| Titre : | Social inequalities in infant mortality related to congenital anomalies: a population-based study in Paris |
| Titre original: | Inégalités sociales dans la mortalité infantile liée aux anomalies congénitales : une étude à partir du registre des anomalies congénitales de Paris |
| Auteurs : | Bermet Amirova ; Ecole des hautes études en santé publique (EHESP) (Rennes, FRA) |
| Type de document : | Mémoire |
| Année de publication : | 2025 |
| Description : | 46p. |
| Langues: | Anglais |
| Classement : | MPH/ (Mémoires MPH à partir de 2024) |
| Mots-clés : | Malformation ; Dépistage anténatal ; Inégalité sociale ; Mortalité infantile ; Parcours de soins ; Avortement thérapeutique |
| Résumé : |
Background : Congenital anomalies (CAs) are a major cause of infant mortality. Despite universal prenatal care in France, social inequalities in CA outcomes may persist. This study aimed to: (1) assess socio-spatial disparities in CA prevalence and infant mortality; (2) examine associations between socioeconomic status (SES) and antenatal detection, termination of pregnancy for fetal anomaly (TOPFA), and live birth.
Methods : Data came from the Paris congenital anomaly registry (remaPAR) covering 2019–2022. Maternal addresses were geocoded to the IRIS level and linked to census data. A deprivation index (P-FDep) was constructed using principal component analysis. First, we estimated crude odds ratios (cOR) for risk of CA prevalence and infant mortality across deprivation quintiles using a census-based control population. We then estimated relative risks (RR) adjusted for individual SES variables (maternal occupation, insurance status, geographic origin) using Poisson regression models to assess the association between SES and key outcomes. Results : Compared to the least deprived area (Q1), CA prevalence (cOR = 1.25, 95% CI: 1.11–1.40) and infant mortality (cOR = 3.70, 95% CI: 1.50–9.11) were higher in the most deprived areas (Q5). The antenatal detection rate was 71.2%, but it was significantly lower among women of sub-Saharan African origin (aRR = 0.85, 95% CI: 0.78–0.93). Among detected cases, women with no defined occupation (aRR = 0.73, 95% CI: 0.60–0.90) and those of North African (aRR = 0.85, 95% CI: 0.72–1.01) or sub-Saharan African origin (aRR = 0.81, 95% CI: 0.66– 0.99) were less likely to terminate, contributing to higher proportions of live births in these groups. P-FDep was associated with all outcomes in unadjusted models, but these associations were attenuated after adjustment. Conclusion : This study highlights social differences across the CA care pathway, which reflect both structural factors and variations in prenatal decision-making. Further research is needed to assess causal pathways and the contribution of each care stage to infant mortality. |
| Diplôme : | Master MPH of public health |
| Plan de classement simplifié : | Master of Public Health - master international de Santé Publique (MPH) |
| En ligne : | https://documentation.ehesp.fr/memoires/2025/mph/bermet_amirova.pdf |
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