Éditeur(s) : HAL CCSD
Résumé : International audience
Purpose: Social inequalities in cancer incidence and mortality have been reported in France, but no data are available for the French overseas territories. Our objective was to explore the association between cancer incidence and the socioeconomic level of the residence area in the French West Indies. Methods: Cancer incidence data were obtained from the cancer registries of Guadeloupe and Martinique (2009–2010). To assess socioeconomic status, we developed a specific index of social deprivation from census data at a small area level. We used Bayesian methods to evaluate the association between cancer incidence and the deprivation index, for all cancers combined and for the major cancer sites. Results: There was no clear association between area‐based deprivation and the incidence of all cancers combined. In men, higher area deprivation was associated with a higher incidence of prostate cancer (relative risk (RR) 1.25, 95% credible interval (CI) 1.04–1.49; RR 1.08, CI 0.91–1.29 in the categories of intermediate and high deprivation, respectively, compared to low deprivation), but was not associated with respiratory cancer. Women living in the most deprived areas had a higher incidence of stomach (RR 1.77, CI 1.12–2.89), breast (RR 1.15, CI 0.90–1.45), and cervical (RR 1.13, CI 0.63–2.01) cancers and a lower incidence of respiratory cancer (RR 0.65, CI 0.38–1.11). Conclusion: These first results in the French West Indies suggest specific patterns for some cancer sites that need to be further investigated. © 2017, Springer International Publishing AG.
Cancer Causes and Control

hal-01671494
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01671494
DOI : 10.1007/s10552-017-0946-3
PUBMED : 28849411

Éditeur(s) : HAL CCSD Elsevier
Résumé : International audience
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.
ISSN: 0048-9697

inserm-00838330
http://www.hal.inserm.fr/inserm-00838330
DOI : 10.1016/j.scitotenv.2013.03.027
PUBMED : 23563257

Éditeur(s) : HAL CCSD BioMed Central
Résumé : International audience
BACKGROUND: Although widely used, area-based deprivation indices remain sensitive to urban-rural differences as such indices are usually standardised around typical urban values. There is, therefore, a need to determine to what extent available deprivation indices can be used legitimately over both urban and rural areas. METHODS: This study was carried out in Brittany, France, a relatively affluent region that contains deep rural areas. Among the 1,736 residential census block groups (IRIS) composing the Brittany region, 1,005 (57.9%) are rural. Four deprivation indices were calculated: two scores (Carstairs and Townsend) developed in the UK and two more recent French measures (Havard and Rey). Two standardisation levels were considered: all of the IRIS and only the urban IRIS of the region. Internal validity (Kappa coefficients and entropy values) and external validity (relationship with colorectal cancer screening [CCS] attendance) were investigated. RESULTS: Regardless of the deprivation measure used, wealthy areas are mostly clustered in the West and at the outskirts of major towns. Carstairs and Rey scores stand out by all evaluation criteria, capturing both urban and rural deprivation. High levels of agreements were found across standardisation levels (κ = 0.96). The distributions of deprivation scores were balanced across urban and rural areas, and high Shannon entropy values were observed in the capital city (≥0.93). Similar and significant negative trends were observed between CCS attendance and both deprivation indices, independent of the degree of urbanisation. CONCLUSIONS: These results provide support, despite potential sociological objections, for the use of a compromise index that would facilitate comparisons and interpretations across urban and rural locations in public health research.
ISSN: 1476-072X

hal-01063904
https://hal.archives-ouvertes.fr/hal-01063904
https://hal.archives-ouvertes.fr/hal-01063904/document
https://hal.archives-ouvertes.fr/hal-01063904/file/1476-072X-13-22.pdf
PUBMED : 24929662

Éditeur(s) : HAL CCSD
Résumé : Pregnancy is a sensitive and critical period for the development of the child and the health of adults-to-be. The biological and physiological adaptation of the body dealing physical and psychosocial stressors during this period may exert its effects in adulthood (and possibly over several generations). This delayed toxicity presupposes intrinsically the need to study the effects of exposure to environmental risk factors during fetal life using a holistic approach involving risk factors at both the micro (individual characteristics) and the macro level (physical and psycho-social context). Given the heterogeneity of the Breton territory in which this work was conducted, we explored whether the impact of social inequalities and the physical environment (air pollution) on birth outcomes (fetal growth and the risk of prematurity) could be modified according to an urban or rural place of residence. This work was based on data collected as part of the Breton mother-child cohort PELAGIE, which had included 3421 pregnant women between 2002- 2006. The anthropometric parameters and gestational age at birth were measured by medical personnel at delivery. We defined urban and rural areas according to the definition of “urban units” from the National Census Bureau (INSEE). The annual concentrations of air pollution (nitrogen dioxide (NO2)) were estimated using a land-use regression modeled at a 100 m scale and developed as part of an European project. Finally, neighbourhood deprivation was estimated using a composite index developed at census blocks level and whose use was legitimated over both urban and rural areas. Neighbourhood deprivation was associated with an increased risk of infants with fetal growth restriction, only for women living in rural areas. We also observed an increased risk of preterm birth associated with NO2 concentrations > 16.4 μg.m-3, only among women residing in urban areas. The associations between air pollution and fetal growth, although sex-specific, did not seem on the other hand, to vary significantly according to the urban-rural spectrum. This work confirms the need to explore the influence of both social and environmental inequalities on intrauterine development, and to assess the role of place-based factors, such as the urban-rural context, in shaping these inequalities.
La grossesse est une période sensible et déterminante pour le développement de l’enfant et l’état de santé à l’âge adulte. L'adaptation biologique et physiologique de l'organisme face à des « stresseurs » physiques et psychosociaux au cours de cette période peut ainsi exercer ses effets à l'âge adulte (et possiblement sur plusieurs générations). Cette toxicité différée suppose intrinsèquement la nécessité d’étudier les conséquences des expositions environnementales au cours de la vie foetale et ce suivant une approche holistique intégrant autant les facteurs de risque à des niveaux micro (caractéristiques individuelles) et macro (expositions physiques externes et contexte psycho-social). Etant donné l’hétérogénéité du territoire breton dans lequel s’inscrit ce travail de thèse, nous avons cherché à explorer l’impact des inégalités sociales et de l’environnement physique (pollution atmosphérique) sur l’issue de la grossesse (croissance foetale et risque de prématurité) indépendamment chez des femmes enceintes résidant dans des zones urbaines et rurales. Ce travail s’est appuyé sur les données issues de la cohorte bretonne mère-enfant PELAGIE, qui a inclus 3421 femmes enceintes entre 2002- 2006. Les paramètres anthropométriques et l’âge gestationnel à la naissance ont été renseignés à l’accouchement par le personnel médical. Le contexte urbain et rural breton a été caractérisé à partir de la définition des unités urbaines de l’INSEE. Les concentrations annuelles de pollution atmosphérique (dioxyde d’azote (NO2)) ont été modélisées à une échelle de 100 m à partir d’un modèle de "land-use regression" développé à l’échelle européenne. Enfin, le niveau socio-économique des IRIS a été estimé à l’aide d’un indice de désavantage social - construit à partir des données du recensement de l’INSEE et dont la validité et l’adaptabilité à des territoires à la fois urbains et ruraux a été examinée au préalable. Nos résultats suggèrent une influence délétère d’un contexte de vie socioéconomique défavorable sur la croissance intra-utérine, spécifiquement chez les femmes résidant en milieu rural. Nous avons également observé une augmentation du risque de prématurité associée à des niveaux > 16.4 μg.m-3 de NO2 dans l’air, à l’inverse, uniquement chez les femmes résidant dans des zones urbaines. Les associations entre l’exposition à la pollution atmosphérique et les marqueurs de la croissance intra-utérine, bien que sexe-spécifiques, ne semblent en revanche pas varier sensiblement suivant le gradient urbain-rural. Ce travail confirme la nécessité d’évaluer l’influence des inégalités sociales et environnementales sur le développement intra-utérin et de considérer l’importance et le rôle du contexte de vie, notamment urbain-rural, dans la formation de ces inégalités.
https://tel.archives-ouvertes.fr/tel-01308518

NNT : 2015REN1B010
tel-01308518
https://tel.archives-ouvertes.fr/tel-01308518
https://tel.archives-ouvertes.fr/tel-01308518/document
https://tel.archives-ouvertes.fr/tel-01308518/file/BERTIN_M--lanie.pdf

Éditeur(s) : HAL CCSD Springer Verlag
Résumé : International audience
In France, reducing social health inequalities has become an explicit goal of health policies over the past few years, one of its objectives is specifically the reduction of the perinatal mortality rate. This study investigates the association between infant mortality and social deprivation categories at a small area level in the Lille metropolitan area, in the north of France, to identify census blocks where public authorities should prioritize appropriate preventive actions. We used census data to establish a neighbourhood deprivation index whose multiple dimensions encompass socioeconomic characteristics. Infant mortality data were obtained from the Lille metropolitan area municipalities to estimate a death rate at the census tract level. We used Bayesian hierarchical models in order to reduce the extra variability when computing relative risks (RR) and to assess the associations between infant mortality and deprivation. Between 2000 and 2009, 668 cases of infant death occurred in the Lille metropolitan area (4.2 per 1,000 live births). The socioeconomic status is associated with infant mortality, with a clear gradient of risk from the most privileged census blocks to the most deprived ones (RR = 2.62, 95 % confidence interval [1.87; 3.70]). The latter have 24.6 % of families who were single parents and 29.9 % of unemployed people in the labor force versus 8.5 % and 7.7 % in the former. Our study reveals socio-spatial disparities in infant mortality in the Lille metropolitan area and highlights the census blocks most affected by the inequalities. Fine spatial analysis may help inform the design of preventive policies tailored to the characteristics of the local communities.
ISSN: 1092-7875

hal-00876255
https://hal.archives-ouvertes.fr/hal-00876255
DOI : 10.1007/s10995-013-1251-8
PUBMED : 23479336

Éditeur(s) : HAL CCSD Elsevier
Résumé : International audience
Background: While it is known that cancer risk is related to area-level socioeconomic status, the extent to which these inequalities are explained by contextual effects is poorly documented especially for head and neck cancer. Methods: A case-control study, ICARE, included 2415 head and neck cancer cases and 3555 controls recruited between 2001 and 2007 from 10 French regions retrieved from a general cancer registry. Individual socioeconomic status was assessed using marital status, highest educational level and occupational social class. Area-level socioeconomic status was assessed using the French version of the European Deprivation Index (EDI). The relationship between both individual and area-based socioeconomic level and the risk of head and neck cancer was assessed by multilevel analyses. Results: A higher risk for head and neck cancer was found in divorced compared with married individuals (OR = 2.14, 95% CI = 1.78-2.57), for individuals with a basic school-leaving qualification compared with those with higher education (OR = 4.55 95% CI = 3.72-5.57), for manual workers compared with managers (OR = 4.91, 95% CI = 3.92-6.15) and for individuals living in the most deprived areas compared with those living in the most affluent ones (OR = 1.98, 95% CI = 1.64-2.41). The influence of area-level socioeconomic status measured by EDI remained after controlling for individual socioeconomic characteristics (OR = 1.51; 95% confidence interval: 1.23-1.85, p-value = 0.0003). Conclusions: The role of individual socioeconomic status in the risk of head and neck cancer is undeniable, although contextual effects of deprived areas also increase the susceptibility of individuals developing the disease. (C) 2017 Elsevier Ltd. All rights reserved.
ISSN: 1368-8375

hal-01578588
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01578588
DOI : 10.1016/j.oraloncology.2017.06.014
PUBMED : 28688682

Éditeur(s) : HAL CCSD Elsevier
Résumé : International audience
Several studies have documented that more deprived populations tend to live in areas characterized by higher levels of environmental pollution. Yet, time trends and geographic patterns of this disproportionate distribution of environmental burden remain poorly assessed, especially in Europe. We investigated the spatial and temporal relationship between ambient air nitrogen dioxide (NO2) concentrations and socioeconomic and demographic data in four French metropolitan areas (Lille in the North, Lyon in the center, Marseille in the South, and Paris) during two different time periods. The geographical unit used was the census block. The dependent variable was the NO2 annual average concentration (μg/m(3)) per census block, and the explanatory variables were a neighborhood deprivation index and socioeconomic and demographic data derived from the national census. Generalized additive models were used to account for spatial autocorrelation. We found that the strength and direction of the association between deprivation and NO2 estimates varied between cities. In Paris, census blocks with the higher social categories are exposed to higher mean concentrations of NO2. However, in Lille and Marseille, the most deprived census blocks are the most exposed to NO2. In Lyon, the census blocks in the middle social categories were more likely to have higher concentrations than in the lower social categories. Despite a general reduction in NO2 concentrations over the study period in the four metropolitan areas, we found contrasting results in the temporal trend of environmental inequalities. There is clear evidence of city-specific spatial and temporal environmental inequalities that relate to the historical socioeconomic make-up of the cities and its evolution. Hence, general statements about environmental and social inequalities can be made.
ISSN: 0013-9351

hal-01063900
https://hal.archives-ouvertes.fr/hal-01063900
DOI : 10.1016/j.envres.2014.07.017
PUBMED : 25199972

Éditeur(s) : HAL CCSD
Résumé : International audience
To study social health inequalities, contextual data may constitute an appropriate alternative to individual socioeconomic characteristics, often hard to retrieve. Indices can be used to summarize the multiple dimensions of the neighborhood socioeconomic status. The main objectives of this work are to develop a statistical procedure to create a neighborhood socioeconomic index and to investigate the influence of the clustering method of the deprivation index on the measure of health inequalities. Our study setting is composed of three major French metropolitan areas: Lille, Lyon and Marseille. The statistical unit is the French census block. The methodology uses several successive principal components analyses to select variables and create the index. Deprivation categories are drawn with hierarchical clustering on principal components. Twenty socioeconomic variables are selected in the neighborhood deprivation index. An optimal clustering obtained by HC is in three classes and the clusters are ordered along the first axis of the PCA.
SFDS - 44èmes journées de Statistique - 2012
Bruxelles, Belgium

hal-00734769
https://hal.archives-ouvertes.fr/hal-00734769
https://hal.archives-ouvertes.fr/hal-00734769/document
https://hal.archives-ouvertes.fr/hal-00734769/file/submission_44.pdf

Éditeur(s) : HAL CCSD
Résumé : International audience
Radiocarbon dating and "old wood problem" in the Antilles : the state of the artAmong the many effects that may distort the interpretation of radiocarbon dates are those for which the age of the archaeological event is different from the radiocarbon age of the sample or "14C event" age. This type of problem arises in many cases, notably in the "old wood effect”, and occurs in various regions of the world where very long-lived trees species are common. In the Caribbean anthracological studies indicate a very high frequency of some indigenous centuries-old species such as Guaiacum, Guaiacum officinale L. However the absence of tree-ring data in humid tropical zones deprives us of an accurate inventory of long-lived species and especially the assessment of their longevity. Here we present measurements which enable us to estimate the longevity of archaeological Guaiacum wood posts. They highlight a gap of several centuries between wood from the outer edge and the heart of the tree. This example illustrates the additional uncertainty that can result from dating archeological events when dates are realized on unidentified botanical species from which the area that was sampled is unknown. Another source of error could arise from the use of rot-proof dead wood as fuel if we take into consideration that major hurricanes can produce large amounts of dead wood that may be collected for decades, even centuries. To improve chronometric data used in archaeological interpretations, it is necessary to ensure the quality of the dating process by following a protocol similar to those used in other regions of the world based on a better understanding of the material to be dated by preliminary identifications of wood samples: species, anatomical part, wood moisture content (unseasoned or seasoned).
Radiocarbono y "problema madera vieja", que data de las Antillas: estado del arteEntre los muchos efectos que pueden distorsionar la interpretación de fechas de radiocarbono, destacan aquellos para los que la edad de la prueba arqueológica es diferente de la edad de radiocarbono de la muestra, o la edad del "evento de radiocarbono." Este tipo de problema se presenta en muchos casos, especialmente uno llamado "efecto madera vieja." Esto se refleja en diversas regiones del mundo donde las especies de plantas de mucha longevidad son comunes. En el Caribe, los estudios antracológicos disponibles indican una muy alta frecuencia de algunas especies autóctonas como el guayaco, Guaiacum officinale L. Sin embargo, la casi ausencia de datos de anillos de árboles en los trópicos húmedos, nos impide realizar un inventario exacto de especies de mucha longevidad y sobre todo la evaluación de la longevidad. Algunas de las pruebas presentadas aquí permitieron una estimación de la longevidad de de unos postes de guayaco de origen arqueológico. Ponen de manifiesto una brecha de varios siglos entre las partes externas y el corazón del tronco. Este ejemplo ilustra la aparición de una incertidumbre adicional en la datación de los eventos arqueológicos cuando no conocemos la especie botánica y tampoco la zona de la muestra en el árbol. Otra fuente de error puede surgir de la utilización de la madera muerta de calidad duradera como combustible ya que los grandes huracanes pueden producir grandes cantidades de madera muerta, que puede ser requerida durante décadas, incluso siglos. Para mejorar los datos cronométricos utilizados en interpretaciones arqueológicas, es necesario asegurarse de la calidad de las fechas, y por lo tanto seguir un protocolo similar a los utilizados en otras regiones fundado en una mejor comprensión de los elementos: especie, parte anatómica, humedad de la madera usada (verde o seco).
Parmi les nombreux effets susceptibles de fausser l’interprétation des datations par le radiocarbone, figurent ceux pour lesquels l’âge de l’événement archéologique est différent de l’âge radiocarbone de l’échantillon, ou âge de l’« événement radiocarbone ». Ce type de problème se pose dans de nombreux cas, en particulier celui dénommé « effet vieux bois ». Cette question est prise en compte dans diverses régions du monde où des espèces végétales très longévives sont fréquentes. Dans les Antilles les études anthracologiques disponibles indiquent une fréquence très importante de certaines espèces autochtones multiséculaires dont le gaïac, Guaiacum officinale L.. Cependant, la quasi absence de données dendrochronologiques dans la zone tropicale humide, nous privent d’un inventaire précis des espèces longévives et surtout de l’évaluation de leur longévité. Quelques tests présentés ici ont permis une estimation de la longévité de poteaux d’origine archéologique en bois de gaïac. Ils mettent en évidence un décalage de plusieurs siècles entre les parties externes et le cœur du tronc. Cet exemple illustre l’apparition d’une incertitude supplémentaire dans la datation de l’événement archéologique lorsque que l’on ne connaît ni l’espèce botanique ni la zone de prélèvement dans l’arbre. Une autre source d’erreur pourrait provenir de l’utilisation de bois mort de qualité très durable comme combustible, sachant que les grands cyclones peuvent produire d’importantes quantités de bois mort susceptible d’être récolté pendant des décennies, voire des siècles. Afin d’améliorer les données chronologiques utilisées dans les interprétations archéologiques, il apparaît nécessaire de s’assurer de la qualité des datations, et donc de suivre un protocole similaire à ceux utilisés dans d’autres régions basé sur une meilleure connaissance des éléments datés : espèce, partie anatomique, humidité du bois utilisé (vert ou sec).
Puerto Rico 2013 : Actas del 25to Congreso Internacional de Arqueología del Caribe - Proceeding of the 25th International Congress for Caribbean Archeology - Comptes rendus des communications du 25e Congrés International de l'Archéologie de la Caraïbe
San-Juan, Puerto Rico

hal-01198567
https://hal.archives-ouvertes.fr/hal-01198567
https://hal.archives-ouvertes.fr/hal-01198567/document
https://hal.archives-ouvertes.fr/hal-01198567/file/Stouvenot%20et%20al.%202015.%20Effet%20vieux%20bois%20radiocarbone%20Antilles%20HD.pdf

Éditeur(s) : HAL CCSD Public Library of Science
Résumé : International audience
Background We conducted this systematic review and meta-analysis to address the open question of a possible association between the socioeconomic level of the neighborhoods in which pregnant women live and the risk of Congenital Heart Defects (CHDs), Neural Tube Defects (NTDs) and OroFacial Clefts (OFCs). Methods We searched MEDLINE from its inception to December 20th, 2015 for case-control, cohort and ecological studies assessing the association between neighborhood socioeconomic level and the risk of CHDs, NTDs and the specific phenotypes Cleft Lip with or without Cleft Palate (CLP) and Cleft Palate (CP). Study-specific risk estimates were pooled according to random-effect and fixed-effect models. Results Out of 245 references, a total of seven case-control studies, two cohort studies and two ecological studies were assessed in the systematic review; all studies were enrolled in the meta-analysis with the exception of the two cohort studies. No significant association has been revealed between CHDs or NTDs and neighborhood deprivation index. For CLP phenotype subgroups, we found a significantly higher rate in deprived neighborhoods (Odds Ratios (OR) = 1.22, 95% CI: 1.10, 1.36) whereas this was not significant for CP phenotype subgroups (OR = 1.20, 95%CI: 0.89, 1.61). Conclusion In spite of the small number of epidemiological studies included in the present literature review, our findings suggest that neighborhood socioeconomic level where mothers live is associated only with an increased risk of CLP phenotype subgroups. This finding has methodological limitations that impede the formulation of firm conclusions, and further investigations should confirm this association. © 2016 Deguen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
ISSN: 1932-6203

hal-01406070
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01406070
DOI : 10.1371/journal.pone.0159039
PUBMED : 27783616

Éditeur(s) : HAL CCSD Public Library of Science
Résumé : International audience
BACKGROUND: While a great number of papers have been published on the short-term effects of air pollution on mortality, few have tried to assess whether this association varies according to the neighbourhood socioeconomic level and long-term ambient air concentrations measured at the place of residence. We explored the effect modification of 1) socioeconomic status, 2) long-term NO2 ambient air concentrations, and 3) both combined, on the association between short-term exposure to NO2 and all-cause mortality in Paris (France).METHODS: A time-stratified case-crossover analysis was performed to evaluate the effect of short-term NO2 variations on mortality, based on 79,107 deaths having occurred among subjects aged over 35 years, from 2004 to 2009, in the city of Paris. Simple and double interactions were statistically tested in order to analyse effect modification by neighbourhood characteristics on the association between mortality and short-term NO2 exposure. The data was estimated at the census block scale (n=866).RESULTS: The mean of the NO2 concentrations during the five days prior to deaths were associated with an increased risk of all-cause mortality: overall Excess Risk (ER) was 0.94% (95%CI=[0.08;1.80]. A higher risk was revealed for subjects living in the most deprived census blocks in comparison with higher socioeconomic level areas (ER=3.14% (95%CI=[1.41-4.90], p extless0.001). Among these deprived census blocks, excess risk was even higher where long-term average NO2 concentrations were above 55.8 μg/m3 (the top tercile of distribution): ER=4.84% (95%CI=[1.56;8.24], p for interaction=0.02).CONCLUSION: Our results show that people living in census blocks characterized by low socioeconomic status are more vulnerable to air pollution episodes. There is also an indication that people living in these disadvantaged census blocks might experience even higher risk following short-term air pollution episodes, when they are also chronically exposed to higher NO2 levels
ISSN: 1932-6203

hal-01187406
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01187406
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01187406/document
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01187406/file/journal.pone.0131463.PDF
DOI : 10.1371/journal.pone.0131463

Éditeur(s) : HAL CCSD BioMed Central
Résumé : International audience
Background: An environmental health inequality is a major public health concern in Europe. However just few studies take into account a large set of characteristics to analyze this problematic. The aim of this study was to identify and describe how socioeconomic, health accessibility and exposure factors accumulate and interact in small areas in a French urban context, to assess environmental health inequalities related to infant and neonatal mortality.Methods: Environmental indicators on deprivation index, proximity to high-traffic roads, green space, and healthcare accessibility were created using the Geographical Information System. Cases were collected from death certificates in the city hall of each municipality in the Nice metropolitan area. Using the parental addresses, cases were geocoded to their census block of residence. A classification using a Multiple Component Analysis following by a Hierarchical Clustering allow us to characterize the census blocks in terms of level of socioeconomic, environmental and accessibility to healthcare, which are very diverse definition by nature. Relation between infant and neonatal mortality rate and the three environmental patterns which categorize the census blocks after the classification was performed using a standard Poisson regression model for count data after checking the assumption of dispersion.Results: Based on geographic indicators, three environmental patterns were identified. We found environmental inequalities and social health inequalities in Nice metropolitan area. Moreover these inequalities are counterbalance by the close proximity of deprived census blocks to healthcare facilities related to mother and newborn. So therefore we demonstrate no environmental health inequalities related to infant and neonatal mortality.Conclusion: Examination of patterns of social, environmental and in relation with healthcare access is useful to identify census blocks with needs and their effects on health. Similar analyzes could be implemented and considered in other cities or related to other birth outcomes.
ISSN: 1476-069X

halshs-01366285
https://halshs.archives-ouvertes.fr/halshs-01366285
https://halshs.archives-ouvertes.fr/halshs-01366285/document
https://halshs.archives-ouvertes.fr/halshs-01366285/file/art_10.1186_s12940-016-0163-7.pdf
PUBMED : 27449640

Éditeur(s) : HAL CCSD MDPI
Résumé : International audience
Infant and neonatal mortality indicators are known to vary geographically, possibly as a result of socioeconomic and environmental inequalities. To better understand how these factors contribute to spatial and temporal patterns, we conducted a French ecological study comparing two time periods between 2002 and 2009 for three (purposefully distinct) Metropolitan Areas (MAs) and the city of Paris, using the French census block of parental residence as the geographic unit of analysis. We identified areas of excess risk and assessed the role of neighborhood deprivation and average nitrogen dioxide concentrations using generalized additive models to generate maps smoothed on longitude and latitude. Comparison of the two time periods indicated that statistically significant areas of elevated infant and neonatal mortality shifted northwards for the city of Paris, are present only in the earlier time period for Lille MA, only in the later time period for Lyon MA, and decrease over time for Marseille MA. These city-specific geographic patterns in neonatal and infant mortality are largely explained by socioeconomic and environmental inequalities. Spatial analysis can be a useful tool for understanding how risk factors contribute to disparities in health outcomes ranging from infant mortality to infectious disease-a leading cause of infant mortality.
ISSN: 1660-4601

hal-01359563
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01359563
DOI : 10.3390/ijerph13060624
PUBMED : 27338439

Éditeur(s) : HAL CCSD Intech
Résumé : International audience
The socio-economic status (SES) of populations has an influence on the incidence or mortality rates of numerous health outcomes, among which respiratory diseases (Prescott et al., 2003; Ellison-Loschmann et al., 2007). Considering asthma, the possible contribution of SES to overall prevalence –regardless of asthma severity-, remains controversial in industrialized countries. Several studies indicate that allergic asthma is more prevalent in more well-off populations whereas the non-allergic forms of asthma are more common in the deprived ones (Cesaroni et al., 2003; Blanc et al., 2006). On the other hand, severe asthma whatever its etiology appears to be more frequent in the latter populations, as compared to the more affluent (Basagana et al., 2004). Risk factors for exacerbations (e.g., passive smoking (Wright Subramanian, 2007), psychosocial stress (Gold & Wright, 2005), cockroach allergens (Kitch et al., 2000), and suboptimal compliance with anti-inflammatory medication (Gottlieb et al., 1995)) are generally more common among people with asthma and low SES than their better-off counterparts. These observations support the hypothesis that some factors more present in deprived populations contribute to asthma exacerbation (Mielck et al., 1996).
Air Pollution

Droits : http://creativecommons.org/licenses/by-nc-nd/
ISBN : 978-953-307-143-5
hal-01118620
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01118620
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01118620/document
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01118620/file/Ambient%20aire-%20chapter.pdf

Éditeur(s) : HAL CCSD Oxford Journals
Résumé : International audience
Background - Several studies have investigated the implication of biological and environmental factors on geographic variations of end-stage renal disease (ESRD) incidence at large area scales, but none of them assessed the implication of neighbourhood characteristics (healthcare supply, socio-economic level and urbanization degree) on spatial repartition of ESRD. We evaluated the spatial implications of adjustment for neighbourhood characteristics on the spatial distribution of ESRD incidence at the smallest geographic unit in France.Methods - All adult patients living in Bretagne and beginning renal replacement therapy during the 2004–09 period were included. Their residential address was geocoded at the census block level. Each census block was characterized by socio-economic deprivation index, healthcare supply and rural/urban typology. Using a spatial scan statistic, we examined whether there were significant clusters of high risk of ESRD incidence.Results - The ESRD incidence was non-randomly spatially distributed, with a cluster of high risk in the western Bretagne region (relative risk, RR = 1.28, P-value = 0.0003). Adjustment for sex, age and neighbourhood characteristics induced cluster shifts. After these adjustments, a significant cluster (P = 0.013) persisted.Conclusions - Our spatial analysis of ESRD incidence at a fine scale, across a mixed rural/urban area, indicated that, beyond age and sex, neighbourhood characteristics explained a great part of spatial distribution of ESRD incidence. However, to better understand spatial variation of ESRD incidence, it would be necessary to research and adjust for other determinants of ESRD.
Clinical Kidney Journal

hal-01118626
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01118626
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01118626/document
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01118626/file/Spatial%20distribution%20of%20end-stage%20renal%20disease.pdf
DOI : 10.1093/ckj/sfu131

Éditeur(s) : HAL CCSD BioMed Central
Résumé : International audience
Background: Despite intensive research over several decades, the etiology of multiple sclerosis (MS) remains poorly understood, although environmental factors are supposedly implicated. Our goal was to identify spatial clusters of MS incident cases at the small-area level to provide clues to local environmental risk factors that might cause or trigger the disease. Methods: A population-based and multi-stage study was performed in the French Brittany region to accurately ascertain the clinical onset of disease during the 2000-2004 period. The municipality of residence at the time of clinical onset was geocoded. To test for the presence of MS incidence clusters and to identify their approximate locations, we used a spatial scan statistic. We adjusted for socioeconomic deprivation, known to be strongly associated with increased MS incident rates, and scanned simultaneously for areas with either high or low rates. Sensitivity analyses (focusing on relapsing-remitting forms and/or places of residence available within the year following clinical onset) were performed. Results: A total of 848 incident cases of MS were registered in Brittany, corresponding to a crude annual incidence rate of 5.8 per 100,000 inhabitants. The spatial scan statistic did not find a significant cluster of MS incidence in either the primary analysis (p value >= 0.56) or in the sensitivity analyses (p value >= 0.16). Conclusion: The findings of this study indicate that MS incidence is not markedly affected across space, suggesting that in the years preceding the first clinical expression of the disease, no environmental trigger is operative at the small-area population level in the French Brittany region.
ISSN: 1476-072X

hal-01616063
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01616063
DOI : 10.1186/s12942-017-0108-6
PUBMED : 28934989