lille and Lyon metropolitan areas during the period. We found evidence of statistically significant precise clusters of elevated infant mortality for Lille and an east-west gradient of infant mortality risk for Lyon. Exposure to NO2 did not explain the spatial relationship. The Lille MA, socioeconomic deprivation index explained the spatial variation observed. These techniques provide evidence of clusters of significantly elevated infant mortality risk in relation with the neighborhood socioeconomic status. This method could be used for public policy management to determine priority areas for interventions. Moreover, taking into account the relationship between social and environmental exposure may help identify areas with cumulative inequalities.
Keywords : Deprivation index Infant mortality Small areas Generalized additive models Air pollution
Type de document :
Article dans une revue
Science of the Total Environment, Elsevier, 2013, 454-455, pp.433-441. 〈10.1016/j.scitotenv.2013.03.027〉
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http://www.hal.inserm.fr/inserm-00838330
Contributeur : Clémence Martin <>
Soumis le : mardi 25 juin 2013 - 12:22:46
Dernière modification le : mardi 16 octobre 2018 - 15:02:49

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ADEME | IECN | IRSET | BIOSIT | UNIV-LORRAINE | UR1-UFR-SVE | EHESP | USPC | IRSET-9 | UNIV-ANGERS | UNIV-RENNES | IECLPS

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Cindy Padilla, Severine Deguen, Benoit Lalloue, Olivier Blanchard, Charles Beaugard, et al.. Cluster analysis of social and environment inequalities of infant mortality. A spatial study in small areas revealed by local disease mapping in France.. Science of the Total Environment, Elsevier, 2013, 454-455, pp.433-441. 〈10.1016/j.scitotenv.2013.03.027〉. 〈inserm-00838330〉

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