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Comparative Study
.2016 Jun 22;13(6):624.
doi: 10.3390/ijerph13060624.

City-Specific Spatiotemporal Infant and Neonatal Mortality Clusters: Links with Socioeconomic and Air Pollution Spatial Patterns in France

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Comparative Study

City-Specific Spatiotemporal Infant and Neonatal Mortality Clusters: Links with Socioeconomic and Air Pollution Spatial Patterns in France

Cindy M Padilla et al. Int J Environ Res Public Health..

Abstract

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.

Keywords: cluster analysis; environmental nuisances; infant mortality; neighborhood deprivation; neonatal mortality; spatial modeling.

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Figures

Figure 1
Figure 1
Location of the three metropolitan areas and the city of Paris in France.
Figure 2
Figure 2
Prevalence of infant mortality in Paris at two time periods estimated using GAMs for the crude analysis (A); and adjusted for NO2 concentrations (B) and deprivation index (C). Solid lines identify areas with statistically significant elevated risk (hotspots).
Figure 3
Figure 3
Prevalence of neonatal mortality in the Lille MA at two time periods estimated using GAMs for the crude analysis (A); and adjusted for NO2 concentrations (B) and deprivation index (C). Solid lines identify areas with statistically significant elevated risk (hotspots).
Figure 4
Figure 4
Prevalence of infant mortality in the Marseille MA at the two time periods estimated using GAMs for the crude analysis (A); and adjusted for NO2 concentrations (B) and deprivation index (C). Solid lines identify areas with statistically significant elevated risk (hotspots).
Figure 5
Figure 5
Prevalence of infant mortality in the Lyon MA at two time periods estimated using GAMs for the crude analysis (A); adjusted for NO2 concentrations (B) and fully adjusted for NO2 concentrations and deprivation index (C). Solid lines identify areas with statistically significant elevated risk (hotspots).
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References

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