Are Wealthier Times Healthier in Cities? Economic Fluctuations and Mortality in Urban Areas of Latin America.
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SUBMITTER: Leveau CM
PROVIDER: S-EPMC8696345 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:The concept of a so-called urban advantage in health ignores the possibility of heterogeneity in health outcomes across cities. Using a harmonized dataset from the SALURBAL project, we describe variability and predictors of life expectancy and proportionate mortality in 363 cities across nine Latin American countries. Life expectancy differed substantially across cities within the same country. Cause-specific mortality also varied across cities, with some causes of death (unintentional and violent injuries and deaths) showing large variation within countries, whereas other causes of death (communicable, maternal, neonatal and nutritional, cancer, cardiovascular disease and other noncommunicable diseases) varied substantially between countries. In multivariable mixed models, higher levels of education, water access and sanitation and less overcrowding were associated with longer life expectancy, a relatively lower proportion of communicable, maternal, neonatal and nutritional deaths and a higher proportion of deaths from cancer, cardiovascular disease and other noncommunicable diseases. These results highlight considerable heterogeneity in life expectancy and causes of death across cities of Latin America, revealing modifiable factors that could be amenable to urban policies aimed toward improving urban health in Latin America and more generally in other urban environments.
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Project description:Levels of women's empowerment (WE) can contribute to differences in infant mortality rates (IMRs) across cities. We used a cross-sectional multilevel study to examine associations of WE with IMRs across 286 cities in seven Latin American countries. We estimated IMRs for 2014-2016 period and combined city socioeconomic indicators into factors reflecting living conditions and service provision. WE was operationalized: (1) in cities, by using scores for women's labor force participation (WLFP) and educational attainment among women derived from education and employment indicators disaggregated by sex; (2) in countries, by including a scale of enforcements of laws related to women's rights. We estimated adjusted percent differences in IMRs associated with higher WE scores across all cities and stratified by country GDP. We found substantial heterogeneity in IMRs and WE across cities. Higher WLFP was associated with lower IMRs. Higher women's educational attainment was associated with lower IMRs only in cities from countries with lower GDP. Poorer national enforcement of laws protecting women's rights was associated with higher IMRs in all countries. Women's empowerment could have positive implications for population health. Fostering women's socioeconomic development and girls' education should be part of strategies to reduce IMRs in cities of Global South.
| S-EPMC7614198 | biostudies-literature
Project description:BackgroundMental health is an important contributor to the global burden of disease, and depression is the most prevalent mental disorder in Latin America and the Caribbean (LAC). Informal jobs, often characterized by precarious working conditions, low wages, and limited employment benefits, are also highly prevalent in LAC and may be associated with poorer mental health. Our study tests the association between informal employment and major depressive symptoms in LAC cities.MethodsWe used individual-level data collected by the Development Bank of Latin America via their "Encuesta CAF" (ECAF) 2016, a cross-sectional household survey of 11 LAC cities (N = 5430). Depressive symptoms were measured using the 10-item Center for Epidemiologic Studies Short Depression Scale with possible total score ranging from 0 to 30. Scores were dichotomized, with a score >‾ 16 indicating the presence of major depressive symptoms. Informal employment was defined based on self-reported lack of contribution to the social security system. We used generalized estimating equation (GEE) log-binomial models to estimate the association between informal employment and depressive symptoms overall and by gender. Models were adjusted for age, education, and household characteristics.ResultsOverall, individuals employed in informal jobs had a 27% higher prevalence of major depressive symptoms (Prevalence Ratio [PR]: 1.27; 95% Confidence Interval [CI]: 1.00, 1.62) compared to those in formal jobs. The prevalence of depressive symptoms among individuals with informal jobs was higher compared to those with formal jobs in both women (PR: 1.36, 95% CI: 1.06, 1.74) and men (PR: 1.22; 95% CI: 0.90, 1.65).ConclusionsInformal employment in LAC was associated with a higher prevalence of major depressive symptoms. It is important to develop policies aiming at reducing informal jobs and increasing universal social protection for informal workers.
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Project description:ObjectiveUsing data compiled by the SALURBAL project (Urban Health in Latin America; 'Salud Urbana en América Latina') we quantified variability in low birth weight (LBW) across cities in Latin America, and evaluated the associations of socio-economic characteristics at various levels (maternal, sub-city and city) with the prevalence of LBW.MethodsThe sample included 8 countries, 360 cities, 1321 administrative areas within cities (sub-city units) and birth registers of more than 4.5 million births for the year 2014. We linked maternal education from birth registers to data on socioeconomic characteristics of sub-cities and cities using the closest available national population census in each country. We applied linear and Poisson random-intercept multilevel models for aggregated data.ResultsThe median prevalence of city LBW by country ranged from a high of 13% in Guatemala to a low of 5% in Peru (median across all cities was 7.8%). Most of the LBW variability across sub-cities was between countries, but there were also significant proportions between cities within a country, and within cities. Low maternal education was associated with higher prevalence of LBW (Prevalence rate ratios (PRR) for less than primary vs. completed secondary or more 1.12 95% CI 1.10, 1.13) in the fully adjusted model. In contrast, higher sub-city education and a better city social environment index were independently associated with higher LBW prevalence after adjustment for maternal education and age, city population size and city gross domestic product (PRR 1.04 95% CI 1.03, 1.04 per SD higher sub-city education and PRR 1.02 95% CI 1.00, 1.04 per SD higher SEI). Larger city size was associated with a higher prevalence of LBW (PRR 1.06; 95% CI 1.01, 1.12).ConclusionOur findings highlight the presence of heterogeneity in the distribution of LBW and the importance of maternal education, local and broader social environments in shaping LBW in urban settings of Latin America. Implementing context-sensitive interventions guided to improve women's education is recommended to tackle LBW in the region.
| S-EPMC8073945 | biostudies-literature
Project description:In the twenty-first century, ongoing rapid urbanization highlights the need to gain deeper insights into the social structure of cities. While work on this challenge can profit from abundant data sources, the complexity of this data itself proves to be a challenge. In this paper, we use diffusion maps, a manifold learning method, to discover hidden manifolds in the UK 2011 census dataset. The census key statistics and quick statistics report 1450 different statistical features for each census output area. Here, we focus primarily on the city of Bristol and the surrounding countryside, comprising 3490 of these output areas. Our analysis finds the main variables that span the census responses, highlighting that university student density and poverty are the most important explanatory variables of variation in census responses.
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Project description:Governments, development banks, corporations, and nonprofits are increasingly considering the potential contribution of watershed conservation activities to secure clean water for cities and to reduce flood risk. These organizations, however, often lack decision-relevant, initial screening information across multiple cities to identify which specific city-watershed combinations present not only water-related risks but also potentially attractive opportunities for mitigation via natural infrastructure approaches. To address this need, this paper presents a novel methodology for a continental assessment of the potential for watershed conservation activities to improve surface drinking water quality and mitigate riverine and stormwater flood risks in 70 major cities across Latin America. We used publicly available geospatial data to analyze 887 associated watersheds. Water quality metrics assessed the potential for agricultural practices, afforestation, riparian buffers, and forest conservation to mitigate sediment and phosphorus loads. Flood reduction metrics analyzed the role of increasing infiltration, restoring riparian wetlands, and reducing connected impervious surface to mitigate riverine and stormwater floods for exposed urban populations. Cities were then categorized based on relative opportunity potential to reduce identified risks through watershed conservation activities. We find high opportunities for watershed activities to mitigate at least one of the risks in 42 cities, potentially benefiting 96 million people or around 60% of the urbanites living in the 70 largest cities in Latin America. We estimate water quality could be improved for 72 million people in 27 cities, riverine flood risk mitigated for 5 million people in 13 cities, and stormwater flooding mitigated for 44 million people in 14 cities. We identified five cities with the potential to simultaneously enhance water quality and mitigate flood risks, and in contrast, six cities where conservation efforts are unlikely to meaningfully mitigate either risk. Institutions investing in natural infrastructure to improve water security in Latin America can maximize their impact by focusing on specific watershed conservation activities either for cleaner drinking water or flood mitigation in cities identified in our analysis where these interventions are most likely to reduce risk.
| S-EPMC6303038 | biostudies-literature
Project description:ObjectiveUsing newly harmonised individual-level data on health and socio-economic environments in Latin American cities (from the Salud Urbana en América Latina (SALURBAL) study), we assessed the association between obesity and education levels and explored potential effect modification of this association by city-level socio-economic development.DesignThis cross-sectional study used survey data collected between 2002 and 2017. Absolute and relative educational inequalities in obesity (BMI ≥ 30 kg/m2, derived from measured weight and height) were calculated first. Then, a two-level mixed-effects logistic regression was run to test for effect modification of the education-obesity association by city-level socio-economic development. All analyses were stratified by sex.SettingOne hundred seventy-six Latin American cities within eight countries (Brazil, Chile, Colombia, Costa Rica, El Salvador, Guatemala, Mexico and Peru).Participants53 186 adults aged >18 years old.ResultsAmong women, 25 % were living with obesity and obesity was negatively associated with educational level (higher education-lower obesity) and this pattern was consistent across city-level socio-economic development. Among men, 18 % were living with obesity and there was a positive association between education and obesity (higher education-higher obesity) for men living in cities with lower levels of development, whereas for those living in cities with higher levels of development, the pattern was inverted and university education was protective of obesity.ConclusionsAmong women, education was protective of obesity regardless, whereas among men, it was only protective in cities with higher levels of development. These divergent results suggest the need for sex- and city-specific interventions to reduce obesity prevalence and inequalities.
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Project description:Annual trivalent influenza vaccines (TIV) containing 2 A strains and one B lineage have been recommended for the prevention of influenza in most of Latin American countries. However, the circulation of 2 B lineages (Victoria and Yamagata) and difficulties in predicting the predominating lineage have led to the development of quadrivalent influenza vaccines (QIV), including both B lineages. Thus, the objective was to estimate the public health impact and influenza-related costs if QIV would have been used instead of TIV in 3 Latin American countries. We used a static model over the seasons 2010-2014 in Brazil, 2007-2014 in Colombia and 2006-2014 in Panama, focusing on population groups targeted by local vaccination recommendations: young children, adults with risk factors and the elderly. In Brazil, between 2010 and 2014, using QIV instead of TIV would have avoided US$ 6,200 per 100,000 person-years in societal costs, based on 168 influenza cases, 89 consultations, 3.2 hospitalizations and 0.38 deaths per 100,000 person-years. In Colombia and Panama, these would have ranged from US$ 1,000 to 12,700 (based on 34 cases, 13-25 consultations, 0.6-8.9 hospitalizations and 0.04-1.74 deaths) and from US$ 3,000 to 33,700 (based on 113 cases, 55-82 consultations, 0.5-27.8 hospitalizations and 0.08-6.87 deaths) per 100,000 person-years, respectively. Overall, the broader protection offered by QIV would have reduced the influenza humanistic and economic burden in the 3 countries. Despite the lack of local data leading to several extrapolations, this study is the first to give quantitative estimates of the potential benefits of QIV in Latin America.
| S-EPMC5404619 | biostudies-literature
Project description:The negative impacts of rapid urbanization in developing countries have led to a deterioration in urban air quality, which brings increasing negative impact to its surrounding areas (e.g. in China). However, to date there has been rare quantitative estimation of the urban air pollution to its surrounding areas in China.We thus evaluated the impact of air pollution on the surrounding environment under rapid urbanization in Chinese prefectures during 1999 - 2011. We found that: (1) the urban environment generated increasing negative impact on the surrounding areas, and the PM2.5 concentration difference between urban and rural areas was particularly high in large cities. (2) Nearly half of the Chinese prefectures (156 out of 350) showed increased impact of urban PM2.5 pollution on its surrounding areas. Those prefectures were mainly located along two belts: one from northeast China to Sichuan province, the other from Shanghai to Guangxi province. Our study demonstrates the deterioration in urban air quality and its potential impacts on its surrounding areas in China. We hope that the results presented here will encourage different approaches to urbanization to mitigate the negative impact caused by urban air pollution, both in China and other rapidly developing countries.
| S-EPMC4518225 | biostudies-literature
Project description:BackgroundFeatures of the urban physical environment may be linked to the development of high blood pressure, a leading risk factor for global burden of disease.ObjectivesWe examined associations of urban physical environment features with hypertension and blood pressure measures in adults across 230 Latin American cities.MethodsIn this cross-sectional study we used health, social, and built environment data from the SALud URBana en América Latina (SALURBAL) project. The individual-level outcomes were hypertension and levels of systolic and diastolic blood pressure. The exposures were city and subcity built environment features, mass transit infrastructure, and green space. Odds ratios (ORs) and mean differences and 95% confidence intervals (CIs) were estimated using multilevel logistic and linear regression models, with single- and multiple-exposure models adjusted for individual-level age, sex, education, and subcity educational attainment.ResultsA total of 109,176 participants from 230 cities and eight countries were included in the hypertension analyses and 50,228 participants from 194 cities and seven countries were included in the blood pressure measures analyses. Participants were 18-97 years of age. In multiple-exposure models, higher city fragmentation was associated with higher odds of having hypertension (OR per standard deviation (SD) increase=1.11; 95% CI: 1.01, 1.21); presence (vs. no presence) of mass transit in the city was associated with higher odds of having hypertension (OR=1.30; 95% CI: 1.09, 1.54); higher subcity population density was associated with lower odds of having hypertension (OR per SD increase=0.90; 95% CI: 0.85, 0.94); and higher subcity intersection density was associated with higher odds of having hypertension [OR per SD increase=1.09; 95% CI: 1.04, 1.15). The presence of mass transit was also associated with slightly higher systolic and diastolic blood pressure in multiple-exposure models adjusted for treatment. Except for the association between intersection density and hypertension, associations were attenuated after adjustment for country. An inverse association of greenness with continuous blood pressure emerged after country adjustment.DiscussionOur results suggest that urban physical environment features-such as fragmentation, mass transit, population density, and intersection density-may be related to hypertension in Latin American cities. Reducing chronic disease risks in the growing urban areas of Latin America may require attention to integrated management of urban design and transport planning. https://doi.org/10.1289/EHP7870.
| S-EPMC8846315 | biostudies-literature