An Empirical Fact of Urban Health Advantage vs. Urban Health Penalty - Scaling Analysis of Death Count in 4 Major Disease Categories

Abstract

Through analyzing the scaling relationship between the population size and the death count of four major disease categories in the United States from 1999 to 2010, we discover that there is a super-linear relationship in terms of the total counties, regardless of the four disease categories. We interpret this as evidence of an “urban health penalty.” When looking at sub-group analysis, however, we notice many cases where sub-linear relationships exist, indicating an “urban health advantage.” Specifically, we find sub-linear relationship for the number of cancer cases from top 20 to roughly the top 100 populated counties, whereas for circulatory diseases, sub-linearity is found up to the top 60 populated counties. Respiratory disease cases prolong sub-linearity up until the top 120 counties. In all three disease categories except for the Endocrine, Nutritional and Metabolic (ENM) disease category, we establish a tipping point of sub- to super-linearity, implying that, for the varying size of the county population, cities show an “urban health advantage” with a tipping point, beyond which an “urban health penalty” replaces it. In the case of the ENM category, however, there is no sign of sub-linearity in any of the top sub-groups, and cities display an “urban health penalty” as a result, both for the total counties and for the various top sub-groups. Considering additional variables in terms of several econometric methodologies simultaneously strengthen the findings of our study.