INFLUENCE OF VULNERABILITY AND RESILIENCE ON INCIDENCE OF CORONARY HEART DISEASE, A STUDY AT FINE GEOGRAPHIC SCALE
Keywords:cardiovascular disease, multiple exposure, composite index, resilience, environmental health determinants
University of Lille, IMT Lille Douai, Yncrea Hauts-de-France ULR 4515 – LGCgE, F-59000 Lille, France
Univ. Lille, CHU Lille, Institut Pasteur de Lille, Inserm UMR1167 RID-AGE (Risk Factors and Molecular Determinants of Aging-Related Diseases), F-59000 Lille, France
Univ. Lille, CHU Lille, ULR 2694 – METRICS, F-59000 Lille, France
Background: Cardiovascular disease is the leading cause of death and disability worldwide. Certain risk factors are modifiable (smoking, diabetes, …) whereas others not (genetic predispositions, age, …). Environmental conditions are also a recognized risk factor, and among them air pollution is the one for which the strongest links have been demonstrated. However, a holistic description of territory characteristics needs to go beyond solely vulnerability, i.e. the determinants that have a negative impact on health to which populations are subjected. Although the positive impact of surrounding environment is more and more considered, studies mainly focus on greenspaces accessibility for CVD.
Aim: The purpose of the study is to investigate at a fine geographic scale the relationship between multiple facets of territorial characteristics and the incidence of CHD.
Methods: In light of the diversity of the health determinants involved, two spatialized composite indices have been constructed to combine different indicators that measure and transcribe the multifaceted issues of environmental health. The theoretical framework relies on data collected from public and national database providers. Vulnerability and resilience indices have thus been developed in order to appraise the association between the cumulative constraints and nuisances (air pollution, noise, …), the capacity of a territory to cope with health inequalities (greenspaces, healthcare systems, natural resources…) and the incidence of CHD. CHD data for the Lille urban area were obtained from the French WHO-MONICA population-based CHD registry. Standardized incidence ratios (SIR) were computed to assess the spatial distribution of CHD (ratio between the observed number of cases and the expected number after indirect standardization of age and gender, confounding factors in CHD).
Results: The Lille urban area presents a strong and significant spatial heterogeneity of CHD incidence. High pollution areas mainly located along main roads tend to overlap with high incidence rates. Low pollution areas for their part are generally detected in rural territories where the incidence rate of CHD tend to be lower.
Conclusion(s): This study provides a better understanding of the dynamics of environmental and social inequalities in health at the neighborhood level. This could help to implement specifically tailored public health policies.
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