High-income Cities Research Articles

Urban Green Spaces in Africa: A Bibliometric Analysis

Africa has a lower proportion of urban areas compared to other continents, yet it is experiencing rapid urbanization, which is posing a significant threat to the urban ecosystem. This study presents the results of a bibliometric analysis from publications on urban green spaces (UGS) research in African cities. From the Web of Science, Science Direct, Google Scholar, and PubMed databases, 264 articles on UGS research in Africa were included in this study. This research topic experienced rapid growth, as more than 68% of all the articles were produced in the past five years, where about 63% of the studies included in this analysis were carried out in only four countries. Most of the studies were carried out at the intracity scale, with the main focus being on the ecosystem services provided by UGS. Change detection and overall UGS mapping studies show that high-income cities have a high percentage of UGS, while many African cities exhibited lower green coverage. We commend the work from researchers; however, there is still a gap to fill both in terms of high-quality datasets and state-of-the-art technology usage, and there is also a need for more comparative studies among cities and countries at the continental scale.

Incidence and mortality of endometrial cancer in China, data from China Cancer Registry Annual Report, 2004-2017

Objective: To analysis the incidence rate and mortality rate of endometrial cancer in China from 2004 to 2017 according to the data from China Cancer Registry Annual Report. Methods: The incidence and mortality data of endometrial cancer were extracted from the China Cancer Registry Annual Report 2004 to 2017, and the incidence, mortality, number of new cases, number of deaths were extracted according to the region (national, urban, rural and eastern, middle and western areas) and the age composition of population to estimate the incidence and mortality of endometrial cancer nationwide. The age-standardized incidence rate and mortality rate were calculated based on the Chinese standard population in 2000 (ASIRC, ASIRW) and Segi's world population (ASMRC, ASMRW). Join Point regression was used to calculate the annual percentage change of morbidity rate, and Cochran-Armitage trend test was used to analyze the changing trend of morbidity and mortality. Results: From 2004 to 2017, the number of women covered by the China Cancer Registry Annual Report has increased from 35 571 657 to 215 201 995, and the total population of the covered areas has increased from 5.53% to 31.39%. The crude incidence rate of endometrial cancer increased from 6.20/100 000 to 10.06/100 000, and showed an upward trend over time (P<0.001). After adjusting for age, ASIRC increased from 5.75/100 000 in 2004 to 6.79/100 000 in 2017, and ASIRW increased from 5.60/100 000 in 2004 to 6.56/100 000 in 2017, both showing an upward trend over time (all P<0.001). The crude incidence rates in urban area and rural area were respectively 10.89/100 000 and 9.25/100 000 in 2017, and the ASIRC was higher in urban than rural areas (7.14/100 000 vs 6.43/100 000) after adjusting for age. The ASIRW was higher in eastern areas than middle areas and western areas (7.16/100 000 vs 6.44/100 000 vs 5.60/100 000). The incidence rate in rural areas showed more significant growth than urban areas [annual percent change (APC): 3.2% vs 0.7%, P<0.001]. The age-specific incidence rate increased with age and reached a peak in the age group of 50-54 years (25.70/100 000). Incidence rate in the under-40 age group increased more in rural areas than in urban areas (69.84% vs-7.09%). From 2004 to 2017, the age-standardized mortality rate shows a decreasing trend, with the ASMRC from 1.83/100 000 to 1.47/100 000, and the ASMRW from 1.81/100, 000 to 1.46/100, 000. There was no significant difference between urban and rural areas in mortality of endometrial cancer. Age-specific mortality rates increased with age, reaching a peak in the age group 85 years and older (13.16/100 000). Conclusions: Recent years, there was an increasing incidence rate of endometrial cancer in China. Especially in rural areas, the incidence rate of endometrial cancer is increasing rapidly in young women under 40 years of age. There were differences between urban and rural areas and regions in the incidence rate of endometrial cancer. The incidence rates of endometrial cancer in some high-income cities have occupied the first place of female reproductive system malignant cancers. The age-standardized mortality rate of endometrial cancer shows a decreasing trend.

Evaluations of Compliance With California's First Tobacco Sales Bans and Tobacco Marketing in Restricted and Cross-Border Stores.

Beverly Hills and Manhattan Beach were the first California cities to end tobacco sales. Previous research assessed retailers' perceptions of the laws. This study is the first to evaluate compliance (Study 1), assess whether branded or unbranded tobacco cues remain, and examine cigarette prices/discounts in cross-border stores (Study 2). Each of the four data collectors requested Marlboro or e-cigarettes (randomly assigned) in all restricted stores (n = 33) until four attempts were exhausted or a violation occurred. Follow-up visits recorded whether former tobacco retailers advertised tobacco or contained unbranded cues. In a random sample of 126 cross-border stores (half within 1 mile of no-sales cities and half 2-4 miles away), data collectors recorded price of Marlboro and presence of cigarette discounts. Mixed models (stores within tracts), tested for differences between near and far stores, adjusting for store type and median household income. Compliance was 87.5%: three stores sold Marlboro (US $8, $10, and $10) and one sold Puff Bar (US $16). Tobacco-branded items and unbranded tobacco cues remained in one store each. Mean Marlboro price was US $10.61 (SD = 1.92) at stores within 1 mile of no-sales cities, averaging US $0.73 more than at stores farther away (p < .05). However, odds of advertising cigarette discounts did not differ between stores nearby and farther from no-sales cities. Nearly all retailers complied with tobacco sales bans within 6-12 months of implementation. In addition, retail tobacco marketing was nearly eliminated in the two cities. There was no evidence of price gouging for Marlboro cigarettes in cross-border stores. Evidence from two early adopters of tobacco sales bans suggests that such local laws can be implemented effectively in California, although results from these high-income cities in a state with a strong tobacco control record limits generalizability. Enforcement involving routine purchase attempts rather than visual inspection of tobacco products is recommended. Although Beverly Hills and Manhattan Beach are each surrounded by communities where tobacco sales persist, there was no evidence of price gouging for cigarettes or greater presence of discounts in cross-border stores. Evaluations of the economic impacts and public health benefits of tobacco sales bans are much needed.

How population aging promotes carbon emission reduction in Chinese cities: The chain mediating role of industrial upgrading and energy conservation

High carbon emissions and population aging are two obstacles to China's development as an emerging economy. It is urgent to scientifically examine the impacts of population aging on carbon emissions to discover new pathways for urban carbon emission reduction. However, existing studies face challenges in terms of focusing on and methodology for accurately capturing the role of industrial production and energy consumption in the environmental effects of population aging. This paper constructs a chain mediation analytical framework and systematically examines the intrinsic linkages between population aging and carbon emissions in Chinese cities from 2000 to 2020 using a two-way fixed effects model. This paper has three main findings. (1) The positive correlation between urban population aging and carbon emissions development is generally low, with coupling coordination degree values of 0.4233, 0.4458, 0.4220, 0.4715, and 0.4665 for each yearly cross-section. (2) For every 1% increase in the population aging rate, carbon emissions decrease by 0.3478% on average. The carbon reduction effect of population aging is significantly greater in low-emissions cities and high-income cities than in other cities. (3) The industrial upgrading (IU) path, energy conservation (EC) path and chain mediation (CM) path account for 72.43%, 7.23% and 20.34%, respectively, of the indirect effects. If the causal link between IU and EC is not considered, the EC effect will be overestimated by 281.16%. The results of the study suggest that properly coping with population aging and reducing carbon emissions are not completely opposed to each other, a conclusion that passes both endogeneity exclusion and robustness check. This paper advocates replacing the one-size-fits-all approach in carbon emissions management and investing more in policy preferences to support carbon emission reduction in both high-emissions and low-income cities.

Non-beverage alcohol consumption in Russia: new evidence from Jewish Autonomous Oblast.

Previous studies in Izhevsk, Novosibirsk, and Kazan have found that non-beverage alcohol is a large part of alcohol consumption in Russia. Whereas those places are relatively high-income cities, there are no studies about such a problem in low-income regions of Russia. The aim of this study is to investigate correlates and factors associated with non-beverage alcohol consumption in eastern regions of Russia, e.g. the Jewish Autonomous Oblast and to assess effectiveness of implementing Russian policies to restrict consumption of non-beverage alcohol. A survey of adults in the Jewish Autonomous Oblast of Russia was performed on workdays to assess non-beverage drinking patterns in summer 2022. The questionnaire included questions about socio-demographic status and alcohol use, including non-beverage alcohol consumption and drinking patterns. We use logistic regression to identify risk factors of consuming non-beverages. First, ~30% of individuals suffering from alcohol problems drink non-beverage alcohol. Second, those who regularly consume non-beverage alcohol compared with those who chronically drink legal strong alcohol are on average more likely to experience the negative effects of alcohol consumption. Third, income and marriage are the main factors negatively associated with surrogate alcohol consumption. Besides, age shows a curvilinear relationship with that. We suggest that a modified anti-surrogate policy to increase the minimum price of pharmacy alcohol and to enforce restrictions on the sale of non-beverage alcohol is needed in Russia. Such measures could prevent an increase in non-beverage alcohol consumption in Russia against the backdrop of declining real incomes of the population.

Will changes in charging and gasoline prices affect electric vehicle sales? Evidence from China.

Electric vehicles and gasoline vehicles are substitutes for each other, and the cost of fuel is an important factor when consumers are faced with choices. Understanding the influence of changes in gasoline prices and charging prices on electric vehicle sales is of reference significance for promoting electric vehicles in the private sector. This paper uses data covering 212 prefecture-level cities from January, 2020, to August, 2022, for analysis, and the results show that different income groups have different sensitivities to the difference in oil and electricity prices. Additionally, changes in gasoline prices and charging prices will significantly affect electric vehicle sales in low-income and middle-income cities, electric vehicle sales in high-income cities will not be affected. Compared with nonpilot cities, residents of pilot cities are more sensitive to fuel price changes, indicating that the policy basis has a certain positive effect on the promotion of electric vehicles. It is recommended to consider the income status of regional residents when formulating policies for the use of electric vehicles. At the same time, publicity efforts should be increased to highlight the gap between the cost of fuel vehicles and electric vehicles.

Floating Population: Migration With(Out) Family and the Spatial Distribution of Economic Activity

This paper argues that migrants’ decision to bring their dependent family members shapes their consumption behavior, their choice of destination, and their sensitivity to migration barriers. We document that in China: (i) rural migrants disproportionately move to expensive cities; (ii) in these cities they live without their family and in poorer housing conditions; and (iii) they remit more, especially when living without their family. We then develop a quantitative general equilibrium spatial model in which migrant households choose whether, how (with or without their family), and where to migrate. We estimate the model using plausibly exogenous variation in wages, housing prices, and exposure to family migration costs. We use the model to estimate migration costs and relate them to migration policy. We find that hukou policies protect workers in large, expensive, and high income cities at the expense of rural households, who use remittances to overcome some of these costs.

The Linkage Between Economic Growth, Education and Health: Empirical Study in Java Island

Java Island accounts for more than half of Indonesia’s gross domestic product (GDP), hence it is where the majority of economic activities are concentrated, even though mostly of those major contributions are from certain cities. However, the quality of education and health shown by average years of schooling and life expectancy at birth in Java Island is unevenly distributed when compared with economic growth. This research aims to analyze the causalities and effects of economic growth, education, and health using simultaneous equations models on panel data that consists of 34 cities in Java Island spanning from 2015 to 2019, which are decomposed into three income classifications. Results indicate positive and significant effect from education toward economic growth on every income level. Health instead only brings positive and significant effect toward economic growth in high-income cities. Economic growth affects education positively in upper-middle and lower-middle income cities, and affects health positively only in upper-middle income. Ultimately, the relationship between education and health shows that they have positive and significant effects on each other and are consistent across all income groups.

To what extent is sustainability addressed at urban scale and how aligned is it with Earth's productive capacity?

Humanity's demand for resources exceeds annually the Earth's productive capacity (EPC), defined as the total regenerative and assimilative capacities of our planet. This article asks what role is given to living within EPC by cities in the quest for urban sustainability and how comprehensively are high-income cities assessing and reducing their impact. Our methodology comprises three steps: 1. urban sustainability literature review, 2. verification of sustainability frameworks and indicators aligned with the goal of living within earth's productive capacity, 3. study of high-income cities that have intentionally reduced their carbon footprint over the 1990-2020 period. Eleven sustainability frameworks were identified as fully aligned with the goal of living within EPC. Most cities work with indicators related to climate change; however, a singular focus risks underestimating cities’ total global ecological impacts. A shortlist of 24 cities who achieved at least a 15% reduction in their carbon footprint between 1990 and 2020 was developed. These reductions were insufficient in magnitude to meet climate stability goals. To achieve a just transition towards living within EPC, cities must confront their overconsumption by using EPC compliant tools and frameworks, and develop specific reduction targets considering global limits, local responsibilities, and capacities to mitigate.

Chinese Patients' Virtual Consultation Use of Different Sponsorship Types of Telemedicine Platforms: A Cross-Sectional Study in Zhejiang Province, China.

Background: Virtual consultation has been one of the most prevalent direct-to-consumer telemedicine services in China. However, little is known about patients' virtual consultation use of different sponsorship types of telemedicine platforms. This study aimed to examine Chinese patients' virtual consultation use and identify the factors that affect consultation use of different sponsorship types of platforms. Methods: We conducted a cross-sectional survey on 1,653 participants in tier 1, tier 2, and tier 3 hospitals in 3 cities with different income levels, in Zhejiang Province, in May and June 2019. Multinomial logistic regression analysis was used to identify the factors that affect patients' virtual consultation use of different sponsorship types of platforms. Results: The most frequently used consultation platform was digital health company-sponsored platforms (36.60%), hospital-sponsored platforms (34.57%), doctors' personal social media (11.09%), other company-sponsored platforms (9.24%), and medical e-commerce company-sponsored platforms (8.50%). The patients' virtual consultation use of different sponsorship types of platforms was determined by education levels, monthly income levels, perceived health status, internet use, and city income levels. Conclusions: Chinese patients' virtual consultation service use varied by platform sponsorship type. Digital health company-sponsored platforms owned advantages over other platform types in high-end consumers with higher education levels, higher income levels, living in high-income cities, and active in internet use. This study implied that different sponsorship types of direct-to-consumer telemedicine platforms in China differ from each other in online health care resource allocation, business model, and competitive advantage.

Medical information seeking behavior of urban patients in Zhejiang Province, China: a cross-sectional study

BackgroundHealth information seeking behavior (HISB) is a prevalent research topic. However, little is known about sociodemographic factors of HISB in China. This study aimed to examine the HISB of urban patients in China and identify predictors of source preference, online information seeking, and the timing of online seeking.MethodsBased on the Health Information National Trends Survey (HINTS), this study conducted a cross-sectional survey of 1653 participants in different types of hospitals in 3 cities of different income levels within Zhejiang Province, China. Binary logistic regression analysis and multinomial logistic regression analysis were used to identify predictors of source preference, online medical information seeking, and the timing of online seeking for urban patients.ResultsThe offline was the primary source of medical information for 58.61% of adult urban patients, while 78.19% had ever sought medical information online. 36.81% of online medical information seekers sought information before the medical visit, 8.65% sought information after the visit, and 54.54% sought information before and after the visit. China’s urban patients with higher education levels, higher income levels, young, active in internet use, and living in high-income cities were more likely to be active online medical information seekers (using the internet as the primary source) and online medical information seekers (having ever sought medical information online). Except for gender and age, most sociodemographic characteristics were not significantly associated with the timing of online medical information seeking.ConclusionsSignificant predictors of active online medical information seekers and online medical information seekers in China were almost the same. Regional economic development had a significant direct impact on medical information seekers. Most sociodemographic characteristics were not significantly associated with the timing of online medical information seeking. The findings of this study imply that China’s health information technology industry has Chinese characteristics.

Price versus quantity measures to deal with pollution and congestion in urban areas: A political economy approach

Pollution and congestion in urban areas are serious externalities that can be mitigated through the adoption of either price- or quantity-based mechanisms. While price restrictions are occasionally applied, quantity constraints based on car vintage are becoming increasingly popular. Our model provides a comprehensive analysis that explains this prevalence of quantity over price schemes. We also elucidate some other stylized facts observed in urban areas applying traffic restrictions, such as the implementation of hybrid price-and-quantity systems, the use of trial periods, the commitment to invest in public transit to enhance the acceptability of urban tolls, and the concentration of quantity restrictions in high-income cities.

OFDI activity and urban-regional development cycles: a co-evolutionary perspective

PurposeWhile conventional views of foreign investment activity primarily relate to efficiency-seeking investments, the authors argue that most other outward foreign direct investments (OFDIs) likely have positive effects on income development in the home region. Data on the US urban system not only illustrates this but also shows that this impact is not equal in all city-regions. The purpose of this paper is to develop an explanation as to why high- and low-income cities are associated with self-reinforcing cycles of OFDI activity that have different home-region impacts.Design/methodology/approachConventional views assume that inward foreign direct investments (IFDIs) have a positive impact on target regions, while OFDIs are often treated as the flip side of this story, being seen as having negative effects by shifting jobs and income abroad. This paper counters this logic by developing a conceptual argument that systematically distinguishes different types of OFDIs and relates them to economic development effects in the home (investing) region.FindingsUsing a co-evolutionary conceptualization, this paper suggests that many high-income cities are characterized by a virtuous cycle of development where high, successful OFDI activity generates both positive income effects as well as incentives to engage in further OFDIs in the future, thus leading to additional income increases. In contrast, it is suggested that low-income cities are characterized by what we refer to as vicious cycles of development with low OFDI activity, few development impulses and a lack of incentives and capabilities for future investments.Originality/valueThis paper develops a counter-perspective to conventional views of OFDI activity, arguing that these investments have a positive impact on regional income levels. The authors develop a spatially sensitive explanation which acknowledges that OFDIs do not trigger a linear process but are associated with diverging inter-urban development paths and may contribute to higher levels of intra-urban inequality. From these findings, the authors derive conclusions for future research and public policy.

Urban traffic congestion in twelve large metropolitan cities: A thematic analysis of local news contents, 2009–2018

The urban population are increasingly suffering from rising transport costs, worsening air quality, longer commuting time, and traffic congestion. Although much scholarly attention has focused on modeling urban traffic congestion, news contents about traffic jam have rarely been examined systematically. This study selects 12 large metropolitan cities across Asia (Beijing, Bengaluru, Hong Kong, Jakarta, Kuala Lumpur, Manila, and Singapore), Oceania (Auckland and Sydney), Europe (London) and North America (Los Angeles and Toronto) for an in-depth content analysis. More than 40,000 pieces of congestion-related articles in the 2009–2018 period have been identified in the local news media of these cities. We apply techniques of text analytics to analyze underlying themes in relation to sustainable transport and congestion-mitigation measures. Also, a sentiment analysis is conducted to examine the level of frustration expressed. Results show that traffic congestion is no longer perceived to be primarily an economic issue. Concerns over the environmental impacts of traffic congestion were increasingly discussed. Based on the content analysis, cities in Asia mentioned a lot about congestion-related PM2.5 pollution and climate change was a recurrent theme among non-Asian cities. Economic cost related to traffic congestion has received much more attention in high-income cities. With regard to congestion mitigation measures, terms related to promoting public and active transport was the most popular, followed by restriction and regulation measures, and then intelligent transport system (ITS) or smart mobility adoption. It is noteworthy that road capacity expansion has attracted the lowest coverage. Generally, high-density cities discussed more about public and active transport in alleviating traffic jams; and police enforcement was seen as important in tackling traffic congestion across all cities. In relation to the sentiment, there is a positive association between the overall traffic congestion level and the congestion frustration level expressed in local news.

Urban climate-health governance: Charting the role of public health in large global city adaptation plans

Over the last decade many large world cities have scaled up efforts at climate adaptation, a primary focus of which is protecting population health. With extreme weather disasters increasing worldwide, public health agencies are among local institutions under greatest stress; the Covid-19 pandemic has only heightened pressure on these agencies. Yet the limited literature examining adaptation actions across world cities suggest few, mainly high-income cities report health-related adaptation, while city public health agency engagement in adaptation has received little research attention. In this comparative review, we aimed to characterize the public health role in the adaptation plans of 22 large cities pre-identified as highly health-adaptive, by examining five health-associated adaptation activities chosen as “promising practice” based on evidence synthesized from evaluation research and practical experience: (i) hazard and vulnerability mapping; (ii) extreme weather preparedness and response; (iii) extreme heat plans (including heat early warning); (iv) non-heat early warning (e.g., flooding, vector-borne disease); and (v) climate-health monitoring and outcome surveillance. We found most (90%) city adaptation plans reported actions in at least three of these five activity areas. However, only 73% of these health-focused plans reported involvement of a public health agency (though the share was higher for cities in low- and middle-income countries). We detected differences across the five activities, including an ascending pattern of public health engagement starting with heat plans and including activities such as preparedness and mapping as health agency involvement increased. We also identified substantial presence of other city agencies–notably urban planning, emergency management and public utilities–in implementing these health-associated activities. With every world region likely to experience more widespread and intensifying climate impacts, and growing pressure on local public health agencies in conjunction with the Covid-19 pandemic, we identify opportunities for enhancing public health engagement in climate adaptation in large cities with a view to scaling up their ability to contribute to climate adaptation goals.

Economic environmental imbalance in China — Inter-city air pollutant emission linkage in Beijing–Tianjin–Hebei (BTH) urban agglomeration

Production fragmentation makes the air pollution policy no longer at the local scale but requires accounting more about embodied emissions cross-region through supply chains. Here, we map the consumption-driven NOx networks of Beijing-Tianjin-Hebei urban agglomeration (BTH) in China using the city-level multi-regional input-output model. The results show that the construction, service, and equipment manufacturing sectors in Beijing and Tianjin indirectly drive more than half of BTH NOx emissions (54%). Moreover, 75% of NOx flows in the supply chains are traded from cities with low efficiency (high intensity) to cities with high efficiency (low intensity), which reflects the economic environmental imbalance in BTH. Especially, for the metals smelting and pressing sector and nonmetal mineral products sector, there is a wider gap in emission intensity between production-oriented cities (1.03–4.43 Mt/million yuan) and consumer-oriented cities (0.08–0.45 Mt/million yuan), which leads to additional emissions of air pollutants to increase. At the same time, for the provinces in the south and north China, the role of BTH in the supply chain is different, which leads to an economic environmental imbalance between the north and the south. Synchronous outsourcing of production and technology is the key to solving the economic environmental imbalance. The consumption-oriented high-income cities are suggested to increase the financial and technical support to improve the efficiency of pollution control in production-oriented cities.

Socioeconomic level and associations between heat exposure and all-cause and cause-specific hospitalization in 1,814 Brazilian cities: A nationwide case-crossover study

BACKGROUND AND AIM: Little is known about socioeconomic disparities in vulnerability to heat. We aimed to evaluate whether there were socioeconomic disparities in vulnerability to heat-related all-cause and cause-specific hospitalization among Brazilian cities. METHODS: We collected daily hospitalization and weather data in the hot season (city-specific 4 adjacent hottest months each year) during 2000–2015 from 1,814 Brazilian cities covering 78.4% of the Brazilian population. A time-stratified case-crossover design modeled by quasi-Poisson regression and a distributed lag model was used to estimate city-specific heat–hospitalization association. Then meta-analysis was used to synthesize city-specific effect estimates according to different socioeconomic quartiles or levels. RESULTS:We included 49 million hospitalizations (58.5% female; median [interquartile range] age: 33.3 [19.8–55.7] years). For cities of lower middle income (LMI), upper middle income (UMI), and high income (HI) according to the World Bank’s classification, every 5°C increase in daily mean temperature during the hot season was associated with a 5.1% (95% CI 4.4%–5.7%,), 3.7% (3.3%–4.0%), and 2.6% (1.7%–3.4%) increase in all-cause hospitalization, respectively. The inter-city socioeconomic disparities in the association were strongest for children and adolescents (0–19 years) (effect estimates: 9.9% in LMI cities vs 5.2% in HI cities). The disparities were particularly evident for hospitalization due to certain diseases, including ischemic heart disease (effect estimates: 5.6% in LMI cities vs 0.5% in HI cities), asthma (3.7% vs −6.4%), pneumonia (8.0% vs 3.8%), renal diseases (9.6% vs 4.9%), mental health conditions (17.2% vs 5.5%), and neoplasms (3.1% vs −0.1%). The disparities were similar when stratifying the cities by other socioeconomic indicators (urbanization rate, literacy rate, and household income). CONCLUSIONS:Less developed cities displayed stronger associations between heat exposure and all-cause hospitalizations and certain types of cause-specific hospitalizations in Brazil. This may exacerbate the existing geographical health and socioeconomic inequalities under a changing climate. KEYWORDS: Temperature, Socio-economic factors (non-chemical stressors), Environmental disparities, Environmental justice, Big data

Socioeconomic inequality in vulnerability to all-cause and cause-specific hospitalisation associated with temperature variability: a time-series study in 1814 Brazilian cities

BACKGROUND AND AIM: Exposure to temperature variability has been associated with increased risk of mortality and morbidity. We aimed to evaluate whether the association between short-term temperature variability and hospitalisation was affected by local socioeconomic level in Brazil. METHODS: We collected city-level socioeconomic data, and daily hospitalisation and weather data from 1814 Brazilian cities between Jan 1, 2000, and Dec 31, 2015. All-cause and cause-specific hospitalisation data was from the Hospital Information System of the Unified Health System in Brazil. City-specific daily minimum and maximum temperatures came from a 0·25° × 0·25° Brazilian meteorological dataset. We represented city-specific socioeconomic level using literacy rate, urbanisation rate, average monthly household income per capita and GDP per capita over the study peroid. We used quasi-Poisson regression to do time-series analyses and obtain city-specific associations between temperature variability (TV) and hospitalisation. We pooled city-specific estimates according to different socioeconomic quartiles or levels using random-effect meta-analyses. RESULTS:We included a total of 147 959 243 hospitalisations (59·0% female) during the study period. Overall, we estimated that the hospitalisation risk due to every 1°C increase in the temperature variability in the current and previous day (TV0–1) increased by 0·52% (95% CI 0·50−0·55). For lower-middle-income cities, this risk was 0·63% (95% CI 0·58–0·69), for upper-middle-income cities it was 0·50% (0·47–0·53), and for high-income cities it was 0·39% (0·33–0·46). The socioeconomic inequality in vulnerability to TV0–1 was especially evident for people aged 0–19 years (effect estimate 1·21% for lower-middle income vs 0·52% for high income) and people aged 60 years or older (0·60% vs 0·43%), and for hospitalisation due to infectious diseases (1·62% vs 0·56% ), respiratory diseases (1·32% vs 0·55% ), and endocrine diseases (1·21% vs 0·32% ). CONCLUSIONS:People living in less developed cities in Brazil were more vulnerable to hospitalisation related to temperature variability, which could exacerbate existing health and socioeconomic inequalities in Brazil. KEYWORDS: Temperature extremes and variability, Socio-economic factors (non-chemical stressors), Environmental justice, Environmental disparities

Broadband Internet and Income Inequality

Abstract Digital technologies like the Internet can affect income inequality through increased demand for employment in manual and abstract jobs and reduced demand for employment in routine jobs. In this paper, we combine city-level income distribution and jobs data with broadband data from France to investigate the impact of broadband Internet access on income inequality. Using an instrumental variable estimation strategy, we find that broadband Internet reduces income inequality through increased employment in manual jobs. These effects increase with the availability of skilled workers and are significant in cities with a large service sector or high-speed Internet access. Further, the diffusion of broadband Internet comes with relatively greater benefits in low-income cities compared to high-income cities. Several robustness checks support these findings.

Does the ownership of health website matter? A cross-sectional study on Chinese consumer behavior

BackgroundOwnership has significant impact on website motivation. Consumers may heavily rely on the health website ownership cue when assessing credibility and making behavioral response toward health information on it. Health websites were primarily divided into four different ownership types (i.e., governmental, organizational, commercial, and personal) in China’s context. However, research on Chinese consumer behavior toward different ownership types of health websites is scarce. ObjectivesTo investigate the most credible and most commonly used health website ownership type among Chinese consumers, and to identify the influencing factors on perceived credibility, and actual usage of health websites. MethodsA cross-sectional survey of 1653 participants was conducted in 3-tier hospitals in 3 cities with different income levels. Multinomial logistic regression analyses were used to identify factors influencing Chinese consumers’ perceived credibility and actual use of health websites. ResultsThe most credible health website was the organizational, followed by the governmental, commercial, and personal. The most commonly used health website was the commercial, followed by the organizational, governmental, and personal. Individuals in medium-income and low-income cities were more likely than those in high-income cities to trust and use non-governmental health websites. Compared to the governmental health website, consumers of high-level hospitals were less likely than those of primary hospitals to trust and use personal health websites. Compared to the governmental health website, high-income individuals were more likely than low-income individuals to trust the personal health website, and use the organizational and commercial health website. ConclusionsBoth Chinese consumers’ perceived credibility and actual use of health website varied by ownership, and there was a gap between perceived credibility and actual usage of health website. Most sociodemographic factors had no statistically significant correlations with perceived credibility and actual usage of health website. City income level, consumer type and consumer income level were significantly associated with perceived credibility, actual usage of health websites.