title: City-Specific Spatiotemporal Infant and Neonatal Mortality Clusters: Links with Socioeconomic and Air Pollution Spatial Patterns in France.
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.
authors.affiliation: Department of Quantitative Methods in Public Health, EHESP School of Public Health-Sorbonne-Paris Cit&#233;, Rennes 35043, France. cindy.padilla@ehesp.fr.|IRSET-Research Institute of Environmental and Occupational Health, Rennes 35000, France. cindy.padilla@ehesp.fr.
authors.forename: Cindy M
authors.initials: CM
authors.lastname: Padilla
authors.affiliation: Department of Environmental and Occupational Health, EHESP School of Public Health, Rennes, Sorbonne-Paris Cit&#233; 35043, France. wahida.kihal@ehesp.fr.
authors.forename: Wahida
authors.initials: W
authors.lastname: Kihal-Talantikit
authors.affiliation: Program in Public Health, Chao Family Cancer Center, University of Irvine, Irvine, CA 92697, USA. vvieira@uci.edu.
authors.forename: Verónica M
authors.initials: VM
authors.lastname: Vieira
authors.affiliation: IRSET-Research Institute of Environmental and Occupational Health, Rennes 35000, France. severine.deguen@ehesp.fr.|Department of Environmental and Occupational Health, EHESP School of Public Health, Rennes, Sorbonne-Paris Cit&#233; 35043, France. severine.deguen@ehesp.fr.
authors.forename: Séverine
authors.initials: S
authors.lastname: Deguen
mesh_terms: D000397:Air Pollution / Q000009:adverse effects*; D002947:Cities / Q000706:statistics & numerical data*; D016000:Cluster Analysis; D004781:Environmental Exposure / Q000706:statistics & numerical data*; D005260:Female; D005544:Forecasting; D005602:France; D005843:Geography; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D008297:Male; D008962:Models, Theoretical; D010297:Paris; D012111:Residence Characteristics; D012307:Risk Factors; D012959:Socioeconomic Factors; D062211:Spatio-Temporal Analysis
keywords: cluster analysis; environmental nuisances; infant mortality; neighborhood deprivation; neonatal mortality; spatial modeling