Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania, USA
History and Political Science, Drexel University, Philadelphia, Pennsylvania, USA.
J Epidemiol Community Health. 2021 Mar;75(3):264-270. doi: 10.1136/jech-2020-215137. Epub 2020 Oct 15.
Urbanisation in Latin America (LA) is heterogeneous and could have varying implications for infant mortality (IM). Identifying city factors related to IM can help design policies that promote infant health in cities.
We quantified variability in infant mortality rates (IMR) across cities and examined associations between urban characteristics and IMR in a cross-sectional design. We estimated IMR for the period 2014-2016 using vital registration for 286 cities above 100 000 people in eight countries. Using national censuses, we calculated population size, growth and three socioeconomic scores reflecting living conditions, service provision and population educational attainment. We included mass transit availability of bus rapid transit and subway. Using Poisson multilevel regression, we estimated the per cent difference in IMR for a one SD (1SD) difference in city-level predictors.
Of the 286 cities, 130 had <250 000 inhabitants and 5 had >5 million. Overall IMR was 11.2 deaths/1000 live births. 57% of the total IMR variability across cities was within countries. Higher population growth, better living conditions, better service provision and mass transit availability were associated with 6.0% (95% CI -8.3 to 3.7%), 14.1% (95% CI -18.6 to -9.2), 11.4% (95% CI -16.1 to -6.4) and 6.6% (95% CI -9.2 to -3.9) lower IMR, respectively. Greater population size was associated with higher IMR. No association was observed for population-level educational attainment in the overall sample.
Improving living conditions, service provision and public transportation in cities may have a positive impact on reducing IMR in LA cities.
拉丁美洲（LA）的城市化是多样化的，可能对婴儿死亡率（IM）产生不同的影响。确定与 IM 相关的城市因素有助于制定促进城市婴儿健康的政策。
我们量化了 8 个国家 286 个 10 万以上人口城市的婴儿死亡率（IMR）的差异，并在横断面设计中研究了城市特征与 IMR 之间的关联。我们使用生命登记数据估算了 2014-2016 年期间的 IMR，数据来自 8 个国家的 286 个城市。我们使用全国人口普查计算了人口规模、增长以及反映生活条件、服务提供和人口教育程度的三个社会经济评分。我们还包括公共交通（快速公交和地铁）的可达性。使用泊松多层回归，我们估计了城市水平预测因子每相差一个标准差（1SD），IMR 的差异百分比。
在 286 个城市中，有 130 个城市的人口不足 25 万，5 个城市的人口超过 500 万。总体 IMR 为每 1000 例活产 11.2 例死亡。城市间 IMR 总变异的 57%在国家内。较高的人口增长率、更好的生活条件、更好的服务提供和公共交通的可用性与 IMR 降低 6.0%（95%CI-8.3 至 3.7%）、14.1%（95%CI-18.6 至-9.2%）、11.4%（95%CI-16.1 至-6.4%）和 6.6%（95%CI-9.2 至-3.9%）相关。人口规模越大，IMR 越高。在总体样本中，人口教育程度与 IMR 之间没有关联。
改善城市的生活条件、服务提供和公共交通可能对降低 LA 城市的 IMR 产生积极影响。
