Intraurban Variations in Adult Mortality in a Large Latin American City

Abstract

Urbanization is high and growing in low-and middle-income countries, but intraurban variations in adult health have been infrequently examined. We used spatial analysis methods to investigate spatial variation in total, cardiovascular disease, respiratory disease, and neoplasm adult mortality in Buenos Aires, Argentina, a large city within a middle-income country in Latin America. Conditional autoregressive models were used to examine the contribution of socioeconomic inequalities to the spatial patterning observed. Spatial autocorrelation was present in both men and women for total deaths, cardiovascular deaths, and other causes of death (Moran_s Is ranging from 0.15 to 0.37). There was some spatial autocorrelation for respiratory deaths, which was stronger in men than in women. Neoplasm deaths were not spatially patterned. Socioeconomic disadvantage explained some of this spatial patterning and was strongly associated with death from all causes except respiratory deaths in women and neoplasms in men and women [relative rates (RR) for 90th vs 10th percentile of percent of adults with incomplete high school and 95% confidence intervals: 1.23 and 1.09-1.39 vs 1.24 and 1.08-1.42 for total deaths in men and women, respectively; 1.36 and 1.15-1.60 vs 1.22 and 1.01-1.47 for cardiovascular deaths; 1.21 and 0.97-1.52 vs 1.07 and 0.85-1.34 for respiratory deaths; 0.94 and 0.85-1.04 vs 1.03 and 0.87-1.22 for neoplasms; and 1.49 and 1.20-1.85 vs 1.63 and 1.31-2.03 for other deaths].There is substantial intraurban variation in risk of death within cities. This spatial variability was present for multiple causes of death and is partly explained by the spatial patterning of socioeconomic disadvantage. Our results highlight the pervasive role of space and social inequalities in shaping life and death within large cities.

Provision and Use of Maternal Health Services among Urban Poor Women in Kenya: What Do We Know and What Can We Do?

“…33 Recent evidence suggests that within-urban differences in health are much larger than intrarural disparities and that the spatial patterning of intra-urban variations in health and survival are closely associated with the spatial patterning of socioeconomic conditions within the cities. 14,34,35 Our findings on the provision of health services in the Nairobi slum communities concurs with those reported in other studies in substantiating the concern that the well-established concept of urban health advantage has shifted to urban penalty for rapidly growing segments of urban populations in the developing world. 13,15 The disparity in the types of health facilities available for the urban poor -which is less likely to be found in rural or urban non-poor areas -suggests that the meaning of access to health facilities by the least wealthy groups of urban dwellers should be examined more carefully.…”

“…36 This study has shown that despite the high prevalence of ANC, the proportion of slum women who made the recommended number of visits or who initiated the visit in the first trimester of pregnancy -as recommended -remains low compared to Nairobi as a whole and, importantly, compared to rural populations. While the comparison of slum residents with Nairobi as a whole exemplifies the intra-urban disparities discussed earlier, 12,34,35 the fact that rural women had better outcomes than their urban poor counterparts illustrates the existence of an urban health penalty along with that of an urban health advantage in Kenya. 13,15 The bivariate analysis reported in this study shows that household wealth and respondents' education were associated with the frequency and timing of ANC.…”

Salud auto-referida y desigualdades sociales, ciudad de Buenos Aires, Argentina, 2005

“…En la ciudad de Buenos Aires se encontró -a partir de un análisis espacial -una asociación entre áreas (fracciones censales) con menores niveles de educación y mayores tasas de mortalidad total, cardiovascular y respiratoria. Estos hallazgos que relacionan desigualdades sociales con desigualdades en salud son congruentes con los resultados de la presente investigación 26 .…”

“…En esta investigación se concibe a la fracciones censales como un proxy de vecindad, como se ha empleado en otras investigaciones 10,26,29 . Las fracciones censales son definidas por el Censo Nacional de Población, Hogares y Viviendas a partir de aspectos operativos censales, como la organización del trabajo del censista, y también tiene en cuenta criterios demográficos, económi-cos y socioculturales 22 .…”

“…El nivel de educación ha sido descrito como un buen indicador de condiciones de vida 33 ; y la proporción de educación secundaria incompleta o inferior fue utilizada en otras investigaciones 26 , mostrándose consistente con los objetivos propuestos en la investigación. Es de tener en cuenta que la ciudad de Buenos Aires es la jurisdicción con mayor nivel educacional (terciario o universitario completo) de Argentina.…”