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Maternal and Child Health Journal

, Volume 18, Issue 1, pp 171–179 | Cite as

An Ecological Study to Identify Census Blocks Supporting a Higher Burden of Disease: Infant Mortality in the Lille Metropolitan Area, France

  • Cindy PadillaEmail author
  • Benoit Lalloué
  • Cheri Pies
  • Emminarie Lucas
  • Denis Zmirou-Navier
  • Deguen Séverine
Article

Abstract

In France, reducing social health inequalities has become an explicit goal of health policies over the past few years, one of its objectives is specifically the reduction of the perinatal mortality rate. This study investigates the association between infant mortality and social deprivation categories at a small area level in the Lille metropolitan area, in the north of France, to identify census blocks where public authorities should prioritize appropriate preventive actions. We used census data to establish a neighbourhood deprivation index whose multiple dimensions encompass socioeconomic characteristics. Infant mortality data were obtained from the Lille metropolitan area municipalities to estimate a death rate at the census tract level. We used Bayesian hierarchical models in order to reduce the extra variability when computing relative risks (RR) and to assess the associations between infant mortality and deprivation. Between 2000 and 2009, 668 cases of infant death occurred in the Lille metropolitan area (4.2 per 1,000 live births). The socioeconomic status is associated with infant mortality, with a clear gradient of risk from the most privileged census blocks to the most deprived ones (RR = 2.62, 95 % confidence interval [1.87; 3.70]). The latter have 24.6 % of families who were single parents and 29.9 % of unemployed people in the labor force versus 8.5 % and 7.7 % in the former. Our study reveals socio-spatial disparities in infant mortality in the Lille metropolitan area and highlights the census blocks most affected by the inequalities. Fine spatial analysis may help inform the design of preventive policies tailored to the characteristics of the local communities.

Keywords

Infant mortality Small-area analysis Social health inequalities Census tracts Deprivation index Bayesian models 

Notes

Acknowledgments

The authors thank all scientific researchers of the Equit Area project, personnel of the local council of Lille Metropolitan area and Grégoire Rey of the CepiDC institute for their participation. Equit’Area project was supported by the French National Research Agency (ANR), the EHESP School of Public Health, the French Health General Directorate (DGS), the Environment and Energy Management Agency (ADEME) and the Nord-Pas de Calais region.

Conflict of interest

None declared.

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Cindy Padilla
    • 1
    • 2
    • 3
    Email author
  • Benoit Lalloué
    • 1
    • 2
    • 5
  • Cheri Pies
    • 6
  • Emminarie Lucas
    • 1
  • Denis Zmirou-Navier
    • 1
    • 2
    • 4
  • Deguen Séverine
    • 1
    • 2
  1. 1.EHESP School of Public Health (Ecole des Hautes Etudes en Santé Publique), Rennes, Sorbonne Paris CitéRennes CedexFrance
  2. 2.INSERM U1085 (IRSET)RennesFrance
  3. 3.French Environment and Energy Management Agency 20Angers CedexFrance
  4. 4.Lorraine University Medical schoolVandoeuvre-les-NancyFrance
  5. 5.Institut Elie Cartan UMR 7502Nancy University, CNRS, INRIAVandoeuvre-les-NancyFrance
  6. 6.School of Public HealthUniversity of CaliforniaBerkeleyUSA

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