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1.
J Urban Health ; 99(3): 409-426, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1824782

ABSTRACT

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.


Subject(s)
Suicide , Urbanization , Cities , Humans , Income , Urban Population
2.
Sci Adv ; 7(50): eabl6325, 2021 Dec 10.
Article in English | MEDLINE | ID: covidwho-1571131

ABSTRACT

We explored how mortality scales with city population size using vital registration and population data from 742 cities in 10 Latin American countries and the United States. We found that more populated cities had lower mortality (sublinear scaling), driven by a sublinear pattern in U.S. cities, while Latin American cities had similar mortality across city sizes. Sexually transmitted infections and homicides showed higher rates in larger cities (superlinear scaling). Tuberculosis mortality behaved sublinearly in U.S. and Mexican cities and superlinearly in other Latin American cities. Other communicable, maternal, neonatal, and nutritional deaths, and deaths due to noncommunicable diseases were generally sublinear in the United States and linear or superlinear in Latin America. Our findings reveal distinct patterns across the Americas, suggesting no universal relation between city size and mortality, pointing to the importance of understanding the processes that explain heterogeneity in scaling behavior or mortality to further advance urban health policies.

3.
Lancet Digit Health ; 3(11): e716-e722, 2021 11.
Article in English | MEDLINE | ID: covidwho-1557380

ABSTRACT

BACKGROUND: Little is known about the effect of changes in mobility at the subcity level on subsequent COVID-19 incidence, which is particularly relevant in Latin America, where substantial barriers prevent COVID-19 vaccine access and non-pharmaceutical interventions are essential to mitigation efforts. We aimed to examine the longitudinal associations between population mobility and COVID-19 incidence at the subcity level across a large number of Latin American cities. METHODS: In this longitudinal ecological study, we compiled aggregated mobile phone location data, daily confirmed COVID-19 cases, and features of urban and social environments to analyse population mobility and COVID-19 incidence at the subcity level among cities with more than 100 000 inhabitants in Argentina, Brazil, Colombia, Guatemala, and Mexico, from March 2 to Aug 29, 2020. Spatially aggregated mobile phone data were provided by the UN Development Programme in Latin America and the Caribbean and Grandata; confirmed COVID-19 cases were from national government reports and population and socioeconomic factors were from the latest national census in each country. We used mixed-effects negative binomial regression for a time-series analysis, to examine longitudinal associations between weekly mobility changes from baseline (prepandemic week of March 2-9, 2020) and subsequent COVID-19 incidence (lagged by 1-6 weeks) at the subcity level, adjusting for urban environmental and socioeconomic factors (time-invariant educational attainment, residential overcrowding, population density [all at the subcity level], and country). FINDINGS: We included 1031 subcity areas, representing 314 Latin American cities, in Argentina (107 subcity areas), Brazil (416), Colombia (82), Guatemala (20), and Mexico (406). In the main adjusted model, we observed an incidence rate ratio (IRR) of 2·35 (95% CI 2·12-2·60) for COVID-19 incidence per log unit increase in the mobility ratio (vs baseline) during the previous week. Thus, 10% lower weekly mobility was associated with 8·6% (95% CI 7·6-9·6) lower incidence of COVID-19 in the following week. This association gradually weakened as the lag between mobility and COVID-19 incidence increased and was not different from null at a 6-week lag. INTERPRETATION: Reduced population movement within a subcity area is associated with a subsequent decrease in COVID-19 incidence among residents of that subcity area. Policies that reduce population mobility at the subcity level might be an effective COVID-19 mitigation strategy, although they should be combined with strategies that mitigate any adverse social and economic consequences of reduced mobility for the most vulnerable groups. FUNDING: Wellcome Trust. TRANSLATION: For the Spanish translation of the abstract see Supplementary Materials section.


Subject(s)
COVID-19/epidemiology , Population Dynamics , Poverty , COVID-19/therapy , COVID-19 Vaccines , Cell Phone , Cities , Health Services Accessibility , Humans , Incidence , Latin America/epidemiology , Longitudinal Studies , Pandemics , SARS-CoV-2
4.
Int J Environ Res Public Health ; 18(22)2021 11 11.
Article in English | MEDLINE | ID: covidwho-1512344

ABSTRACT

Active transportation (AT) is widely viewed as an important target for increasing participation in aerobic physical activity and improving health, while simultaneously addressing pollution and climate change through reductions in motor vehicular emissions. In recent years, progress in increasing AT has stalled in some countries and, furthermore, the coronavirus (COVID-19) pandemic has created new AT opportunities while also exposing the barriers and health inequities related to AT for some populations. This paper describes the results of the December 2019 Conference on Health and Active Transportation (CHAT) which brought together leaders from the transportation and health disciplines. Attendees charted a course for the future around three themes: Reflecting on Innovative Practices, Building Strategic Institutional Relationships, and Identifying Research Needs and Opportunities. This paper focuses on conclusions of the Research Needs and Opportunities theme. We present a conceptual model derived from the conference sessions that considers how economic and systems analysis, evaluation of emerging technologies and policies, efforts to address inclusivity, disparities and equity along with renewed attention to messaging and communication could contribute to overcoming barriers to development and use of AT infrastructure. Specific research gaps concerning these themes are presented. We further discuss the relevance of these themes considering the pandemic. Renewed efforts at research, dissemination and implementation are needed to achieve the potential health and environmental benefits of AT and to preserve positive changes associated with the pandemic while mitigating negative ones.


Subject(s)
COVID-19 , Exercise , Humans , SARS-CoV-2 , Transportation
5.
Lancet Digit Health ; 3(11): e716-e722, 2021 11.
Article in English | MEDLINE | ID: covidwho-1377902

ABSTRACT

BACKGROUND: Little is known about the effect of changes in mobility at the subcity level on subsequent COVID-19 incidence, which is particularly relevant in Latin America, where substantial barriers prevent COVID-19 vaccine access and non-pharmaceutical interventions are essential to mitigation efforts. We aimed to examine the longitudinal associations between population mobility and COVID-19 incidence at the subcity level across a large number of Latin American cities. METHODS: In this longitudinal ecological study, we compiled aggregated mobile phone location data, daily confirmed COVID-19 cases, and features of urban and social environments to analyse population mobility and COVID-19 incidence at the subcity level among cities with more than 100 000 inhabitants in Argentina, Brazil, Colombia, Guatemala, and Mexico, from March 2 to Aug 29, 2020. Spatially aggregated mobile phone data were provided by the UN Development Programme in Latin America and the Caribbean and Grandata; confirmed COVID-19 cases were from national government reports and population and socioeconomic factors were from the latest national census in each country. We used mixed-effects negative binomial regression for a time-series analysis, to examine longitudinal associations between weekly mobility changes from baseline (prepandemic week of March 2-9, 2020) and subsequent COVID-19 incidence (lagged by 1-6 weeks) at the subcity level, adjusting for urban environmental and socioeconomic factors (time-invariant educational attainment, residential overcrowding, population density [all at the subcity level], and country). FINDINGS: We included 1031 subcity areas, representing 314 Latin American cities, in Argentina (107 subcity areas), Brazil (416), Colombia (82), Guatemala (20), and Mexico (406). In the main adjusted model, we observed an incidence rate ratio (IRR) of 2·35 (95% CI 2·12-2·60) for COVID-19 incidence per log unit increase in the mobility ratio (vs baseline) during the previous week. Thus, 10% lower weekly mobility was associated with 8·6% (95% CI 7·6-9·6) lower incidence of COVID-19 in the following week. This association gradually weakened as the lag between mobility and COVID-19 incidence increased and was not different from null at a 6-week lag. INTERPRETATION: Reduced population movement within a subcity area is associated with a subsequent decrease in COVID-19 incidence among residents of that subcity area. Policies that reduce population mobility at the subcity level might be an effective COVID-19 mitigation strategy, although they should be combined with strategies that mitigate any adverse social and economic consequences of reduced mobility for the most vulnerable groups. FUNDING: Wellcome Trust. TRANSLATION: For the Spanish translation of the abstract see Supplementary Materials section.


Subject(s)
COVID-19/epidemiology , Population Dynamics , Poverty , COVID-19/therapy , COVID-19 Vaccines , Cell Phone , Cities , Health Services Accessibility , Humans , Incidence , Latin America/epidemiology , Longitudinal Studies , Pandemics , SARS-CoV-2
6.
Transport Policy ; 2021.
Article in English | ScienceDirect | ID: covidwho-1307230

ABSTRACT

COVID-19 has upended travel across the world, disrupting commute patterns, mode choices, and public transit systems. In the United States, changes to transit service and reductions in passenger volume due to COVID-19 are lasting longer than originally anticipated. In this paper we examine the impacts of the COVID-19 pandemic on individual travel behavior across the United States. We analyze mobility data from a sample drawn from a nationwide smartphone-based panel curated by a private firm, Embee Mobile, in combination with a survey that we administered to that sample in August 2020. Our analysis provides insight into travel patterns and the immediate impacts of the COVID-19 pandemic on transit riders. We investigated three questions. First, how do transit riders differ socio-demographically from non-riders? Second, how has the travel behavior of transit riders changed due to the pandemic in comparison to non-riders, controlling for other factors? And third, how has this travel behavior varied across different types of transit riders? The travel patterns of transit riders were more significantly disrupted by the pandemic than the travel of non-riders, as measured by the average weekly number of trips and distance traveled before and after the onset of the pandemic. This was calculated using GPS traces from panel member smartphones. Our survey of the panel revealed that of transit riders, 75% reported taking transit less since the pandemic, likely due to a combination of being affected by transit service changes, concerns about infection risk on transit, and trip reductions due to shelter-in-place rules. Less than 10 percent of transit riders in our sample reported that they were comfortable using transit despite COVID-19 infection risk, and were not affected by transit service reductions. Transit riders were also more likely to have changed their travel behavior in other ways, including reporting an increase in walking. However, lower-income transit riders were different from higher-income riders in that they had a significantly smaller reduction in the number of trips and distance traveled, suggesting that these lower-income households had less discretion over the amount of travel they carried out during the pandemic. These results have significant implications for understanding the way welfare has been affected for transportation-disadvantaged populations during the course of the pandemic, and insight into the recovery of U.S. transit systems. The evidence from this unique dataset helps us understand the future effects of the pandemic on transit riders in the United States, either in further recovery from the pandemic with the anticipated effects of mass vaccination, or in response to additional waves of COVID-19 and other pandemics.

7.
Journal of Transport & Health ; 21:101021, 2021.
Article in English | ScienceDirect | ID: covidwho-1126956

ABSTRACT

Background Transportation policies and projects have multiple impacts on health. Research on these impacts can help promote positive and reduce adverse health consequences of decisions made by transportation agencies. Methods In 2019 the U.S. National Cooperative Highway Research Program published a research roadmap for transportation and public health based on an extensive literature search and key informant interviews. The roadmap identified 44 research gaps and 122 research needs on a wide range of relevant topics. From this list, using pre-established criteria including specificity, equity, potential impact, and long-term usefulness, we selected 20 topics suitable for further research especially in academic settings. Results We present the questions, context, and possible research approach for each of the 20 topics. These topics cover issues ranging from integrating equity into performance measures and developing forecasting models for active travel to incorporating health questions into routine household travel surveys and examining health impacts of autonomous vehicles. We added questions on the impacts of the COVID-19 pandemic on transportation. Discussion This list will be useful to faculty, researchers, and students as they consider topics for research in transportation and public health. Results of research on these topics could influence transportation decisions in policy making, planning and community participation, capital programming, project design, and implementation. Future leaders of transportation agencies, transportation providers, and advocacy organizations may be more likely to consider transportation policies that incorporate a health perspective if their training includes research findings that increase their awareness of the health impacts of these policies.

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