Padilla Cindy M, Kihal-Talantikit Wahida, Perez Sandra, Deguen Severine
Department of Quantitative Methods in Public Health, EHESP School of Public Health, Sorbonne-Paris Cité, 35043, Rennes, France.
Department of Environmental and Occupational Health, EHESP School of Public Health, Sorbonne-Paris Cité, 35043, Rennes, France.
Environ Health. 2016 Jul 22;15(1):79. doi: 10.1186/s12940-016-0163-7.
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.
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.
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.
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.
环境健康不平等是欧洲主要的公共卫生问题。然而，仅有少数研究考虑了大量特征来分析这一问题。本研究的目的是识别和描述在法国城市环境中，社会经济、健康可及性和暴露因素如何在小区域内积累和相互作用，以评估与婴儿和新生儿死亡率相关的环境健康不平等。
利用地理信息系统创建了关于贫困指数、靠近交通繁忙道路、绿地和医疗可及性的环境指标。病例从尼斯大都市区各市政府的死亡证明中收集。利用父母的住址，将病例地理编码到其居住的普查街区。通过多元成分分析后进行层次聚类的分类方法，使我们能够根据社会经济、环境和医疗可及性水平对普查街区进行特征描述，这些本质上是非常多样化的定义。在检查离散假设后，使用标准的泊松回归模型对计数数据进行分析，以研究分类后对普查街区进行分类的三种环境模式与婴儿和新生儿死亡率之间的关系。
基于地理指标，识别出三种环境模式。我们在尼斯大都市区发现了环境不平等和社会健康不平等。此外，这些不平等被贫困普查街区与母婴相关医疗设施的近距离所抵消。因此，我们证明不存在与婴儿和新生儿死亡率相关的环境健康不平等。
对社会、环境模式以及与医疗可及性相关的模式进行检查，有助于识别有需求的普查街区及其对健康的影响。类似的分析可以在其他城市实施并考虑，或者与其他出生结局相关。
