title: An exploratory spatial analysis to assess the relationship between deprivation, noise and infant mortality: an ecological study.
abstract: BACKGROUND
  Few studies have explored how noise might contribute to social health inequalities, and even fewer have considered infant mortality or its risk factors as the health event of interest.In this paper, we investigate the impact of neighbourhood characteristics - both socio-economic status and ambient noise levels - on the spatial distribution of infant mortality in the Lyon metropolitan area, in France.
  
  
  METHODS
  All infant deaths (n = 715) occurring between 2000 and 2009 were geocoded at census block level. Each census block was assigned multi-component socio-economic characteristics and Lden levels, which measure exposure to noise. Using a spatial-scan statistic, we examined whether there were significant clusters of high risk of infant mortality according to neighbourhood characteristics.
  
  
  RESULTS
  Our results highlight the fact that infant mortality is non-randomly distributed spatially, with clusters of high risk in the south-east of the Lyon metropolitan area (RR = 1.44; p = 0.09). After adjustments for socio-economic characteristics and noise levels, this cluster disappears or shifts according to in line with different scenarios, suggesting that noise and socio-economic characteristics can partially explain the spatial distribution of infant mortality.
  
  
  CONCLUSIONS
  Our findings show that noise does have an impact on the spatial distribution of mortality after adjustments for socio-economic characteristics. A link between noise and infant mortality seems plausible in view of the three hypothetical, non-exclusive, pathways we propose in our conceptual framework: (i) a psychological pathway, (ii) a physiological disruption process and (iii) an unhealthy behaviours pathway. The lack of studies makes it is difficult to compare our findings with others. They require further research for confirmation and interpretation.
authors.affiliation: EHESP School of Public Health, Rennes, 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: Benoit
authors.initials: B
authors.lastname: Lalloue
authors.forename: Christophe
authors.initials: C
authors.lastname: Rougier
authors.forename: Jérôme
authors.initials: J
authors.lastname: Defrance
authors.forename: Denis
authors.initials: D
authors.lastname: Zmirou-Navier
authors.forename: Séverine
authors.initials: S
authors.lastname: Deguen
mesh_terms: D002947:Cities; D016000:Cluster Analysis; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008962:Models, Theoretical; D009622:Noise / Q000009:adverse effects*; D011247:Pregnancy; D015995:Prevalence; D012111:Residence Characteristics; D012923:Social Class; D062206:Spatial Analysis