Effet à long terme et transférabilité d'un programme de prévention primaire du diabète de type 2 dans les quartiers vulnérables à la Réunion

Le diabète de type 2 (DT2) est une pathologie plus fréquente dans les départements d'outre-mer qu'en France métropolitaine. Ce constat serait d'autant plus vrai dans les quartiers vulnérables ultra-marins présentant une population exposée de surcroît à des déterminants sociaux qui favorisent la survenue de cette maladie, notamment l'accès réduit au système de santé. Ainsi, dans ce cadre de travail, la modification des comportements pour la réduction des facteurs de risque selon une approche de prévention primaire dans un quartier vulnérable, serait une stratégie d'action appropriée pour améliorer la santé de la population locale. Afin de tester cette hypothèse, nous avons évalué l'effet à long terme d'une intervention sur le mode de vie réalisée en 2001-2003 pour réduire le risque de DT2 par la perte de poids, chez 445 sujets non diabétiques à risque, en surpoids ou obèses, âgés de 18-40 ans, vivant dans deux quartiers vulnérables de la Réunion. Neuf ans après l'inclusion dans l'essai d'intervention, le suivi des participants montrait une diminution du niveau d'adiposité dans le groupe intervention comparativement au groupe témoin. Ces résultats suggèrent que l'initiation de modifications comportementales sur l'alimentation et l'activité physique associée aux pratiques communautaires autour de la santé et à l'amélioration de l'accès à la prévention en proximité, dans un contexte et un environnement " obésogènes ", présenteraient un bénéfice en santé à long terme. Suite à cette étude épidémiologique portant sur la validation d'un modèle de prévention primaire destiné à la population réunionnaise défavorisée, nous nous sommes intéressés à la problématique de la transférabilité de ce type d'intervention. Les interventions de santé publique sont des " boîtes noires " difficiles à décrire, à évaluer et à transférer. Elles ne peuvent être reproduites en l'état dans un nouveau contexte d'implémentation au risque de ne plus être efficaces et de ne pas savoir pourquoi. Ainsi, dans ce cadre de travail, il serait utile de dégager les processus théoriques " standardisables par fonction " potentiellement transférables de l'intervention (les fonctions clés) des activités concrètes implémentées sur le terrain dépendantes du contexte, et d'identifier les éléments contextuels signifiants pouvant modifier l'intervention. La construction du modèle fonctions clés / implémentation / contexte (FIC) et l'explicitation du modèle de causalité du programme de prévention, selon une approche rétrospective, collaborative entre porteur de projet, acteur de terrain et chercheurs de différentes disciplines, a permis de mieux décrire l'intervention étudiée, d'analyser sa transférabilité et de discuter son évaluation. Cette intervention sur le mode de vie comprenait treize fonctions clés réparties selon trois stratégies d'action visant la réduction des inégalités sociales de santé (renforcement des individus, renforcement de la communauté, amélioration des conditions de vie) et six objectifs spécifiques sous-jacents. Le modèle de causalité impliquait des déterminants individuels, méso-sociaux et environnementaux de la santé. L'analyse des modalités du transfert du programme vers un autre quartier vulnérable de la Réunion en 2004, a montré que : des fonctions clés, des modalités d'implémentation et des éléments contextuels étaient possiblement engagés dans la transférabilité de cette intervention. Un élargissement des méthodes de recherche concernant la population, les indicateurs de résultats et les analyses de données, serait nécessaire pour mieux évaluer l'impact de ce type d'intervention dans le réseau social du quartier.Type 2 diabetes (T2D) is more prevalent in the French overseas territories than it is in mainland France. This observation is even more valid with respect to the disadvantaged neighbourhoods of overseas territories. Indeed, the population in these neighbourhoods is exposed to social determinants that favour the onset of T2D, including lower access to health care. In this context, we put forward the hypothesis that improvements in behaviour for risk factor reduction according to a primary prevention approach within a vulnerable neighbourhood constitute an appropriate strategy for ameliorating the health of the local population. In order to test this hypothesis, we evaluated the long-term effectiveness of a lifestyle intervention conducted in 2001-2003 and aimed at reducing the risk of T2D through weight loss in 445 high-risk non-diabetic overweight or obese subjects aged 18-40 years and living in two disadvantaged neighbourhoods of Reunion Island. Nine years after the inclusion in the intervention control trial, the follow-up of participants revealed a reduction in adiposity levels in the intervention group compared with the control group. This suggests that the initiation of changes in diet and physical activity combined with community health practices and improving prevention access within district present long-term health benefits in a context where "obesogenic" environmental and living conditions prevail. Following this epidemiological study focused on the validation of a primary preventive model for the vulnerable populations of Reunion Island, we examined the transferability of this type of intervention. Public health interventions constitute "black boxes" that are difficult to describe, evaluate and transfer. An intervention cannot be transferred as a whole to a new implementation context, as this could lead to a lack of reproducibility that would be impossible to explain. In this perspective, it seems useful to separate the intervention's "standardisable by function" and potentially transferable theoretical processes (the key functions) from the concrete and context-dependent activities implemented in the field, as well as to identify the significant contextual elements that may alter the intervention. The construction of the key functions/implementation/context model (FIC) and the clarification of the causality model of the prevention program - based on a retrospective collaborative approach that involved a project leader, field worker and researchers from several disciplines - enabled us to better describe the studied intervention, to analyse its transferability, and to discuss its evaluation. This lifestyle intervention was composed of thirteen key functions distributed into three action strategies aimed at reducing social inequalities (strengthening individuals, strengthening communities, improving living conditions) and six specific underlying goals. The causality model included individual, meso-social and environmental health determinants. In 2004, the program was transferred to another vulnerable neighbourhood of Reunion Island. The analysis of the program transfer shows that some of the key functions, modalities of implementation and contextual elements were potentially involved in the transferability of this intervention. A wider range of result indicators, data analyses, and population research methods may be needed to improve the evaluation of the intervention's impact in the neighbourhood's social network

Estimating Chikungunya prevalence in La Réunion Island outbreak by serosurveys: Two methods for two critical times of the epidemic

<p>Abstract</p> <p>Background</p> <p>Chikungunya virus (CHIKV) caused a major two-wave seventeen-month-long outbreak in La Réunion Island in 2005–2006. The aim of this study was to refine clinical estimates provided by a regional surveillance-system using a two-stage serological assessment as gold standard.</p> <p>Methods</p> <p>Two serosurveys were implemented: first, a rapid survey using stored sera of pregnant women, in order to assess the attack rate at the epidemic upsurge (s1, February 2006; n = 888); second, a population-based survey among a random sample of the community, to assess the herd immunity in the post-epidemic era (s2, October 2006; n = 2442). Sera were screened for anti-CHIKV specific antibodies (IgM and IgG in s1, IgG only in s2) using enzyme-linked immunosorbent assays. Seroprevalence rates were compared to clinical estimates of attack rates.</p> <p>Results</p> <p>In s1, 18.2% of the pregnant women were tested positive for CHIKV specific antibodies (13.8% for both IgM and IgG, 4.3% for IgM, 0.1% for IgG only) which provided a congruent estimate with the 16.5% attack rate calculated from the surveillance-system. In s2, the seroprevalence in community was estimated to 38.2% (95% CI, 35.9 to 40.6%). Extrapolations of seroprevalence rates led to estimate, at 143,000 and at 300,000 (95% CI, 283,000 to 320,000), the number of people infected in s1 and in s2, respectively. In comparison, the surveillance-system estimated at 130,000 and 266,000 the number of people infected for the same periods.</p> <p>Conclusion</p> <p>A rapid serosurvey in pregnant women can be helpful to assess the attack rate when large seroprevalence studies cannot be done. On the other hand, a population-based serosurvey is useful to refine the estimate when clinical diagnosis underestimates it. Our findings give valuable insights to assess the herd immunity along the course of epidemics.</p

Impact of Chikungunya Virus Infection on Health Status and Quality of Life: A Retrospective Cohort Study

BACKGROUND:Persistent symptoms, mainly joint and muscular pain and depression, have been reported several months after Chikungunya virus (CHIKV) infection. Their frequency and their impact on quality of life have not been compared with those of an unexposed population. In the present study, we aimed to describe the frequency of prolonged clinical manifestations of CHIKV infection and to measure the impact on quality of life and health care consumption in comparison with that of an unexposed population, more than one year after infection. METHODOLOGY/PRINCIPAL FINDINGS:In a retrospective cohort study, 199 subjects who had serologically confirmed CHIKV infection (CHIK+) were compared with 199 sero-negative subjects (CHIK-) matched for age, gender and area of residence in La Réunion Island. Following an average time of 17 months from the acute phase of infection, participants were interviewed by telephone about current symptoms, medical consumption during the last 12 months and quality of life assessed by the 12-items Short-Form Health Survey (SF-12) scale. At the time of study, 112 (56%) CHIK+ persons reported they were fully recovered. CHIK+ complained more frequently than CHIK- of arthralgia (relative risk = 1.9; 95% confidence interval: 1.6-2.2), myalgia (1.9; 1.5-2.3), fatigue (2.3; 1.8-3), depression (2.5; 1.5-4.1) and hair loss (3.8; 1.9-7.6). There was no significant difference between CHIK+ and CHIK- subjects regarding medical consumption in the past year. The mean (SD) score of the SF-12 Physical Component Summary was 46.4 (10.8) in CHIK+ versus 49.1 (9.3) in CHIK- (p = 0.04). There was no significant difference between the two groups for the Mental Component Summary. CONCLUSIONS/SIGNIFICANCE:More than one year following the acute phase of infection, CHIK+ subjects reported more disabilities than those who were CHIK-. These persistent disabilities, however, have no significant influence on medical consumption, and the impact on quality of life is moderate

Pandemic Influenza Due to pH1N1/2009 Virus: Estimation of Infection Burden in Reunion Island through a Prospective Serosurvey, Austral Winter 2009

International audienceBACKGROUND: To date, there is little information that reflects the true extent of spread of the pH1N1/2009v influenza pandemic at the community level as infection often results in mild or no clinical symptoms. This study aimed at assessing through a prospective study, the attack rate of pH1N1/2009 virus in Reunion Island and risk factors of infection, during the 2009 season.METHODOLOGY/PRINCIPAL FINDINGS: A serosurvey was conducted during the 2009 austral winter, in the frame of a prospective population study. Pairs of sera were collected from 1687 individuals belonging to 772 households, during and after passage of the pandemic wave. Antibodies to pH1N1/2009v were titered using the hemagglutination inhibition assay (HIA) with titers ≥ 1/40 being considered positive. Seroprevalence during the first two weeks of detection of pH1N1/2009v in Reunion Island was 29.8% in people under 20 years of age, 35.6% in adults (20-59 years) and 73.3% in the elderly (≥ 60 years) (P<0.0001). Baseline corrected cumulative incidence rates, were 42.9%, 13.9% and 0% in these age groups respectively (P<0.0001). A significant decline in antibody titers occurred soon after the passage of the epidemic wave. Seroconversion rates to pH1N1/2009 correlated negatively with age: 63.2%, 39.4% and 16.7%, in each age group respectively (P<0.0001). Seroconversion occurred in 65.2% of individuals who were seronegative at inclusion compared to 6.8% in those who were initially seropositive.CONCLUSIONS: Seroincidence of pH1N1/2009v infection was three times that estimated from clinical surveillance, indicating that almost two thirds of infections occurring at the community level have escaped medical detection. People under 20 years of age were the most affected group. Pre-epidemic titers ≥ 1/40 prevented seroconversion and are likely protective against infection. A concern was raised about the long term stability of the antibody responses

Long-term effectiveness and transferability of a type 2 diabetes primary prevention program in disadvantaged neighbourhoods of Reunion island

Le diabète de type 2 (DT2) est une pathologie plus fréquente dans les départements d'outre-mer qu'en France métropolitaine. Ce constat serait d'autant plus vrai dans les quartiers vulnérables ultra-marins présentant une population exposée de surcroît à des déterminants sociaux qui favorisent la survenue de cette maladie, notamment l'accès réduit au système de santé. Ainsi, dans ce cadre de travail, la modification des comportements pour la réduction des facteurs de risque selon une approche de prévention primaire dans un quartier vulnérable, serait une stratégie d'action appropriée pour améliorer la santé de la population locale. Afin de tester cette hypothèse, nous avons évalué l'effet à long terme d'une intervention sur le mode de vie réalisée en 2001-2003 pour réduire le risque de DT2 par la perte de poids, chez 445 sujets non diabétiques à risque, en surpoids ou obèses, âgés de 18-40 ans, vivant dans deux quartiers vulnérables de la Réunion. Neuf ans après l'inclusion dans l'essai d'intervention, le suivi des participants montrait une diminution du niveau d'adiposité dans le groupe intervention comparativement au groupe témoin. Ces résultats suggèrent que l'initiation de modifications comportementales sur l'alimentation et l'activité physique associée aux pratiques communautaires autour de la santé et à l'amélioration de l'accès à la prévention en proximité, dans un contexte et un environnement " obésogènes ", présenteraient un bénéfice en santé à long terme. Suite à cette étude épidémiologique portant sur la validation d'un modèle de prévention primaire destiné à la population réunionnaise défavorisée, nous nous sommes intéressés à la problématique de la transférabilité de ce type d'intervention. Les interventions de santé publique sont des " boîtes noires " difficiles à décrire, à évaluer et à transférer. Elles ne peuvent être reproduites en l'état dans un nouveau contexte d'implémentation au risque de ne plus être efficaces et de ne pas savoir pourquoi. Ainsi, dans ce cadre de travail, il serait utile de dégager les processus théoriques " standardisables par fonction " potentiellement transférables de l'intervention (les fonctions clés) des activités concrètes implémentées sur le terrain dépendantes du contexte, et d'identifier les éléments contextuels signifiants pouvant modifier l'intervention. La construction du modèle fonctions clés / implémentation / contexte (FIC) et l'explicitation du modèle de causalité du programme de prévention, selon une approche rétrospective, collaborative entre porteur de projet, acteur de terrain et chercheurs de différentes disciplines, a permis de mieux décrire l'intervention étudiée, d'analyser sa transférabilité et de discuter son évaluation. Cette intervention sur le mode de vie comprenait treize fonctions clés réparties selon trois stratégies d'action visant la réduction des inégalités sociales de santé (renforcement des individus, renforcement de la communauté, amélioration des conditions de vie) et six objectifs spécifiques sous-jacents. Le modèle de causalité impliquait des déterminants individuels, méso-sociaux et environnementaux de la santé. L'analyse des modalités du transfert du programme vers un autre quartier vulnérable de la Réunion en 2004, a montré que : des fonctions clés, des modalités d'implémentation et des éléments contextuels étaient possiblement engagés dans la transférabilité de cette intervention. Un élargissement des méthodes de recherche concernant la population, les indicateurs de résultats et les analyses de données, serait nécessaire pour mieux évaluer l'impact de ce type d'intervention dans le réseau social du quartier.Type 2 diabetes (T2D) is more prevalent in the French overseas territories than it is in mainland France. This observation is even more valid with respect to the disadvantaged neighbourhoods of overseas territories. Indeed, the population in these neighbourhoods is exposed to social determinants that favour the onset of T2D, including lower access to health care. In this context, we put forward the hypothesis that improvements in behaviour for risk factor reduction according to a primary prevention approach within a vulnerable neighbourhood constitute an appropriate strategy for ameliorating the health of the local population. In order to test this hypothesis, we evaluated the long-term effectiveness of a lifestyle intervention conducted in 2001-2003 and aimed at reducing the risk of T2D through weight loss in 445 high-risk non-diabetic overweight or obese subjects aged 18-40 years and living in two disadvantaged neighbourhoods of Reunion Island. Nine years after the inclusion in the intervention control trial, the follow-up of participants revealed a reduction in adiposity levels in the intervention group compared with the control group. This suggests that the initiation of changes in diet and physical activity combined with community health practices and improving prevention access within district present long-term health benefits in a context where "obesogenic" environmental and living conditions prevail. Following this epidemiological study focused on the validation of a primary preventive model for the vulnerable populations of Reunion Island, we examined the transferability of this type of intervention. Public health interventions constitute "black boxes" that are difficult to describe, evaluate and transfer. An intervention cannot be transferred as a whole to a new implementation context, as this could lead to a lack of reproducibility that would be impossible to explain. In this perspective, it seems useful to separate the intervention's "standardisable by function" and potentially transferable theoretical processes (the key functions) from the concrete and context-dependent activities implemented in the field, as well as to identify the significant contextual elements that may alter the intervention. The construction of the key functions/implementation/context model (FIC) and the clarification of the causality model of the prevention program - based on a retrospective collaborative approach that involved a project leader, field worker and researchers from several disciplines - enabled us to better describe the studied intervention, to analyse its transferability, and to discuss its evaluation. This lifestyle intervention was composed of thirteen key functions distributed into three action strategies aimed at reducing social inequalities (strengthening individuals, strengthening communities, improving living conditions) and six specific underlying goals. The causality model included individual, meso-social and environmental health determinants. In 2004, the program was transferred to another vulnerable neighbourhood of Reunion Island. The analysis of the program transfer shows that some of the key functions, modalities of implementation and contextual elements were potentially involved in the transferability of this intervention. A wider range of result indicators, data analyses, and population research methods may be needed to improve the evaluation of the intervention's impact in the neighbourhood's social network

Analyser la transférabilité d’une intervention : application du modèle fonctions clés/implémentation/contexte à un programme de prévention du diabète

International audienceIntroduction: A type 2 diabetes primary prevention programme that was shown to be feasible and effective in 2003 was transferred to another vulnerable district of Reunion Island in 2004, but its short-term effectiveness could not be reproduced. Based on this example, this article analyses whether the key functions/implementation/context model can be useful to : 1- more accurately describe an evaluated intervention ; and 2- identify the factors involved in the transferability of this intervention. Methods: The causality model of the initial programme is described. We then identified the key functions (or theoretical processes) of this initial programme, implementation of these functions, and the context in which the intervention took place. Transfer was analysed by focusing on the differences between the initial programme and the transferred programme in terms of key functions, implementation and context. Results: The causality model involves individual, meso-social, and environmental health determinants. Our analysis of programme transfer highlights differences in : key functions (two key functions dropped, one key function added, one key function modified), implementation (failure to implement, loss/improvement of quality), and context (population and socioeconomic level of the district concerned). Conclusion: This work supports the hypothesis that the key functions/implementation/context model can be useful to improve the description of an intervention, and analyse the factors involved in its transferability.Introduction : Un programme de prévention primaire du diabète de type 2 ayant démontré sa faisabilité et son efficacité en 2003, a été transféré dans un autre quartier vulnérable réunionnais en 2004. Son efficacité à court terme n’a pu être reproduite. À partir de cet exemple, l’objectif de cet article est d’analyser si le fait de recourir au modèle fonctions clés/implémentation/contexte permet : 1- de mieux décrire une intervention évaluée ; 2- d’identifier les facteurs impliqués dans sa transférabilité. Méthodes : L’approche adoptée consistait à décrire le modèle de causalité du programme initial, les fonctions clés (correspondant aux processus théoriques du programme) et leur implémentation, ainsi que le contexte dans lequel cette intervention s’est déroulée. L’analyse des modalités du transfert portait sur les différences entre le programme initial et le programme transféré, en termes de fonctions clés, d’implémentation et de contexte. Résultats : Le modèle de causalité impliquait des déterminants individuels, méso-sociaux et environnementaux de la santé. L’analyse du transfert a mis en évidence des différences au niveau des fonctions clés (deux fonctions clés abandonnées, une fonction clé ajoutée, une fonction clé modifiée), de l’implémentation (échec de mise en œuvre, perte/amélioration de qualité), et des différences de contexte en termes de population et le niveau socio-économique du quartier. Conclusion : Ce travail suggère que le modèle fonctions clés/implémentation/contexte pourrait contribuer à améliorer la description d’une intervention, ainsi que l’analyse des facteurs impliqués dans sa transférabilité

Long-Term Effectiveness of a Lifestyle Intervention for the Primary Prevention of Type 2 Diabetes in a Low Socio-Economic Community – An Intervention Follow-Up Study on Reunion Island

Cet article est accompagné de 4 annexes publiées en ligne (Supporting Information) et disponibles au téléchargement à l'adresse suivante :doi:10.1371/journal.pone.0146095International audienceIn type 2 diabetes (T2D) prevention research, evidence for maintenance of risk factor reduction after three years of follow-up is needed. The objective of this study was to evaluate the long-term effectiveness of a combined lifestyle intervention aiming at controlling body weight (BW) and waist circumference (WC) in non-diabetic, overweight/obese adults living in a low socioeconomic community. On Reunion Island, 445 adults living in deprived areas, aged 18–40 and at high-risk for T2D, were included in an intervention versus control trial for primary prevention (2001–2002). The intervention promoted a healthy diet and moderate regular physical activity, through actions strengthening individuals or community and improving living conditions. The control group received a one-shot medical information and nutritional advices. After the end of the trial (2003), 259 of the subjects participated in a follow-up study (2010– 2011). The outcomes were the nine-year changes from baseline in BW, body mass index (BMI) and WC measurements, separately. Statistical analyses were performed on an intention to treat basis, using available and imputed datasets. At inclusion, T2D risk factors were prevalent: family history of diabetes in first-degree relatives (42%), women with a personal history of gestational diabetes (11%), total obesity (43%, median BMI 29.1 kg/m²) and central obesity (71%). At follow-up, the adjusted effect on imputed dataset was significant for WC-2.4 cm (95% confidence interval:-4.7 to-0.0 cm, p = 0.046), non-significant for BW-2.2 kg (-4.6 to +0.2 kg, p = 0.073) and BMI-0.81 kg/m² (-1.69 to +0.08 kg/m², p = 0.074). A specific long-term effect was the increased likelihood of reduction in adiposity: BW loss, BMI reduction , and WC reduction were more frequent in the intervention group. In the context of low socio-economic communities, our data support the assumption of long-term effect of lifestyle interventions targeting total obesity and central obesity two major drivers of T2D

Structured self-management education maintained over two years in insufficiently controlled type 2 diabetes patients: the ERMIES randomised trial in Reunion Island.

International audienceABSTRACT: BACKGROUND: Self-management education programs can reduce the complications and mortality in type 2 diabetes. The need to structure these programs for outpatient and community care with a vision for long-term maintenance has been recognised. In Reunion Island, an area affected by epidemiological and nutritional transition, diabetes affects 18% of the adult population over 30 years, with major social disparities, poor glycaemic control and frequent cardiovascular complications. Methods/design ERMIES is a randomised controlled trial designed to test the efficacy of a long-term (2 years) structured group self management educational intervention in improving blood glucose in non-recent, insufficiently controlled diabetes. After an initial structured educational cycle carried out blind for the intervention arm, patients will be randomized in two parallel group arms of 120 subjects: structured on-going group with educational intervention maintained over two years, versus only initial education. Education sessions are organised through a regional diabetes management network, and performed by trained registered nurses at close quarters. The educational approach is theoretically based (socio-constructivism, social contextualisation, empowerment, action planning) and reproducible, thanks to curricula and handouts for educators and learners. The subjects will be recruited from five hospital outpatient settings all over Reunion Island. The main eligibility criteria include: age [greater than or equal to]18 years, type 2 diabetes treated for more than one year, HbA1c [greater than or equal to] 7.5% for [greater than or equal to]3 months, without any severe evolving complication (ischaemic or proliferative retinopathy, severe renal insufficiency, coronaropathy or evolving foot lesion), and absence of any major physical or cognitive handicap. The primary outcome measure is HbA1c evolution between inclusion and 2 years. The secondary outcome measures include anthropometric indicators, blood pressure, lipids, antidiabetic medications, level of physical activity, food ingestion, quality of life, social support, anxiety, depression levels and self-efficacy. An associated nested qualitative study will be conducted with 30 to 40 subjects in order to analyse the learning and adaptation processes during the education cycles, and throughout the study. CONCLUSION: This research will help to address the necessary but difficult issue of structuring therapeutic education in type 2 diabetes based on: efficacy and potential interest of organising on-going empowerment group sessions at close quarters over the long term, in a heterogeneous socioeconomic environment. Trial registration: ID_RCB number : 2011-A00046-35 Clinicaltrials.gov number: NCT01425866

: Exploitation des données de l’enquête transversale ERPPS-2021 à La Réunion

La Réunion est un territoire exposé depuis plusieurs décennies à une transition démographique, épidémiologique et nutritionnelle. D’après l’enquête santé européenne 2019 réalisée chez les personnes vivant à domicile (≥ 15 ans), 23-% de la population réunionnaise adulte présenterait un excès de sédentarité. Dans la perspective d’actions territorialisée basées sur la réduction des facteurs de risque, le comportement sédentaire apparaît comme un facteur modifiable de première importance. Notre objectif est de rechercher les déterminants individuels, sociaux et environnementaux de la sédentarité chez les Réunionnais.es de 15 ans et plus.La réponse à cet objectif s’appuie sur une approche méthodologique pluridisciplinaire combinant l’analyse statistique en santé et l’analyse spatiale. Les données utilisées sont celles de l’enquête régionale sur les pratiques physiques et sportives à La Réunion réalisée en septembre-décembre 2021 (ERPPS-2021), enrichies de bases environnementales (Filosofi, BD TOPO IGN, Base Permanente des Equipements, etc.).Cette enquête téléphonique transversale ponctuelle a fait l’objet d’un échantillonnage aléatoire à partir de la base de sondage Fidéli (Insee).Les analyses statistiques portent sur 2010 participants issus des 4 microrégions de l'île. L'exploitation des données déclaratives (comportements de santé, facteurs psychosociaux, conditions de vie et de travail, caractéristiques socio-économiques du lieu de résidence) et spatiales (facteurs environnementaux) est en cours.Il s’agit d’une approche originale, fondée sur des données probantes, à la frontière de l’épidémiologie sociale et de la géographie de la santé, qui laisse entrevoir des pistes en prévention primaire des maladies chroniques liées au mode de vie