Abstract
AbstractAnalyses of health and mortality disparities between today's urban and rural populations appear to be exclusively focused on vastly urbanising countries. By incorporating environmental data at census tract level and accounting for within‐area homogeneity, this work attempts to extend classic rural–urban comparisons. Geographical information is linked to a register‐based mortality follow up and Spanish census data for the autonomous community of Andalusia. We then apply mixed effects Cox proportional hazards models to estimate individual mortality differences and account for area variations between residential areas. Estimated effects suggest that the shared degree of “urbanicity” does not affect individual hazards of mortality, whereas environmental‐ and population‐based measures influence the relative risk of dying despite controlling for individual‐level risk factors. Although we do not find an impact of physical urban measures, our results reveal persistent that area‐related mortality disparities which can help to explain the mechanisms behind prevalent spatial‐temporal inequalities such as those in Andalusia.
Highlights
According to the latest United Nations report on urbanisation, the proportion of the world population living in urban areas is expected to increase from 55% in 2018 to 68% by the year 2050 (United Nations, 2018)
In the context of this work, we aim to contribute to the debate on urban–rural differences in the field of small area analysis by estimating the effects of environmental impacts and urban characteristics on individual‐level survival over time
In Model 4, when we include population characteristics of small areas, the estimated hazard for the “urbanicity” indicator is very close to one. As this “urbanicity” effect shrinks, we find that the proportions of both unemployed individuals and single households in a census tract increase individual hazards by 0.25 and 0.94 percentage points, respectively
Summary
According to the latest United Nations report on urbanisation, the proportion of the world population living in urban areas is expected to increase from 55% in 2018 to 68% by the year 2050 (United Nations, 2018). Accelerated growth of cities predominantly in developing countries will trigger various changes in social structure, occupational activities, and distribution of wealth. Such a development entails great challenges regarding social equity and long‐term development of public health (Allender, Foster, Hutchinson, & Arambepola, 2008; Woods, 2003). The relationship between health, mortality, and environmental features of residential areas, is complex. Exposure to environmental hazards might have a time‐lagged effect on a person's health, yet residential areas are constantly changing and developing within different cultural and social frameworks (Rydin et al, 2012).
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