title: Green space, social inequalities and neonatal mortality in France.
abstract: BACKGROUND
  Few studies have considered using environmental amenities to explain social health inequalities.Nevertheless, Green spaces that promote good health may have an effect on socioeconomic health inequalities. In developed countries, there is considerable evidence that green spaces have a beneficial effect on the health of urban populations and recent studies suggest they can have a positive effect on pregnancy outcomes. To investigate the relationship between green spaces and the spatial distribution of infant mortality taking account neighborhood deprivation levels.
  
  
  METHODS
  The study took place in Lyon metropolitan area, France. All infant deaths that occurred between 2000 and 2009 were geocoded at census block level. Each census block was assigned greenness and socioeconomic deprivation levels. The spatial-scan statistic was used to identify high risk cluster of infant mortality according to these neighborhood characteristics.
  
  
  RESULTS
  The spatial distribution of infant mortality was not random with a high risk cluster in the south east of the Lyon metropolitan area (p<0.003). This cluster disappeared (p=0.12) after adjustment for greenness level and socioeconomic deprivation, suggesting that these factors explain part of the spatial distribution of infant mortality. These results are discussed using a conceptual framework with 3 hypothetical pathways by which green spaces may have a beneficial effect on adverse pregnancy outcomes: (i) a psychological pathway, (ii) a physiological disruption process and (iii) an environmental pathway.
  
  
  CONCLUSIONS
  These results add some evidence to the hypothesis that there is a relationship between access to green spaces and pregnancy outcomes but further research is required to confirm this.
authors.affiliation: EHESP School of Public Health-Rennes, Sorbonne-Paris Cité, France. wahida.kihal@ehesp.fr.
authors.forename: Wahida
authors.initials: W
authors.lastname: Kihal-Talantikite
authors.forename: Cindy M
authors.initials: CM
authors.lastname: Padilla
authors.forename: Benoît
authors.initials: B
authors.lastname: Lalloué
authors.forename: Marcello
authors.initials: M
authors.lastname: Gelormini
authors.forename: Denis
authors.initials: D
authors.lastname: Zmirou-Navier
authors.forename: Severine
authors.initials: S
authors.lastname: Deguen
mesh_terms: D004777:Environment; D005602:France / Q000453:epidemiology; D040362:Geographic Information Systems; D054624:Health Status Disparities; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D011204:Poverty Areas; D062206:Spatial Analysis; D014504:Urban Health / Q000706:statistics & numerical data*