Impact des inégalités sociales et de la pollution atmosphérique sur le risque d'issues défavorable de grossesse dans la cohorte mère-enfant PELAGIE : rôle du contexte urbain-rural

Pregnancy is a sensitive and critical period for the development of the child and the health of adults-to-be. The biological and physiological adaptation of the body dealing physical and psychosocial stressors during this period may exert its effects in adulthood (and possibly over several generations). This delayed toxicity presupposes intrinsically the need to study the effects of exposure to environmental risk factors during fetal life using a holistic approach involving risk factors at both the micro (individual characteristics) and the macro level (physical and psycho-social context). Given the heterogeneity of the Breton territory in which this work was conducted, we explored whether the impact of social inequalities and the physical environment (air pollution) on birth outcomes (fetal growth and the risk of prematurity) could be modified according to an urban or rural place of residence. This work was based on data collected as part of the Breton mother-child cohort PELAGIE, which had included 3421 pregnant women between 2002- 2006. The anthropometric parameters and gestational age at birth were measured by medical personnel at delivery. We defined urban and rural areas according to the definition of “urban units” from the National Census Bureau (INSEE). The annual concentrations of air pollution (nitrogen dioxide (NO2)) were estimated using a land-use regression modeled at a 100 m scale and developed as part of an European project. Finally, neighbourhood deprivation was estimated using a composite index developed at census blocks level and whose use was legitimated over both urban and rural areas. Neighbourhood deprivation was associated with an increased risk of infants with fetal growth restriction, only for women living in rural areas. We also observed an increased risk of preterm birth associated with NO2 concentrations > 16.4 μg.m-3, only among women residing in urban areas. The associations between air pollution and fetal growth, although sex-specific, did not seem on the other hand, to vary significantly according to the urban-rural spectrum. This work confirms the need to explore the influence of both social and environmental inequalities on intrauterine development, and to assess the role of place-based factors, such as the urban-rural context, in shaping these inequalities.La grossesse est une période sensible et déterminante pour le développement de l’enfant et l’état de santé à l’âge adulte. L'adaptation biologique et physiologique de l'organisme face à des « stresseurs » physiques et psychosociaux au cours de cette période peut ainsi exercer ses effets à l'âge adulte (et possiblement sur plusieurs générations). Cette toxicité différée suppose intrinsèquement la nécessité d’étudier les conséquences des expositions environnementales au cours de la vie foetale et ce suivant une approche holistique intégrant autant les facteurs de risque à des niveaux micro (caractéristiques individuelles) et macro (expositions physiques externes et contexte psycho-social). Etant donné l’hétérogénéité du territoire breton dans lequel s’inscrit ce travail de thèse, nous avons cherché à explorer l’impact des inégalités sociales et de l’environnement physique (pollution atmosphérique) sur l’issue de la grossesse (croissance foetale et risque de prématurité) indépendamment chez des femmes enceintes résidant dans des zones urbaines et rurales. Ce travail s’est appuyé sur les données issues de la cohorte bretonne mère-enfant PELAGIE, qui a inclus 3421 femmes enceintes entre 2002- 2006. Les paramètres anthropométriques et l’âge gestationnel à la naissance ont été renseignés à l’accouchement par le personnel médical. Le contexte urbain et rural breton a été caractérisé à partir de la définition des unités urbaines de l’INSEE. Les concentrations annuelles de pollution atmosphérique (dioxyde d’azote (NO2)) ont été modélisées à une échelle de 100 m à partir d’un modèle de "land-use regression" développé à l’échelle européenne. Enfin, le niveau socio-économique des IRIS a été estimé à l’aide d’un indice de désavantage social - construit à partir des données du recensement de l’INSEE et dont la validité et l’adaptabilité à des territoires à la fois urbains et ruraux a été examinée au préalable. Nos résultats suggèrent une influence délétère d’un contexte de vie socioéconomique défavorable sur la croissance intra-utérine, spécifiquement chez les femmes résidant en milieu rural. Nous avons également observé une augmentation du risque de prématurité associée à des niveaux > 16.4 μg.m-3 de NO2 dans l’air, à l’inverse, uniquement chez les femmes résidant dans des zones urbaines. Les associations entre l’exposition à la pollution atmosphérique et les marqueurs de la croissance intra-utérine, bien que sexe-spécifiques, ne semblent en revanche pas varier sensiblement suivant le gradient urbain-rural. Ce travail confirme la nécessité d’évaluer l’influence des inégalités sociales et environnementales sur le développement intra-utérin et de considérer l’importance et le rôle du contexte de vie, notamment urbain-rural, dans la formation de ces inégalités

Association between prenatal exposure to traffic-related air pollution and preterm birth in the PELAGIE mother–child cohort, Brittany, France. Does the urban–rural context matter?

International audienceIntroduction Evidence has accumulated that exposure to ambient air pollution during pregnancy may influence preterm birth (PTB) in urban settings. Conversely, this relation has barely been investigated in rural areas where individual characteristics (demographic, socioeconomic, and psychosocial factors) and environmental co-exposures may differ. Objective We examined the association between prenatal exposure to traffic-related air pollution and PTB among pregnant women from the PELAGIE mother–child cohort (Brittany, France, 2002–2006) living in urban (n=1550) and rural (n=959) settings. Methods Women’s residences were classified as either urban or rural according to the French census bureau rural–urban definitions. Nitrogen dioxide (NO2) concentrations at home addresses were estimated from adjusted land-use regression models as a marker of traffic-related pollution. Associations between NO2 concentrations and PTB were assessed with logistic regression models. Results Prevalence of PTB was similar among women living in urban (3.2%) and in rural (3.5%) settings. More positive socioeconomic characteristics and health behaviors but more single-parent families were observed among urban women. NO2 exposure averaged 20.8±6.6 µg m−3 for women residing in urban areas and 18.8±5.6 µg m−3 for their rural counterparts. A statistically significant increased risk of PTB was observed among women exposed to NO2 concentrations ≥16.4 µg m−3 and residing in urban areas but not among their rural counterparts. Discussion The results of this study, conducted in a region with interspersed urban–rural areas, are in line with previous findings suggesting an increased risk of PTB associated with higher NO2 concentrations for women living in urban areas. The absence of association among their rural counterparts for whom exposure levels were similar suggests that environmental mixtures and psychosocial inequalities might play a role in this heterogeneit

Impact of social inequality and air pollution on the risk of adverse birth outcomes in the mother-child cohort PELAGIE : role of urban-rural context

La grossesse est une période sensible et déterminante pour le développement de l’enfant et l’état de santé à l’âge adulte. L'adaptation biologique et physiologique de l'organisme face à des « stresseurs » physiques et psychosociaux au cours de cette période peut ainsi exercer ses effets à l'âge adulte (et possiblement sur plusieurs générations). Cette toxicité différée suppose intrinsèquement la nécessité d’étudier les conséquences des expositions environnementales au cours de la vie foetale et ce suivant une approche holistique intégrant autant les facteurs de risque à des niveaux micro (caractéristiques individuelles) et macro (expositions physiques externes et contexte psycho-social). Etant donné l’hétérogénéité du territoire breton dans lequel s’inscrit ce travail de thèse, nous avons cherché à explorer l’impact des inégalités sociales et de l’environnement physique (pollution atmosphérique) sur l’issue de la grossesse (croissance foetale et risque de prématurité) indépendamment chez des femmes enceintes résidant dans des zones urbaines et rurales. Ce travail s’est appuyé sur les données issues de la cohorte bretonne mère-enfant PELAGIE, qui a inclus 3421 femmes enceintes entre 2002- 2006. Les paramètres anthropométriques et l’âge gestationnel à la naissance ont été renseignés à l’accouchement par le personnel médical. Le contexte urbain et rural breton a été caractérisé à partir de la définition des unités urbaines de l’INSEE. Les concentrations annuelles de pollution atmosphérique (dioxyde d’azote (NO2)) ont été modélisées à une échelle de 100 m à partir d’un modèle de "land-use regression" développé à l’échelle européenne. Enfin, le niveau socio-économique des IRIS a été estimé à l’aide d’un indice de désavantage social - construit à partir des données du recensement de l’INSEE et dont la validité et l’adaptabilité à des territoires à la fois urbains et ruraux a été examinée au préalable. Nos résultats suggèrent une influence délétère d’un contexte de vie socioéconomique défavorable sur la croissance intra-utérine, spécifiquement chez les femmes résidant en milieu rural. Nous avons également observé une augmentation du risque de prématurité associée à des niveaux > 16.4 μg.m-3 de NO2 dans l’air, à l’inverse, uniquement chez les femmes résidant dans des zones urbaines. Les associations entre l’exposition à la pollution atmosphérique et les marqueurs de la croissance intra-utérine, bien que sexe-spécifiques, ne semblent en revanche pas varier sensiblement suivant le gradient urbain-rural. Ce travail confirme la nécessité d’évaluer l’influence des inégalités sociales et environnementales sur le développement intra-utérin et de considérer l’importance et le rôle du contexte de vie, notamment urbain-rural, dans la formation de ces inégalités.Pregnancy is a sensitive and critical period for the development of the child and the health of adults-to-be. The biological and physiological adaptation of the body dealing physical and psychosocial stressors during this period may exert its effects in adulthood (and possibly over several generations). This delayed toxicity presupposes intrinsically the need to study the effects of exposure to environmental risk factors during fetal life using a holistic approach involving risk factors at both the micro (individual characteristics) and the macro level (physical and psycho-social context). Given the heterogeneity of the Breton territory in which this work was conducted, we explored whether the impact of social inequalities and the physical environment (air pollution) on birth outcomes (fetal growth and the risk of prematurity) could be modified according to an urban or rural place of residence. This work was based on data collected as part of the Breton mother-child cohort PELAGIE, which had included 3421 pregnant women between 2002- 2006. The anthropometric parameters and gestational age at birth were measured by medical personnel at delivery. We defined urban and rural areas according to the definition of “urban units” from the National Census Bureau (INSEE). The annual concentrations of air pollution (nitrogen dioxide (NO2)) were estimated using a land-use regression modeled at a 100 m scale and developed as part of an European project. Finally, neighbourhood deprivation was estimated using a composite index developed at census blocks level and whose use was legitimated over both urban and rural areas. Neighbourhood deprivation was associated with an increased risk of infants with fetal growth restriction, only for women living in rural areas. We also observed an increased risk of preterm birth associated with NO2 concentrations > 16.4 μg.m-3, only among women residing in urban areas. The associations between air pollution and fetal growth, although sex-specific, did not seem on the other hand, to vary significantly according to the urban-rural spectrum. This work confirms the need to explore the influence of both social and environmental inequalities on intrauterine development, and to assess the role of place-based factors, such as the urban-rural context, in shaping these inequalities

S-325 Gendered occupational inequalities and health over lifetime: how can we work them in?

Introduction Major economic and social changes occurred over the last 50 years, such as the increased participation of women in the labour market and the development of non-standard forms of employment. These trends question the importance of work/employment conditions in the shaping of social inequalities in health over the life course. We thus hypothesize that (1) precarious occupational trajectories may contribute to ill health in adulthood, and that (2) they may affect genders differently. Methods We used the French SIP (Santé Itinéraire Professionnel) national survey that collected information on occupational career and major health events of people aged 40–74 in 2006. We described poor employment conditions in terms of job instability, career discontinuity, qualification trends and versatility. We then applied multiple correspondence analysis and hierarchical ascending classification to identify patterns reflecting the accumulation of precarious employment conditions over job histories. Finally, we quantified the association between the type of occupational trajectory and self-reported health (Mini European Health Module) through multivariate logistic regression. Results We included more than 9500 participants of working-age or < 5 -years retirees at the time of the survey. The classification showed that women were over-represented among most precarious trajectories. We also found that people with precarious trajectories more often reported less than good self-perceived health, currently experiencing longstanding illness or health problem, and activity limitation due to health problems. The trend of increasing ill health across work trajectories (stable/qualified/continuous trajectories serving as a reference) was similar among men and women, although adjusted ORs were slightly higher among women. Conclusion We bring evidence that women experienced more precarious employment trajectories in France over the last decades than did men, with similar health outcomes among men and women. We now seek to expand our gendered perspective by taking into account hazardous working conditions as a potential mediating pathway

Gendered precarious employment trajectories and self-reported health outcomes: a retrospective study in France [presented at an ISEE annual meeting]

International audienceBackground and aim: As precarious employment has been prevalent since the mid-1970s in high-income countries, it emerged as a social determinant of health, with potentially different health consequences for men and women. In France, unemployment and temporary employment have been high since the early 2000s. Our objective was to investigate the gendered influence of precarious employment trajectories on health outcomes in the French context. Methods: We used a retrospective national survey (4445 men, 5371 women) to create patterns of employment trajectories by sex, using multiple correspondence analysis followed by hierarchical ascendant clustering. We considered five dimensions of precariousness: unemployment (%), inactivity (%), frequency of job changes, qualification trend, and versatility of duty. We then explored the associations between the trajectory patterns and four health outcomes (self-perceived health, chronic morbidity, activity limitations and depression) through multivariate logistic regression, taking the most continuous, stable, and skilled trajectories as the reference. Results: Five patterns of employment trajectories were observed in each sex, with some specificities. Highly precarious trajectories concentrated in one cluster in both men (19%) and women (10%) ; they were associated with worse self-perceived health (OR_men=1.34, 95%CI [1.00;1.80] ; OR_women=1.56, 95%CI [1.22;1.99]), and more activity limitations (OR_men=1.52, 95%CI [1.05;2.20] ; OR_women=1.40, 95%CI [1.05;1.88]) as compared to the stable pattern. In women, high precarity was also associated with depression (OR_women=1.37, 95%CI [1.09;1.73]), while those who experienced a sex-specific inactivity pattern (24% of women) or long-lasting low-skill pattern (22%) only reported worse self-perceived health. Men experiencing a sex-specific medium precarity pattern (15%) reported more chronic morbidity and activity limitations than in the stable trajectory. Conclusions: Different patterns of employment trajectories were found in men and women. The precarious patterns were also associated with different adverse health outcomes depending on gender. Ongoing analysis will further address potential mediation through working conditions

0192 Professional trajectory is associated with multiple carcinogenic exposures at work among men : data from a cohort of patients suffering respiratory cancer

International audienceOBJECTIVES: Social position and social mobility are associated with cancer incidence and mortality, yet little is known about their association with mediating factors such as occupational exposures to carcinogens. Our aim was to assess the association between the type of professional trajectory and multiple occupational exposure profiles. METHOD: Data were extracted from the Giscop93 study (n = 1 009), which is a cohort of cancer patients with (mainly) respiratory tumours. Job histories were reconstructed through interview, then a multi-disciplinary expert group examined the probability of occupational exposure to a list of 54 potentially carcinogenic agents. The typology of professional trajectories was built based on employment stability, employment continuity, job qualification trend, and multiple skills through Multiple Correspondence Analysis followed by Ascending Hierarchical Classification. Association with multiple-exposure profiles was then assessed through multiple logistic regression. RESULTS: Men and women differed in terms of predominant job category over the lifecourse (68,2% of blue-collar-workers among men, 57,3% of employees among women, p \textless 0.0001). Professional trajectories were grouped in four classes as "stable qualified, employee" (21,3%), "stable manual, independent blue-collar-worker" (24,4%), "stable tiring, no gain in qualification" (30,5%), and "very unstable, precarious" (23,8%). Among men, the last two categories were associated with exposure to at least five different occupational carcinogens (ORstable_tiring/stable_qualified=2,0 [1,3;3,1], ORvery_unstable/stable_qualified=2,6 [1,6;4,2]). No such association was found among women. CONCLUSIONS: The association found between the type of professional trajectory and multiple occupational exposures among men should be replicated among people not suffering cancer. Forthcoming analysis will investigate the gendered differences observed

Multi-exposition aux cancérogènes professionnels : profils genrés. Résultats à partir d’une cohorte de patients atteints de cancers broncho-pulmonaires en Seine-Saint-Denis

ContexteDiverses initiatives nationales et internationales ont permis d’estimer l’exposition de la population à des cancérogènes en milieu professionnel. Cependant, tant les approches méthodologiques que le nombre restreint d’agents pris en compte sont de nature à sous-estimer les situations de multi-exposition, hier comme aujourd’hui. L’objectif de cette étude est de caractériser la multi-exposition parmi des patients atteints de cancers pouvant avoir une origine professionnelle, en se plaçant au niveau des postes de travail et en partant d’une liste étendue de cancérogènes.MéthodesLes données issues de l’enquête du GISCOP93, conduite chez des patients atteints de cancer principalement pulmonaires, ont été utilisées afin de décrire semi-quantitativement, séparément chez les hommes et les femmes, l’exposition aux cancérogènes des postes expertisés à partir d’une liste de 54 agents (ou groupe d’agents) cancérogènes. Ces expositions ont ensuite été confrontées aux caractéristiques des postes (modèle de poisson avec variance robuste). Des analyses multidimensionnelles ont été réalisées afin d’identifier des profils de cancérogènes fréquemment associés sur les postes multi-exposés.RésultatsRespectivement 61,1 % et 26,7 % des postes occupés par des hommes (834 patients, 5202 postes expertisés) et des femmes (183 patientes, 885 postes expertisés) ont été exposés à au moins un cancérogène. La multi-exposition concerne également les 2/3 des postes exposés chez les hommes (2173 postes exposés à au moins deux cancérogènes) et 1/3 chez les femmes (82 postes). Chez les hommes, les postes d’ouvriers avaient un risque trois à quatre fois plus important d’être exposés comparativement aux employés. Chez les femmes, les postes d’ouvrières dans la métallurgie et la mécanique ainsi que ceux de la confection étaient également de deux à trois fois plus souvent exposés que les postes d’employées. Huit profils de postes multi-exposés associant des cancérogènes communs ont été identifiés chez les hommes : multi-exposition courante ; courante à dominante silice ; métaux lourds et produits de combustion ; composés organiques ; travaux sur métaux ; solvants et métaux lourds ; bois, formol et pesticides ; carburants. Trois profils ont été dégagés chez les femmes : multi-exposition aux composés biologiques et organiques ; travaux sur métaux ; carburants.ConclusionCes résultats provenant d’une enquête considérant le cancer comme un événement sentinelle vis-à-vis des expositions cancérogènes viennent attester d’une multi-exposition genrée aux cancérogènes professionnels, en décalage frappant avec la réalité d’un système de réparation fondé sur une conception mono-factorielle de la cancérogenèse

5. De la reconstitution des parcours de travail à la reconnaissance en maladie professionnelle : enseignements du dispositif d’enquête du Giscop931 sur la question des multiexpositions cancérogènes:

Version ebook paru en 2021, livre paru initialement en 2015

Do Women and Men Have the Same Patterns of Multiple Occupational Carcinogenic Exposures? Results from a Cohort of Cancer Patients

International audienceComplex exposure situations are frequent at the workplace, but few studies have characterized multiple occupational carcinogenic exposures (MOCE) and their gendered differences across jobs’ characteristics. We assessed MOCE separately in male and female jobs and identified patterns of MOCE at job level. Participants (834 men and 183 women) were cancer patients recruited between March 2002 and December 2010 in the ongoing SCOP93 cohort study, Seine-Saint-Denis department, France. Job histories were collected through personal interviews, and carcinogenic exposures were assessed by a multidisciplinary expert committee using a list of 53 carcinogens. Proportion of MOCE (i.e. ≥2 carcinogens) was assessed for male and female jobs separately. Principal component analysis combined with hierarchical ascendant classification was used to identify patterns of MOCE. Among the 5202 male jobs and 885 female jobs, respectively 42 and 9% were multi-exposed. Blue-collar workers and jobs in the construction and industry sectors had the highest rates of MOCE, contrasting with jobs held in recent periods (≥1997) and by patients aged ≥45 years at job start. A gradient of MOCE was also observed according to occupational segregation for both men and women. Eight patterns of MOCE were identified among male jobs: widespread carcinogens, mixed silica dust, heavy metals/combustion products, organic compounds/radiation, metal working, solvents/heavy metals, wood dust/formaldehyde/pesticides, and fuel exhausts. Three patterns of MOCE were found among female jobs: biological/organic compounds, industrial working, and fuel exhausts. Some patterns of MOCE were job-specific, whereas other patterns were found across different occupations. These results suggest that patterns of MOCE partly differ between men and women. They stress the importance of gendering multiple exposure assessment studies and point out the inadequacy of occupational disease compensation systems based on a single factor and non-gendered approach of carcinogenesis, ignoring differences between men and women in complex occupational exposure situations

Precarious employment trajectories and health: combining qualitative and quantitative approaches based on a patient cohort to study the association at the population level

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