Thèse Maladies Inflammatoires Chroniques Expositions Environnementales et Accessibilité une Cartographie Interdisciplinaire pour la Médecine Personnalisée en Région Centre-Val de Loire Micea H/F - 37

Établissement : Université de Tours
École doctorale : Santé, Sciences Biologiques et Chimie du Vivant - SSBCV
Laboratoire de recherche : Centre de Biophysique Moléculaire - équipe NMNS
Direction de la thèse : Denis MULLEMAN ORCID 0000000340897513
Début de la thèse : 2026-10-01
Date limite de candidature : 2026-04-17T23:59:59

Cette thèse vise à établir un lien entre la répartition spatiale des maladies inflammatoires chroniques, les facteurs d'exposition environnementale d'une part, et d'autre part l'accessibilité à la médecine personnalisée et aux biomédicaments. L'une des perspectives souhaitées de cette thèse est de mettre en oeuvre des stratégies préventives et d'organiser l'accès aux soins afin d'améliorer le bien-être des patients atteints de maladies inflammatoires chroniques, en tenant compte des facteurs environnementaux/socio-économique et de l'accès au système de Santé. Ce projet s'inscrit dans le cadre du programme « Loire Val Health », en rassemblant des experts en médecine, chimie et géographie de la région Centre Val de Loire.

Chronic inflammatory diseases, i.e. inflammatory arthritis, inflammatory bowel diseases, multiple sclerosis and psoriasis, represent a challenge for society owing to their prevalence (5 à 7 % of the general population). The economic and social burden of these conditions require personalised medicine strategies to improve patients' well-being and optimal use of expensive drugs, particularly therapeutic antibodies or biopharmaceuticals. While the increasing prevalence, identify patients at risk of developing chronic inflammatory diseases and prevent and treat co-morbidities, in particular cardiovascular, is an unmet need. This is a challenge, for instance in rheumatoid arthritis where an increased in incidence and mortality rate have been observed (Zhang, Gao et al. 2025).
More and more attention has been paid since the last decade on external factors or exposome that can initiate or reduce the emergence of chronic inflammatory diseases. During the sole last two years negative impact of environment has been found on rheumatoid arthritis particularly with small particles (Hu, Shen et al. 2024; Zhao, Smargiassi et al. 2025), volatile organic compounds (Zhou, Wu et al. 2024), pesticides (Parks, Leyzarovich et al. 2024) and metals such as cadmium (Liu, Liu et al. 2024). On the opposite blue space exposure, i.e. living close to certain geographic zone, such as lakes, rivers, oceans, (blue space exposure) (He, Ge et al. 2024) or living in high green space may reduce the risk of rheumatoid arthritis (Hu, Shen et al. 2024;)Stanhope, Weinstein et al. 2025).
In parallel to exposure factors, accessibility to health professional, geographic remoteness and heath care availability and socio-economic context have an impact on the management of patient living with chronic inflammatory diseases. This have been observed for rheumatoid arthritis in Romania (Codreanu, Popescu et al. 2018), inflammatory bowel disease in Canada (Burns, Mathias et al. 2021) and psoriasis in the USA.(Seigel, Shoaib et al. 2024). Access to health care providers in France is heterogeneous and this represents a challenge for some patients living with chronic inflammatory diseases with delay in diagnosis, limited access to biopharmaceuticals leading to insufficient control of the disease, comorbidities and poor quality of life. These combined questions on disease distribution, environmental exposures and healthcare access fall within the field of spatial eco-epidemiology, which aims to identify and explain spatial patterns of health outcomes in relation to environmental and socio-territorial determinants.
Owing the access to the national health data system (SNDS, Système National des Données de Santé) the maps of the health providers in the Loire Valley Region (ARS, Agence nationale de la cohésion des territoires) combined with environmental sources of exposure data such as SIGLES ou Green Data for Health, it is possible to combine the data set on health, environment and accessibility applied to chronic inflammatory diseases.
With an interdisciplinary approach, IDEAL project combines epidemiology, technology for health, Geography of environment and geomatics, public health and humanities. The present Thesis project aligns with the « Biopharmaceuticals » and « Humanities » axes of the ExcellencES sous toutes ses formes' Loire Val-Health (LVH) programme. Both laboratories are partners of LVH.

Objective 1: Epidemiology
The first objective is to establish a map of the population of patients living with chronic inflammatory diseases in the Loire Valley Region (Centre-Val de Loire) and to analyse the demographics, co-morbidities, cardio-vascular in particular, of this population. We hypothesise a heterogeneous distribution of chronic inflammatory diseases and, if confirmed, will try to identify the clusters and their determinants. The analyse will be extended others regions, covering the national territory.

Objective 2: Exposome
The second objective is to analyse the geographical distribution of the patients living with chronic inflammatory diseases in consideration of the exposure to environmental factors such as pollutant in green spaces, naturality/anthropisation of territories, etc.) using open data such as Green Data for Health ; pollution data of atmosphere (Sensor.Community, Open AQ), earth (pesticides use frequency markers - Indicateur de Fréquence de Traitements phytosanitaires), or the CartNat index that measure the degree of naturality of territories.(Guetté 2018; Paumelle, Occelli et al. 2023) The work will consist in comparing the recent literature on environmental factors with the Loire Valley regional context, and to refine this analysis by the implementation of original environmental sources of information.

Objective 3: Accessibility
The third objective aims at characterising the accessibility of patients living with chronic inflammatory diseases to the health care system and medication at the regional scale and, if possible, to compare this accessibility according to the place of residence (urban, rural close to urban or, remote rural places). The third objective will help in understanding the socio-economic factors on the disease prevalence. An on-site qualitative study, possibly with the support of the department of primary care with be conducted to assess the socio-economical and health factors. In parallel a mapping of medical resources of specialists, pharmacists, nurses physiotherapeutic could be performed in parallel, to provide a more specific mapping of the accessibility to heath care for this population of patients.

-For the objective 1 :
Health Data bases, demographic and administrative data bases will be analysed to establish the map of patients living with chronic inflammatory diseases in the Loire valley Region. Patients will be identified by using the health database National system (Système National des Données de Santé /SNDS). Depending on the desired granularity and the risk of re-identification, a broader geographic scale will be adopted. Instead of municipalities we will extend the territory to district, professional community of health territory (communautés professionnelles territoriales de santé - CPTS), local council community (communauté de communes). We will specifically analyse the identified diseases and compare the patients' characteristics to those of the regional population. A more detailed description will be performed in a second step to consider the health care providers, treatment and co-morbidities, in particular cardio-vascular diseases. In addition, we will ask for access to the Loire Valley regional observatory for Health (observatoire régional de la santé du Centre-Val de Loire (https://orscentre.org/).

-For the objective 2:
Spatial data will be used to characterize environmental exposures that will be matched with the health data. To this end we will use environmental health tracking information system, also known as Environmental Public Health Tracking (EPHT). We will ask for access to the SIGLES - Systèmes Information Géographique Liens Environnement Santé (https://www.sigles-sante-environnement.fr/) in the frame of a collaboration. Other sources will be used for specific environmental exposures, in particular the Sensor Community programme and Open AQ (atmospheric pollution), ADONIS data (pesticides) and special databases such as Green Data for Health and CARTNAT.Health (degree of naturality of territories). We will ask for access to the Loire valley regional observatory for Health (observatoire régional de la santé du Centre-Val de Loire (https://orscentre.org/).
We will use the data bases issue from the National Agency for Territorial Cohesion (ANCT) l'Agence nationale de la cohésion des territoires (https://anct.gouv.fr/), a public body that aims to facilitate projects led by local authorities, by deploying State schemes to promote territorial cohesion and by facilitating access to technical support for small local authorities.

-For the objective 3:
We will seek for information on available sources on healthcare resources. Accessibility index (Indicateurs d'accessibilité potentiels localisée) have been developed by the Direction of Research, studies an evaluation and statistics- DREES, together with the Research institute and documentation in health economics-IRDES, to measure the spatial adequacy between the health care resources and need for primary care, at a narrow scale.