Green space and spatial analysis of social inequalities in infant mortality in France

Abstract

Background- Few studies considered environmental benefits to explain social health inequalities. Natural environments that contribute to good health might have an effect on socioeconomic health inequalities. In developed countries, the evidence that green spaces have health benefits for urban population is now strong. Recent studies suggest such positive effects on pregnancy outcomes. Aims- To investigate the relationships between green spaces and the spatial distribution of infant mortality taking into account neighborhood deprivation levels. Methods- The study took place in the Lyon metropolitan area, France (1340 155 in 2009). All infant deaths cases aged <1 yearthat occurred between 2000 and 2009 were geocoded at the census block level (n= 715). Each census block was assigned greenness and socioeconomic deprivation levels. Using a spatial–scan statistic, we examined whether there were significant clusters of high risk of infant mortality according to these neighborhood characteristics. Results- Our results highlight that infant mortality is not randomly spatially distributed, with clusters of high riskin the southwest of the Lyon metropolitan area (53 census blocks; RR:1.70; p<0.003). After adjustment on greenness levels and socioeconomic deprivation, this cluster disappears, suggesting that these factors explain in great part the spatial distribution of infant mortality. No interaction was found between the two factors. Conclusions- We propose 3 hypotheticals not exclusive pathways by which green space may have a beneficial effect on adverse pregnancy outcomes: (i) a psychological pathway, (ii) a physiological disruption process and (iii) an environmental pathway. This work adds some evidence to the link between access to green space and pregnancy outcomes but requires further research for confirmation.