Vulnerability to Heat-related Mortality: A Systematic Review, Meta-analysis, and Meta-regression Analysis

International audienceBACKGROUND: Addressing vulnerability to heat-related mortality is a necessary step in the development of policies dictated by heat action plans. We aimed to provide a systematic assessment of the epidemiologic evidence regarding vulnerability to heat-related mortality. METHODS: Studies assessing the association between high ambient temperature or heat waves and mortality among different subgroups and published between January 1980 and August 2014 were selected. Estimates of association for all the included subgroups were extracted. We assessed the presence of heterogeneous effects between subgroups conducting Cochran Q tests. We conducted random effect meta-analyses of ratios of relative risks (RRR) for high ambient temperature studies. We performed random effects meta-regression analyses to investigate factors associated with the magnitude of the RRR. RESULTS: Sixty-one studies were included. Using the Cochran Q test, we consistently found evidence of vulnerability for the elderly ages \textgreater85 years. We found a pooled RRR of 0.99 (95% confidence interval [CI] = 0.97, 1.01) for male sex, 1.02 (95% CI = 1.01, 1.03) for age \textgreater65 years, 1.04 (95% CI = 1.02, 1.07) for age \textgreater75 years, 1.03 (95% CI = 1.01, 1.05) for low individual socioeconomic status (SES), and 1.01 (95% CI = 0.99, 1.02) for low ecologic SES. CONCLUSIONS: We found strongest evidence of heat-related vulnerability for the elderly ages \textgreater65 and \textgreater75 years and low SES groups (at the individual level). Studies are needed to clarify if other subgroups (e.g., children, people living alone) are also vulnerable to heat to inform public health program

Intervention territoriale visant à lutter contre la pollution atmosphèrique et équité en matière de santé

La combinaison de la pollution atmosphérique et de la défaveur socioéconomique peut contribuer à l’aggravation des inégalités de santé. De nombreuses interventions de lutte contre la pollution atmosphérique sont mises en place à différentes échelles du territoire. La question soulevée est la suivante : «  les bénéfices sur la santé des interventions visant à améliorer la qualité de l’air diffèrent-ils selon les caractéristiques socioéconomiques des populations ?  ». Un panel de professionnels et d’acteurs politiques a été interrogé sur l’enjeu de l’équité en matière de santé dans l’élaboration et la mise en œuvre de ces interventions. Cette recherche révèle une absence d’évaluation de l’équité des politiques environnementales. Afin de prendre en compte les inégalités sociales de santé, nous suggérons d’évaluer systématiquement dans quelle mesure les interventions pourraient involontairement accroitre la vulnérabilité des populations défavorisées par une approche de type Evaluation d’Impact sur l’Equité en matière de Santé.Background – The relationship between the characteristics of the neighbourhoods where people live and health inequalities is now well documented. More specifically, socioeconomic characteristics have been indicated as mediating the health effect of environmental exposure; this is most documented in relation to air pollution. Two mechanisms have been advanced to explain the possible combined effect of socioeconomic status and environmental exposure: i) differential exposure, which explores the possibility that environmental pollutants are not equally distributed across population groups with different socioeconomic characteristics; ii) differential vulnerability, which states that, at the same level of exposure, socially disadvantaged groups experience more severe health effects. Since the ‘70s, corresponding to a growth in awareness of environmental issues, the number of interventions to protect the state of the environment in Europe increased. In France, there are many local interventions which aim to improve air quality, such as the bike share system, the French “bonus / malus” system, areas with 30 km/h speed limit and greater attention to environmental issues in urban planning. However, who will really benefit from these local interventions? Objective – The question raised in this present article is “ Are the health benefits of interventions which aim to reduce air pollution, experienced equally between populations characterized by different socioeconomic status? “ Material and methods – Our study is conducted in Lyon Metropolitan area located in Eastern France. We questioned a sample of 14 professionals with contrasting profiles in terms of their environmental engagement (such as decision-makers, specialists of public policies evaluation and researchers). We focused our interview on three points: the actions and the public policies implemented to decrease the atmospheric pollution; the assessment of these actions in term of health benefits and impact on the social health inequalities; recommendations to improve the consideration of equity in public health interventions. Our article is structured as follows. We will describe, in the first section, the Lyon Metropolitan area (Lyon MA). In the second section, we will give a brief summary of the principal interventions related to air pollution implemented in Lyon MA. In this section, we will also detail the consequences of one specific intervention in relation to neighborhood socioeconomic characteristics. In the third section, we will discuss the factors which might influence the lack of an assessment of implications for health equity in local interventions. Finally, the last section suggests recommendations for future investigations. Results – All professionals reported the absence of an assessment of health inequity as part of intervention; they added that, to their knowledge, social characteristics are not systematically reviewed as part of public health policy interventions. In France, the political climate could explain the lack of attention to issues of heath equity and social health inequity within local action planning; additionally, those professionals interviewed noticed a clear separation between heath, environment, and urbanism policies. Exceptions are found in public health research where socioeconomic status is considered as one important characteristic in health assessment of interventions aiming to improve air quality. Conclusion – The principal recommendation is to include equity issues at the beginning of the development of any given intervention within a territory; the underlying idea is to take into account in the process the ways in which the impact of such an intervention could be socially differentiated. This concept has already been introduced in several countries, for example in Canada, through the approach of Health Equity Impact Assessment (HEIA). In France, it is time to move from the health impact assessment to the HEIA in order to maximize the positive impacts of interventions and to reduce the collateral negative effects that could potentially widen health disparities between population groups

Data analysis techniques: a tool for cumulative exposure assessment.

International audienceEveryone is subject to environmental exposures from various sources, with negative health impacts (air, water and soil contamination, noise, etc.or with positive effects (e.g. green space). Studies considering such complex environmental settings in a global manner are rare. We propose to use statistical factor and cluster analyses to create a composite exposure index with a data-driven approach, in view to assess the environmental burden experienced by populations. We illustrate this approach in a large French metropolitan area. The study was carried out in the Great Lyon area (France, 1.2 M inhabitants) at the census Block Group (BG) scale. We used as environmental indicators ambient air NO2 annual concentrations, noise levels and proximity to green spaces, to industrial plants, to polluted sites and to road traffic. They were synthesized using Multiple Factor Analysis (MFA), a data-driven technique without a priori modeling, followed by a Hierarchical Clustering to create BG classes. The first components of the MFA explained, respectively, 30, 14, 11 and 9% of the total variance. Clustering in five classes group: (1) a particular type of large BGs without population; (2) BGs of green residential areas, with less negative exposures than average; (3) BGs of residential areas near midtown; (4) BGs close to industries; and (5) midtown urban BGs, with higher negative exposures than average and less green spaces. Other numbers of classes were tested in order to assess a variety of clustering. We present an approach using statistical factor and cluster analyses techniques, which seem overlooked to assess cumulative exposure in complex environmental settings. Although it cannot be applied directly for risk or health effect assessment, the resulting index can help to identify hot spots of cumulative exposure, to prioritize urban policies or to compare the environmental burden across study areas in an epidemiological framework.Journal of Exposure Science and Environmental Epidemiology advance online publication, 24 September 2014; doi:10.1038/jes.2014.66

Symptoms of anxiety and depression during the COVID-19 pandemic in six European countries and Australia - Differences by prior mental disorders and migration status

Background: Little is known about changes of mental health during the COVID-19 pandemic in potentially disadvantaged groups. We investigated changes in anxiety and depression symptoms during the first year of the pandemic in six European countries and Australia by prior mental disorders and migration status. Methods: Overall, 4674 adults answered a web-based survey in May-June 2020 and were followed by three repeated surveys up to February 2021. Information on psychosocial, financial and demographic, living conditions, prior mental disorders, depression and anxiety symptoms during the pandemic and migration status was collected. Weighted general estimation equations modelling was used to investigate the association between prior mental disorders, migration status, and symptoms over time. Results: Most participants were <40 years old (48%), women (78%) and highly educated (62%). The baseline prevalence of depressive and anxiety symptoms ranged between 19%-45% and 13%-35%, respectively. In most countries, prevalence rates remained unchanged throughout the pandemic and were higher among people with prior mental disorders than without even after adjustment for several factors. We observed interactions between previous mental disorders and symptoms of anxiety or depression over time in two countries. No difference by migration status was noted. Limitations: Convenience sampling limits generalizability. Self-assessed symptoms of depression and anxiety might involve some misclassification. Conclusions: Depression and anxiety symptoms were worse among individuals with prior mental disorders than without, but there was no clear trend of worsening mental health in the observed groups during the observed period

Expositions environnementales et inégalités sociales de santé

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