Building spatial composite indicators to analyze environmental health inequalities on a regional scale.

BACKGROUND: Reducing health inequalities involves the identification and characterization of social and exposure factors and the way they accumulate in a given area. The areas of accumulation then allow for prioritization of interventions. The present study aims to build spatial composite indicators based on the aggregation of environmental, social and health indicators and their inter-relationships. METHOD: Preliminary work was carried out firstly to homogenize spatial coverage, and secondly to study spatial variation of environmental (EI), socioeconomic (SI) and health (HI) indicators. The aggregation of the different indicators was performed using several methodologies for which results and decision-makers' usability were compared. RESULTS: Four methodologies were tested: 1) A simple summation of normalized HI, EI and SI indicators (IC), 2) the sum of the normalized HI, EI and SI indicators weighted by the first principal component of a Principal Component Analysis (IC PCA), 3) the sum of normalized and weighted indicators of the first principal component of Local Principal Component Analysis (IC LPCA), and 4) the sum of normalized and weighted indicators of the first principal component of a Geographically Weighted Principal Component Analysis (IC GWPCA). CONCLUSION: The GWPCA is particularly adapted to taking into account the spatial heterogeneity and the spatial autocorrelation between SI, EI and HI. This approach invalidates the basic assumptions of many standard statistical analyses. Where socioeconomic indicators present high deprivation and where they are associated with potential modifiable health determinants, decision-makers can prioritize these areas for reducing inequalities by controlling the socioeconomic and health determinants.

Risk assessment of second primary cancer according to histological subtype of non-Hodgkin lymphoma.

Non-Hodgkin lymphoma (NHL) represents a heterogeneous group of diseases that are known to carry a considerable risk of second primary cancer (SPC). However, little attention has been paid to SPC risk assessment according to NHL subtypes. Data from 10 French population-based cancer registries were used to establish a cohort of 7546 patients with a first diagnosis of NHL (eight subtypes) between 1989 and 2004. Standardized incidence ratios (SIRs) of metachronous SPC were estimated. Among the 7546 patients diagnosed with a NHL, the overall SPC risk was 25% higher than that in the reference population (SIR = 1.25, 95% confidence interval 1.15-1.36). In univariate analysis, the SPC risk differed by lymphoma subtype. Interestingly, multivariate analysis showed that SPC risk did not differ significantly across NHL subtypes after adjustment for the other covariates (p = 0.786). Patients with NHL have an increased risk of SPC that is not influenced by the histological NHL subtype.

Healthy by law: heading towards a brave new world?

The law is a tool used by Government to protect public health. Health is an omnipresent preoccupation, inviting each one of us to protect ourselves against potential risks at all times and in all places. The right to health protection is a source of benefit entitlements and rights-obligations that render it effective. However, believing that the law can and should regulate all sectors of human life, still a utopian belief. International law suffers from intrinsic weaknesses that limit its effectiveness. The current economic context has lead to stricter controls over healthcare expenditure faced with the ever-growing demand for treatment, limiting the right to healthcare protection. Through health law, the State has developed controls over individuals. Individual liberties tend to be limited to the cause of the public health policy. Healthy by law, raises a question: are we heading towards a brave new world as described by Aldous Huxley?