Afin de considerer la diversite des plaintes sanitaires exprimees par la population riveraine d'une plateforme industrielle chimique, situee a Salindres dans le Gard (France), une etude epidemiologique cible des indicateurs de la sante percue. L'objectif est de comparer l'etat de sante percue de cette population a celui de la population generale nationale prise comme reference.

Smoking is a major preventable cause of cancers and is increasingly concentrated among the most deprived individuals leading to increasing socioeconomic inequalities in the incidence of cancers linked to smoking. We aimed to estimate the tobacco‐attributable cancer burden according to socioeconomic position in France. The analysis was restricted to cancer sites for which tobacco smoking was recognized as a risk factor. Cancer cases by sex, age group and European Deprivation Index (EDI) among people aged 30–74 between 2006 and 2009 were obtained from cancer registries covering ∼20% of the French population. The tobacco‐attributable burden of cancer according to EDI was estimated applying the population attributable fraction (PAF) computed with the Peto‐Lopez method. The PAF increased from 56% in the least deprived EDI quintile to 70% in the most deprived EDI quintile among men and from 26% to 38% among women. In total, 28% of the excess cancer cases in the four most deprived EDI quintiles in men and 43% in women could be prevented if smoking in these 4 EDI quintiles was similar to that of the least deprived EDI quintile. A substantial smoking‐attributable burden of cancer by socioeconomic position was observed in France. The results highlight the need for policies reducing tobacco consumption. More comprehensive interventions integrating the various dimensions of health determinants and proportionate according to socioeconomic position may essentially contribute to the reduction of socioeconomic inequalities in cancer.

Les effets à long terme de la pollution atmosphérique (PA) sur la mortalité ont été démontrés dans de nombreux pays. En France, ces données sont peu fréquentes. L’objectif de l’étude était d’évaluer le lien entre 25 ans d’exposition à la PA et le risque de mortalité toutes causes non accidentelles et pour causes cardiovasculaires et respiratoires à partir des données de la cohorte française Gazel. L’échantillon de l’étude était composé de 20 327 adultes volontaires travailleurs d’EDF-GDF suivis de 1989 à 2013. L’exposition annuelle aux PM10, PM2,5, NO2, O3, SO2 et benzène a été évaluée au lieu de résidence des participants en utilisant un modèle de chimie transport en prenant en compte le calendrier résidentiel. Les excès de risques, exprimés en hazard ratio (HR), ont été estimés à l’aide d’un modèle de régression à risques proportionnels de Cox en ajustant sur les facteurs de confusion potentiels individuels et contextuels. Les HR ont été calculés pour une augmentation de l’intervalle interquartile de la distribution des concentrations des polluants. Le nombre de décès survenus en fin de période était de 1967 (9,7 %) pour la mortalité toutes causes non accidentelles, 165 (0,8 %) pour causes cardiovasculaires et 284 (1,4 %) pour causes respiratoires. Une exposition à long terme aux PM2,5, PM10–25, NO2 et benzène était associée à une augmentation de la mortalité non accidentelle lorsque l’exposition était prise en compte à l’inclusion. Pour les PM2,5, le HR était de 1,09 (intervalle de confiance [IC] 95 % : 0,99–1,20) pour une augmentation de 5,9 μg/m3 ; pour les PM10−25, HR = 1,09 (IC 95 % : 1,04–1,15) pour une augmentation de 2,2 μg/m3 ; pour le NO2, HR = 1,14 (IC 95 % : 0,99–1,31) pour une augmentation de 19,3 μg/m3 ; et pour le benzène, HR = 1,10 (IC à 95 % : 1,00–1,22) pour une augmentation de 1,7 μg/m3. L’association la plus forte était observée pour les PM10, HR = 1,14 (IC 95 % : 1,05–1,25) pour une augmentation de 7,8 μg/m3. Aucune association n’a été observée entre l’exposition à long terme à la PA et la mortalité cardiovasculaire et respiratoire. Une exposition à long terme aux particules fines, dioxyde d’azote, dioxyde de soufre et benzène est associée à un risque accru de mortalité non accidentelle en France. Nos résultats sont concordants avec les données existantes de la littérature et confirment que la pollution de l’air extérieur est un important facteur de risque environnemental de mortalité.

Purpose of the study. In addition to their daily activity i.e. health risk assessment, monitoring and research, health agencies seek to anticipate future risks to human health. The tools used routinely are watch and foresight. This article describes a project led by a consortium of agencies and research institutions in France, aiming at combining watch and foresight. Sustainable development and its health implications were chosen by the panel.Method. To describe the implementation of sustainable development in France in the next twenty years, a foresight exercise was performed, which led to the following five scenarios: (a) priority without limits to growth; (b) from the technological dead end to social fragmentation; (c) liberalism and green technology; (d) sobriety and low technology; (e) ecological transition orchestrated by the state. In a second step, one hundred risks related "events" were identified through a watch activity and analyzed by projecting them into the future, according to the five scenarios. The events transcribed as "mini stories" were not necessarily considered in the scenarios as they frame a more global vision.Results. This activity evidenced a variety of views, between panel members; this advocates for a collective approach. Risks to human health identified and discussed in the panel included those related e.g. to multi-recycling, agricultural practices, new dietary patterns, green jobs frequently characterized by multiple exposures, and the effect of certain technological innovations. These risks are often common to several scenarios and show various levels of impact on health. (C) 2016 Elsevier Masson SAS. All rights reserved.

Le délai de mis en œuvre du traitement des cancers après le diagnostic est un facteur relativement important à la survie du patient. Cette étude vise à mesurer les délais d'accès au traitement, après la bronchoscopie, chez les patients atteints de cancer du poumon lequel occupe le premier rang des décès dus au cancer en France. Les séjours du PMSI pour cancer du poumon de 2009-2010 ont été sélectionnés grâce au code CIM10 de diagnostic (C33-C34) et chaînés avec ceux des trois années antérieures via un identifiant anonyme individuel dans le but d'exclure les séjours prévalents. Le parcours thérapeutique des patients, ayant bénéficié d'une bronchoscopie, a été reconstitué. Les informations correspondant aux premiers actes chirurgicaux et aux premiers et derniers actes adjuvants après la bronchoscopie ont été retenues pour l'analyse des délais. Au total, 14 596 patients ont été sélectionnés. L'âge moyen était de 63,6 ans (±10,6). Le traitement reposait exclusivement sur la chimiothérapie et/ou la radiothérapie chez plus de 75 % des patients. Le délai médian d'accès au premier traitement était de 34 jours. Il augmentait selon l'âge (p < 0,0001). Chez les patients avec un parcours non chirurgical, le délai médian d'accès à la chimiothérapie et à la radiothérapie était respectivement de 33 et 50 jours. Chez les patients avec un parcours chirurgical, le délai médian d'accès à la chirurgie était de 44 jours. Le délai médian d'accès au premier traitement était faible dans les régions du sud et de l'est et élevé dans le nord et dans les départements d'outre-mer. À notre connaissance, cette étude est la première réalisée en France au niveau national, y compris les départements d'outre-mer. Elle permet d'envisager une production en routine des indicateurs d'accès au traitement des personnes atteintes de cancer du poumon et d'aider les décideurs politiques à mieux planifier les soins spécifiques à ce cancer et à améliorer les délais d'accès aux différents traitements.

EnglishThe broad dissemination of information technology and the use of the Internet in very varied fields, both professional and personal, has triggered an unprecedented rush to collect data of all kinds. This data, personalized or pooled, makes up what today we call “big data”, a mass of highly diverse information that can be used for many and varied purposes, depending on the motivations of the companies or bodies exploiting it. In the health sector, the exploitation of big data is a source of both hope (since it may improve the understanding and solution of medical problems) and dangers (excessive monitoring of individual behaviour, ethical questions etc.), and it is important to bear this in mind if society is to gain optimal benefit from the use of this data. Daniel Eilstein and Jerome Pozuelos offer an overview here of the data gathered in France today with regard to health, how that data is processed, and the questions raised by the protection of personal data. They also show the perspectives opened up in the medical field by the use of such mass data (particularly through what is called data cross-referencing). Here again, research will have to find a solution to the freedom/security dilemma but, provided certain ethical conditions are respected, some noteworthy advances may well eventuate. francaisLa large diffusion des technologies de l’information et de l’utilisation d’Internet dans des domaines tres varies, au niveau tant professionnel que personnel, a ouvert une course sans precedent a la collecte de donnees en tout genre. Ces donnees, personnelles ou mutualisees, constituent ce que l’on appelle aujourd’hui le « big data », une somme d’informations tres diverses susceptibles d’etre utilisees a de multiples fins selon les motivations des entreprises ou organismes exploitant ces donnees de masse. Dans le secteur de la sante, l’exploitation du big data est une source a la fois d’espoirs (car susceptible d’ameliorer la comprehension et la resolution de problemes medicaux) et de risques (controle demesure des comportements individuels, questions ethiques…), qu’il est important d’avoir a l’esprit pour garantir une utilisation optimale, pour la societe, de ces donnees. Daniel Eilstein et Jerome Pozuelos presentent ici un etat des lieux des donnees aujourd’hui recueillies en France en matiere de sante, du traitement qui en est fait, des questions soulevees par la protection des donnees personnelles. Ils montrent aussi les perspectives ouvertes, dans le domaine medical, par l’exploitation de telles donnees de masse (en particulier ce que l’on appelle le croisement de donnees). La aussi, la recherche devra composer avec le dilemme liberte-securite, mais sous reserve du respect de certaines limites ethiques, des avancees notables pourraient advenir.

Objectif : La veille sanitaire est réactive et sans réel recul sur le traitement des signaux et des alertes au risque de ne pas voir venir des modifications profondes à fort impact sur la santé, à moyen ou long terme. Pour anticiper, l’Institut de veille sanitaire a exploré une démarche de veille prospective. Méthodes : Les étapes étaient : 1˚) Sélection de facteurs déterminants pour la santé, 2˚) Identification de variables clés issues des déterminants. Les variables classées en trois groupes (facteurs déclencheurs d’événements de santé, de diffusion et de réponses) faisaient l’objet d’hypothèses d’évolution future, 3˚) Identification, dans les trois groupes, de microscénarios à partir des hypothèses sur les variables, 4˚) Construction de macroscénarios à partir de trois microscénarios issus des trois groupes et 5˚) Identification d’enjeux et de besoins pour l’avenir de la santé publique. Résultats : Vingt-deux variables-clés, 17 microscénarios et cinq macroscénarios ont été identifiés. Les enjeux portent sur les inégalités sociales et territoriales de santé, les fardeaux pour la santé, les responsabilités individuelle et collective face à la santé, les aspects éthiques, les phénomènes émergents, le « Big data » et la fouille de données, les nouvelles technologies de santé, l’emboîtement d’échelles d’analyse. Conclusions : La démarche éclaire les choix de programmation d’un institut de santé publique, en particulier pour la veille et la surveillance. Décrire les futurs possibles et les éléments orientant vers un scénario plutôt qu’un autre peut aider à orienter les choix vers un (ou des) avenir(s) plus favorables pour la santé.

Background: Health surveillance is a reactive process, with no real hindsight for dealing with signals and alerts. It may fail to detect more radical changes with a major medium-term or long-term impact on public health. To increase proactivity, the French Institute for Public Health Surveillance has opted for a prospective monitoring approach.Methods: Several steps were necessary: 1) Identification of public health determinants. 2) Identification of key variables based on a combination of determinants. Variables were classified into three groups (health event trigger factors, dissemination factors and response factors) and were submitted to future development assumptions. 3) Identification, in each of the three groups, of micro-scenarios derived from variable trends. 4) Identification of macro-scenarios, each built from the three micro-scenarios for each of the three groups. 5) Identification of issues for the future of public health.Results: The exercise identified 22 key variables, 17 micro scenarios and 5 macro-scenarios. The topics retained relate to issues on social and territorial health inequalities, health burden, individual and collective responsibilities in terms of health, ethical aspects, emerging phenomena, 'Big data, data mining, new health technologies, interlocking of analysis scales.Conclusions: The approach presented here guides the programming of activities of a health safety agency, particularly for monitoring and surveillance. By describing possible future scenarios, health surveillance can help decision-makers to influence the context towards one or more favourable futures.

Background: Health surveillance is a reactive process, with no real hindsight for dealing with signals and alerts. It may fail to detect more radical changes with a major medium-term or long-term impact on public health. To increase proactivity, the French Institute for Public Health Surveillance has opted for a prospective monitoring approach.Methods: Several steps were necessary: 1) Identification of public health determinants. 2) Identification of key variables based on a combination of determinants. Variables were classified into three groups (health event trigger factors, dissemination factors and response factors) and were submitted to future development assumptions. 3) Identification, in each of the three groups, of micro-scenarios derived from variable trends. 4) Identification of macro-scenarios, each built from the three micro-scenarios for each of the three groups. 5) Identification of issues for the future of public health.Results: The exercise identified 22 key variables, 17 micro-scenarios and 5 macro-scenarios. The topics retained relate to issues on social and territorial health inequalities, health burden, individual and collective responsibilities in terms of health, ethical aspects, emerging phenomena, ‘Big data’, data mining, new health technologies, interlocking of analysis scales.Conclusions: The approach presented here guides the programming of activities of a health safety agency, particularly for monitoring and surveillance. By describing possible future scenarios, health surveillance can help decision-makers to influence the context towards one or more favourable futures.

Background: Time-to-treatment of cancer is becoming a serious political and social issue. A greater understanding of the timeframes involved in cancer care is needed to reduce inequalities in access to care caused by delays.Objective: To describe time delays in each phase of lung cancer treatment after bronchoscopy.Method: Using the international classification of diseases and medical procedures codes, from national hospital discharge database we selected patients newly diagnosed for Lung cancer in 2009-2010 who had undergone treatment.Results: We included 14,596 patients. Median times from bronchoscopy to 1) neo-adjuvant chemotherapy and to surgery in patients with surgical pathway were 34d (Q25 =22; Q75 =47) and 44d (Q25 = 26; Q75 = 82), respectively, 2) chemotherapy and to radiotherapy in patients with non-surgical pathway, were 33d (Q25 =22; Q75 = 49) and 88d (Q25 = 46; Q75 =162) respectively, 3) first treatment irrespective of pathway and treatment combination was 34d (Q25 = 22; Q75 = 50). Time to first treatment was significantly higher with age and with the status of the first care center. It was longer in most northern regions and in overseas districts and shorter in southern and eastern regions of the country.Conclusion: To our knowledge, this is the first study based on medico-administrative database describing time to first treatment after bronchoscopy in patients suffering from lung cancer in France. It could inform decision-making on guidelines on times to access lung cancer treatment. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

Introduction: Long-term exposure to air pollution (AP) has been shown to have an impact on mortality in numerous countries, but since 2005 no data exists for France.Objectives: We analyzed the association between long-term exposure to air pollution and mortality at the individual level in a large French cohort followed from 1989 to 2013.Methods: The study sample consisted of 20,327 adults working at the French national electricity and gas company EDF-GDF. Annual exposure to PM10, PM10-2.5, PM2.3, NO2, O-3, SO2, and benzene was assessed for the place of residence of participants using a chemistry-transport model and taking residential history into account. Hazard ratios were estimated using a Cox proportional-hazards regression model, adjusted for selected individual and contextual risk factors. Hazard ratios were computed for an interquartile range (IQR) increase in air pollutant concentrations.Results: The cohort recorded 1967 non-accidental deaths. Long-term exposures to baseline PM2.3, Phil(10-25), NO2 and benzene were associated with an increase in non-accidental mortality (Hazard Ratio, HR = 1.09; 95% Cl: 0.99, 120 per 5.9 mu g/m(3), PM10-25; HR = 1.09; 95%CI: 1.04, 1.15 per 2.2 mu g/m(3), NO2: HR = 1.14; 95% CI: 0.99, 131 per 19.3 mu g/m(3) and benzene: HR= 1.10; 95% CI: 1.00, 122 per 1.7 mu g/m(3)).The strongest association was found for PM10: HR = 1.14; 95% CI: 1.05, 125 per 7.8 mu g/m(3). PM10, PM10-25 and SO2 were associated with non-accidental mortality when using time varying exposure. No significant associations were observed between air pollution and cardiovascular and respiratory mortality.Conclusion: Long-term exposure to fine particles, nitrogen dioxide, sulfur dioxide and benzene is associated-with an increased risk of non-accidental mortality in France. Our results strengthen existing evidence that outdoor air pollution is a significant environmental risk factor for mortality. Due to the limited sample size and the nature of our study (occupational), further investigations are needed in France with a larger representative population sample. (C) 2015 Elsevier Ltd. All rights reserved.

Le perimetre de l'exercice decrit dans ce rapport est l'« impact sanitaire sur la population du au developpement de technologies vertes ». La definition retenue pour les technologies vertes est celle du ministere en charge de l’environnement : « Les technologies vertes mesurent, previennent, limitent ou corrigent les dommages environnementaux a l’eau, l’air et le sol et les problemes lies aux dechets et aux ecosystemes». L’horizon temporel prospectif, defini pour cet atelier, est de 20 ans. Ce rapport decrit trois activites menees par un groupe de travail, a l'interface veille et prospective. - Un exercice de prospective fonde sur la methode des scenarios. Il s’agissait de construire cinq scenarios fournissant autant de cadres de reference pour stimuler la reflexion sur les risques sanitaires. A chacun de ces scenarios, on peut associer une typologie de risque sanitaire. On a donc parfois volontairement « force le trait » pour faire apparaitre des situations contrastees, fournissant de la matiere pour la reflexion sur les risques. - Une action de veille dans le perimetre de l’exercice. Un peu plus de 700 « elements » ont ete rassembles. - Une recherche sur la maniere de coupler « veille et cadres de references scenarios ».

The French Institute for Public Health Surveillance (InVS) provides surveillance and monitoring of the health status of the French population. In order to optimize the capabilities of surveillance and provide evidence to help decision-making in public health, InVS sets up a program involving all scientific teams (communicable diseases, environment & health, occupational diseases, chronic diseases) of the institute for taking into account the socio-economic dimension …

BACKGROUND:Declared cases of exposures related to potential toxic agents are reported through a national database, the French Network of Poison Centers, and account on average for 200,000 cases per year, including 75,000 to 80,000 symptomatic cases. These data are currently used to investigate signals from local, national or international institutional partners (such as hospitals, local health authorities, and the Rapid Alert System for Food and Feed). Our objective is to complete this classical toxicovigilance activity through the automated detection of unexpected or unusual events in order to identify precociously signals representing potential threats for public health. To reach this objective, the inventory of surveillance and detection methods of unexpected events is necessary.METHODS:A literature review was conducted via Scopus(®) and Pubmed(®) databases, completed with grey literature and data available on worldwide vigilance systems' websites.RESULTS:The most commonly used methods are disproportional measures in the field of pharmacovigilance, some of which are subject to a routine detection at regular time intervals. Criteria of signal generation differ from one system to another, which have implemented data filtering strategies before or after analysis, in order to decrease the number of generated signals and improve their priority level. These signals are then transmitted to an experts committee for a clinical and epidemiological evaluation, and at times, for informing the patient's medical records. We also notice an interest in other approaches such as surveillance methods of temporal series or symbolic methods for associative rules extraction between one or more drugs and one or more adverse effects, with the possibility to include other types of variables, such a demographic data. The developments of probabilistic-based algorithms have also been recently developed, opening new opportunities.CONCLUSION:These surveillance and detection methods are of high interest for the automated detection of signals from the French toxicovigilance network. The initial step to developing these methods consists in studying the statistical quality of data and targeting the needs and expectations of the toxicovigilance network for what we want and what we can detect.

•We analyzed data from hospital discharge and long term illness databases.•We studied times to treatment after colonoscopy in patients with colon or rectum cancer.•Times to treatment were studied according to the patients pathway and to the treatment combination.•We studied time to surgery according to the residence of the patients.

Declared cases of exposures related to potential toxic agents are reported through a national database, the French Network of Poison Centers, and account on average for 200,000 cases per year, including 75,000 to 80,000 symptomatic cases. These data are currently used to investigate signals from local, national or international institutional partners (such as hospitals, local health authorities, and the Rapid Alert System for Food and Feed). Our objective is to complete this classical toxicovigilance activity through the automated detection of unexpected or unusual events in order to identify precociously signals representing potential threats for public health. To reach this objective, the inventory of surveillance and detection methods of unexpected events is necessary.A literature review was conducted via Scopus(®) and Pubmed(®) databases, completed with grey literature and data available on worldwide vigilance systems' websites.The most commonly used methods are disproportional measures in the field of pharmacovigilance, some of which are subject to a routine detection at regular time intervals. Criteria of signal generation differ from one system to another, which have implemented data filtering strategies before or after analysis, in order to decrease the number of generated signals and improve their priority level. These signals are then transmitted to an experts committee for a clinical and epidemiological evaluation, and at times, for informing the patient's medical records. We also notice an interest in other approaches such as surveillance methods of temporal series or symbolic methods for associative rules extraction between one or more drugs and one or more adverse effects, with the possibility to include other types of variables, such a demographic data. The developments of probabilistic-based algorithms have also been recently developed, opening new opportunities.These surveillance and detection methods are of high interest for the automated detection of signals from the French toxicovigilance network. The initial step to developing these methods consists in studying the statistical quality of data and targeting the needs and expectations of the toxicovigilance network for what we want and what we can detect.

Long-term exposure to air pollution (LTEAP) has been associated with mortality in numerous studies. In this study we aimed at analysing the link between air pollution and mortality at the individual level, assessing exposure to various air pollution indicators over 20 years. In specific, we studied the association between LTEAP and mortality in a large cohort recruited from the employees of the French national electricity and gas company, Électricité de France-Gaz de France (EDF-GDF) and followed from 1989 to 2008. The study population consisted of 20327 participants (1243 deaths at the end of the period). Exposure to PM10, PM10-2.5, PM2.5, NO2, O3, SO2, and C6H6 were assessed at the zip code of participants using determinist and geostatistical models taking into account residential history. Hazard ratios were estimated using Cox proportional-hazards regression model adjusted on selected individual and ecologic risk factors. An interquartile range (IQR) elevation in PM10 (7.8) and PM10-2.5 (2.2) at the baseline was respectively associated with an increase in all-cause mortality (ACM) 13% (95% CI, 1-27%) and 9% (95% CI, 2-16%). Annual moving average and cumulative exposure to PM10, PM10-2.5 and SO2 were also significantly associated with ACM. Regarding O3 we found significant negative associations with ACM. Non-significant associations were found with cardiovascular and respiratory mortality. In this cohort, long-term exposures to PM10, PM10-2.5 and SO2 were associated with increased risks of all-cause mortality. These results strengthen the evidence that air pollution, through particulate matter and sulfur dioxide, remains an important environmental risk factor for all-cause mortality. Acknowledgements This work is dedicated to the memory of Christophe Declercq for his valuable contribution to this project as the former coordinator of the surveillance program on air pollution and health at the French Institute for Public Health Surveillance (InVS).

This paper proposes several promising future directions for neighborhood research to address health inequalities. First, there is a need to apply a Geography of Opportunity framework to understand how vast spatial (neighborhood, regional) inequality translates into health inequality. Such a framework highlights inequality that unfolds across an entire region, as well as the continuing significance of race/ethnicity for producing disparities in health and in the social determinants of health. The Geography of Opportunity framework also points to some of the methodological limitations of current neighborhood-health studies, given the structure of neighborhood racial inequality in the US for estimating how important neighborhoods are for producing racial health disparities. Second, there is a need to incorporate life-course concepts, data, and methods, including to model residential histories, neighborhood temporal change and residential mobility, starting early in life. A life-course focus would help inform when in life neighborhoods matter most for health and health inequalities, as well as improve exposure assessment of residential contexts. Third, we must model mechanisms linking neighborhoods and health, including the role of individual and household socioeconomic status. Lastly, we need to more meaningfully integrate social determinants of health, including drawing on policy evaluations that aim to improve neighborhood environments or that aim to expand household neighborhood choice. Doing so would inform how specific modifiable neighborhood exposures stimulated by policy may influence health and health disparities.Cet article présente plusieurs axes de recherche prometteurs dans l'étude des « effets de quartier » sur les inégalités sanitaires. Tout d'abord, il est nécessaire de se placer dans un cadre dit de « Géographie des chances » (Geography of Opportunity) pour comprendre comment les inégalités spatiales (quartier, région) se traduisent en disparités sanitaires. Ce cadre met en évidence des inégalités à l'échelle d'une région entière, ainsi que leur lien – toujours actuel – aux origines ethniques. Deuxièmement, il est nécessaire d'intégrer des concepts, données et méthodes en lien avec le cycle de vie et de modéliser l'histoire résidentielle, l'évolution temporelle des quartiers et la mobilité résidentielle, dès le début de la vie. Une réflexion qui porte sur le cycle de vie pourrait servir à identifier les moments de la vie où le quartier affecte le plus la santé et les inégalités sanitaires, et à améliorer l'évaluation de l'exposition aux contextes résidentiels. Troisièmement, il est nécessaire de modéliser les mécanismes qui lient quartiers et santé, et y inclure le rôle joué par le statut socioéconomique. Il est enfin nécessaire d'intégrer plus judicieusement les déterminants sociaux de la santé, en s'appuyant sur les évaluations de politiques et de programmes visant à améliorer l'environnement. Cela pourrait nous fournir des informations sur la façon dont les expositions spécifiques et modifiables aux quartiers, stimulées par des politiques choisies, peuvent influencer la santé et les disparités sanitaires.

Background. - Epidemiological studies have investigated the health impacts of local sources of environmental pollution using as an outcome variable self-reported health, reflecting the overall perception interviewed people have of their own health. This work aims at analyzing the advantages and the results of this approach. A first step focused on describing the indicators.Methods. - The literature on indicators of self-reported health was reviewed, leading to a discussion on data collection, selection of health effects, data processing, and construction of indicators.Results. - The literature review concerned 51 articles. The use of self-reported health indicators allowed the studies to take into account the health concerns and complaints of populations exposed to environmental pollution. Various indicators of self-reported health were used in the studies. They measured physical, psychological and general dimensions of health. Standardized questionnaires were used less often than ad hoc questionnaires (78% of studies) developed to fit the needs of a given study. Three standardized questionnaires were used more frequently: the MOS Short-Form Health Survey (SF-36) to measure general health perceptions, the General Health Questionnaire (GHQ), and the Symptoms Checklist (SCL-90) to measure psychological distress.Conclusion. - The choice of self-reported health indicators is a compromise between specificity of the studied health issues within a given environment and standardization of the questionnaires used to measure them. Such standardization is necessary to ensure the validity and the reliability of the information collected across time and situations. The psychometric properties of the measuring questionnaires are rarely estimated or verified when they are used. (C) 2013 Elsevier Masson SAS. All rights reserved.