Differences in vaccination coverage can perpetuate COVID-19 disparities. We explored the association between neighborhood-level social vulnerability and COVID-19 vaccination coverage in 16 large US cities from the beginning of the vaccination campaign in December 2020 through September 2021. We calculated the proportion of fully vaccinated adults in 866 zip code tabulation areas (ZCTA) of 16 large US cities: Long Beach, Los Angeles, Oakland, San Diego, San Francisco, and San Jose (CA); Chicago (IL); Indianapolis (IN); Minneapolis (MN); New York City (NY); Philadelphia (PA); and Austin, Dallas, Fort Worth, Houston, and San Antonio (TX). We computed absolute and relative total and Social Vulnerability Index(SVI)-related inequities by city. COVID-19 vaccination coverage was 0.75 times (95% CI 0.69-0.81) or 16% (95% CI 12.1-20.2%) percentage points lower in neighborhoods with the highest social vulnerability as compared to those with the lowest. These inequities were heterogeneous, with cities in the West region generally displaying narrower inequities in both the absolute and relative scales. The SVI domains of socioeconomic status and household composition & disability showed the strongest associations with vaccination coverage. Inequities in COVID-19 vaccinations hamper efforts to achieve health equity, as they mirror and could lead to even wider inequities in other COVID-19 outcomes.

Objectives. To describe the creation of an interactive dashboard to advance the understanding of the COVID-19 pandemic from an equity and urban health perspective across 30 large US cities that are members of the Big Cities Health Coalition (BCHC). Methods. We leveraged the Drexel‒BCHC partnership to define the objectives and audience for the dashboard and developed an equity framework to conceptualize COVID-19 inequities across social groups, neighborhoods, and cities. We compiled data on COVID-19 trends and inequities by race/ethnicity, neighborhood, and city, along with neighborhood- and city-level demographic and socioeconomic characteristics, and built an interactive dashboard and Web platform to allow interactive comparisons of these inequities across cities. Results. We launched the dashboard on January 21, 2021, and conducted several dissemination activities. As of September 2021, the dashboard included data on COVID-19 trends for the 30 cities, on inequities by race/ethnicity in 21 cities, and on inequities by neighborhood in 15 cities. Conclusions. This dashboard allows public health practitioners to contextualize racial/ethnic and spatial inequities in COVID-19 across large US cities, providing valuable insights for policymakers. (Am J Public Health. Published online ahead of print April 14, 2022: e1–e9. https://doi.org/10.2105/AJPH.2021.306708 )

IntroductionWith most of the world’s population living in urban areas, it is important to understand the health effects of city living. Precise descriptions of the relations of city size and growth with population health metrics have not been systematically described. Describing these relationships can provide clues regarding the factors driving differences in health across cities.ObjectiveThe goal of this scoping review is to map the existing evidence regarding the scaling properties of health outcomes, with a special emphasis on city size and growth.Method and analysisWe will conduct this scoping review based on a structured search of a combination of keywords for the exposures that aim to capture the population growth and size of cities along with degree of urbanisation, for health-related outcomes regardless of their type (incidence or prevalence of diseases and injuries and mortality). We will search the MEDLINE and Latin American & Caribbean Health Sciences Literature databases from inception for studies in English, Spanish or Portuguese and perform manual searches of references and citations in the included studies. The search will be conducted from April 2019 to September 2019. We will report results using the PRISMA-ScR guidelines. This review aims to inform future research on the role of increasing levels of urbanisation on health outcomes, provide clues into what city level factors may drive patterns of urban health and lead to the design and implementation of policies that promote sustainable growth and improved health.Ethics and disseminationThis review will not collect any primary data and will rely on published articles. The findings of this review will be published in a peer-reviewed scientific journal.

Urban scaling is a framework that describes how city-level characteristics scale with variations in city size. This scoping review mapped the existing evidence on the urban scaling of health outcomes to identify gaps and inform future research. Using a structured search strategy, we identified and reviewed a total of 102 studies, a majority set in high-income countries using diverse city definitions. We found several historical studies that examined the dynamic relationships between city size and mortality occurring during the nineteenth and early twentieth centuries. In more recent years, we documented heterogeneity in the relation between city size and health. Measles and influenza are influenced by city size in conjunction with other factors like geographic proximity, while STIs, HIV, and dengue tend to occur more frequently in larger cities. NCDs showed a heterogeneous pattern that depends on the specific outcome and context. Homicides and other crimes are more common in larger cities, suicides are more common in smaller cities, and traffic-related injuries show a less clear pattern that differs by context and type of injury. Future research should aim to understand the consequences of urban growth on health outcomes in low- and middle-income countries, capitalize on longitudinal designs, systematically adjust for covariates, and examine the implications of using different city definitions.

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