Abstract
BackgroundAn 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.MethodsEnvironmental 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.ResultsBased 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.ConclusionExamination 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.
Highlights
An environmental health inequality is a major public health concern in Europe
We identified three environmental patterns according to environmental exposure, deprivation and accessibility to healthcare
Using Geographical Information System (GIS) for geographic indicators and a combination of Multiple Component Analysis (MCA) and clustering analysis, we identified three environmental patterns which combined multiple factors and how they accumulate in a small area
Summary
An environmental health inequality is a major public health concern in Europe. 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. Reducing health inequalities involves the characterization and the identification of how factors accumulate and interact in an area. Certain socioeconomic groups bear a disproportionate burden of environmental externalities [3], and vulnerable to the health effects resulting from this exposition [4]. Few have considered to wholesome environments may be related to urban socioeconomic inequalities [13] and have shown that access to green spaces may have a beneficial effect on health [14, 15]
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