1
|
Abstract
We estimated excess mortality in Chilean cities during the COVID-19 pandemic and its association with city-level factors. We used mortality, and social and built environment data from the SALURBAL study for 21 Chilean cities, composed of 81 municipalities or "comunas", grouped in 4 macroregions. We estimated excess mortality by comparing deaths from January 2020 up to June 2021 vs 2016-2019, using a generalized additive model. We estimated a total of 21,699 (95%CI 21,693 to 21,704) excess deaths across the 21 cities. Overall relative excess mortality was highest in the Metropolitan (Santiago) and the North regions (28.9% and 22.2%, respectively), followed by the South and Center regions (17.6% and 14.1%). At the city-level, the highest relative excess mortality was found in the Northern cities of Calama and Iquique (around 40%). Cities with higher residential overcrowding had higher excess mortality. In Santiago, capital of Chile, municipalities with higher educational attainment had lower relative excess mortality. These results provide insight into the heterogeneous impact of COVID-19 in Chile, which has served as a magnifier of preexisting urban health inequalities, exhibiting different impacts between and within cities. Delving into these findings could help prioritize strategies addressed to prevent deaths in more vulnerable communities.
Collapse
Affiliation(s)
- Tania Alfaro
- Escuela de Salud Pública, Facultad de Medicina, Universidad de Chile, Independencia 939, Santiago, Chile.
| | - Kevin Martinez-Folgar
- Urban Health Collaborative; and Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
| | - Alejandra Vives
- Departamento de Salud Pública, Pontificia Universidad Católica de Chile, CEDEUS, Santiago, Chile
| | - Usama Bilal
- Urban Health Collaborative; and Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
| |
Collapse
|
2
|
Lazo M, Martinez-Folgar K, Bilal U. Racial/Ethnic Disparities in Hepatocellular Carcinoma: The Role of Neighborhood Socioeconomic Deprivation. Cancer Epidemiol Biomarkers Prev 2022; 31:1254-1256. [PMID: 35775232 DOI: 10.1158/1055-9965.epi-22-0378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 04/14/2022] [Accepted: 04/18/2022] [Indexed: 11/16/2022] Open
Abstract
The prevention of hepatocellular carcinoma (HCC) and reduction of its disparities necessitates research on the role of contextual social determinants of health. Empirical evidence on the role of contextual factors (e.g., neighborhood built and social environment) in these disparities is extremely limited. Oluyomi and colleagues conducted a Texas-wide study examining the contribution of neighborhood-level socioeconomic deprivation, proxied by the area deprivation index on HCC disparities. Future studies are needed to complement and extend these findings. See related article by Oluyomi et al., p. 1402.
Collapse
Affiliation(s)
- Mariana Lazo
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, Pennsylvania.,Department of Community Health and Prevention, Drexel Dornsife School of Public Health, Philadelphia, Pennsylvania
| | - Kevin Martinez-Folgar
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, Pennsylvania.,Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, Pennsylvania
| | - Usama Bilal
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, Pennsylvania.,Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, Pennsylvania
| |
Collapse
|
3
|
Bilal U, de Castro CP, Alfaro T, Barrientos-Gutierrez T, Barreto ML, Leveau CM, Martinez-Folgar K, Miranda JJ, Montes F, Mullachery P, Pina MF, Rodriguez DA, dos Santos GF, Andrade RFS, Diez Roux AV. Scaling of mortality in 742 metropolitan areas of the Americas. Sci Adv 2021; 7:eabl6325. [PMID: 34878846 PMCID: PMC8654292 DOI: 10.1126/sciadv.abl6325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/20/2021] [Indexed: 06/13/2023]
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.
Collapse
Affiliation(s)
- Usama Bilal
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
- Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
| | - Caio P. de Castro
- Center for Data and Knowledge Integration for Health (CIDACS), Fiocruz, Salvador, Bahia, Brazil
- Institute of Physics, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Tania Alfaro
- Escuela de Salud Pública, Universidad de Chile, Santiago de Chile, Chile
| | | | - Mauricio L. Barreto
- Center for Data and Knowledge Integration for Health (CIDACS), Fiocruz, Salvador, Bahia, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Carlos M. Leveau
- Instituto de Producción, Economía y Trabajo, Universidad Nacional de Lanús, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Kevin Martinez-Folgar
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
- Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
| | - J. Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Felipe Montes
- Department of Industrial Engineering, Universidad de los Andes, Bogotá, Colombia
| | - Pricila Mullachery
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
| | - Maria Fatima Pina
- Institute for Information and Communication on Health—ICICT/FIOCRUZ, Rio de Janeiro, Brazil
- i3S—Instituto de Investigação e Inovação em Saúde, Porto, Portugal
| | - Daniel A. Rodriguez
- Department of City and Regional Planning, University of California, Berkeley, Berkeley, CA, USA
| | - Gervasio F. dos Santos
- Center for Data and Knowledge Integration for Health (CIDACS), Fiocruz, Salvador, Bahia, Brazil
- Economics Faculty, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Roberto F. S. Andrade
- Center for Data and Knowledge Integration for Health (CIDACS), Fiocruz, Salvador, Bahia, Brazil
- Institute of Physics, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Ana V. Diez Roux
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
- Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
| |
Collapse
|
4
|
Lima EEC, Vilela EA, Peralta A, Rocha M, Queiroz BL, Gonzaga MR, Piscoya-Díaz M, Martinez-Folgar K, García-Guerrero VM, Freire FHMA. Investigating regional excess mortality during 2020 COVID-19 pandemic in selected Latin American countries. Genus 2021; 77:30. [PMID: 34744175 PMCID: PMC8564791 DOI: 10.1186/s41118-021-00139-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 10/11/2021] [Indexed: 11/10/2022] Open
Abstract
In this paper, we measure the effect of the 2020 COVID-19 pandemic wave at the national and subnational levels in selected Latin American countries that were most affected: Brazil, Chile, Ecuador, Guatemala, Mexico, and Peru. We used publicly available monthly mortality data to measure the impacts of the pandemic using excess mortality for each country and its regions. We compare the mortality, at national and regional levels, in 2020 to the mortality levels of recent trends and provide estimates of the impact of mortality on life expectancy at birth. Our findings indicate that from April 2020 on, mortality exceeded its usual monthly levels in multiple areas of each country. In Mexico and Peru, excess mortality was spreading through many areas by the end of the second half of 2020. To a lesser extent, we observed a similar pattern in Brazil, Chile, and Ecuador. We also found that as the pandemic progressed, excess mortality became more visible in areas with poorer socioeconomic and sanitary conditions. This excess mortality has reduced life expectancy across these countries by 2-10 years. Despite the lack of reliable information on COVID-19 mortality, excess mortality is a useful indicator for measuring the effects of the coronavirus pandemic, especially in the context of Latin American countries, where there is still a lack of good information on causes of death in their vital registration systems. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1186/s41118-021-00139-1.
Collapse
Affiliation(s)
| | | | - Andrés Peralta
- Public Health Institute, Pontifical Catholic University of Ecuador (PUCE) – Ecuador, Quito, Ecuador
| | | | | | - Marcos R. Gonzaga
- Departamento de Demografia e Ciências Atuariais, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | | | - Kevin Martinez-Folgar
- Urban Health Collaborative & Department of Epidemiology and Biostatistics, Dornsife School of Public
Health, Drexel University, Philadelphia, PA USA
| | | | - Flávio H. M. A. Freire
- Departamento de Demografia e Ciências Atuariais, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| |
Collapse
|
5
|
Martinez-Folgar K, Alburez-Gutierrez D, Paniagua-Avila A, Ramirez-Zea M, Bilal U. Excess Mortality During the COVID-19 Pandemic in Guatemala. Am J Public Health 2021; 111:1839-1846. [PMID: 34554821 PMCID: PMC8561179 DOI: 10.2105/ajph.2021.306452] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 01/22/2023]
Abstract
Objectives. To describe excess mortality during the COVID-19 pandemic in Guatemala during 2020 by week, age, sex, and place of death. Methods. We used mortality data from 2015 to 2020, gathered through the vital registration system of Guatemala. We calculated weekly mortality rates, overall and stratified by age, sex, and place of death. We fitted a generalized additive model to calculate excess deaths, adjusting for seasonality and secular trends and compared excess deaths to the official COVID-19 mortality count. Results. We found an initial decline of 26% in mortality rates during the first weeks of the pandemic in 2020, compared with 2015 to 2019. These declines were sustained through October 2020 for the population younger than 20 years and for deaths in public spaces and returned to normal from July onward in the population aged 20 to 39 years. We found a peak of 73% excess mortality in mid-July, especially in the population aged 40 years or older. We estimated a total of 8036 excess deaths (95% confidence interval = 7935, 8137) in 2020, 46% higher than the official COVID-19 mortality count. Conclusions. The extent of this health crisis is underestimated when COVID-19 confirmed death counts are used. (Am J Public Health. 2021;111(10): 1839-1846. https://doi.org/10.2105/AJPH.2021.306452).
Collapse
Affiliation(s)
- Kevin Martinez-Folgar
- Kevin Martinez-Folgar and Usama Bilal are with the Department of Epidemiology and Biostatistics and the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Diego Alburez-Gutierrez is with the Laboratory of Digital and Computational Demography, Max Planck Institute for Demographic Research, Rostock, Germany. Alejandra Paniagua-Avila is with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Manuel Ramirez-Zea is with the INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Diego Alburez-Gutierrez
- Kevin Martinez-Folgar and Usama Bilal are with the Department of Epidemiology and Biostatistics and the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Diego Alburez-Gutierrez is with the Laboratory of Digital and Computational Demography, Max Planck Institute for Demographic Research, Rostock, Germany. Alejandra Paniagua-Avila is with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Manuel Ramirez-Zea is with the INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Alejandra Paniagua-Avila
- Kevin Martinez-Folgar and Usama Bilal are with the Department of Epidemiology and Biostatistics and the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Diego Alburez-Gutierrez is with the Laboratory of Digital and Computational Demography, Max Planck Institute for Demographic Research, Rostock, Germany. Alejandra Paniagua-Avila is with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Manuel Ramirez-Zea is with the INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Manuel Ramirez-Zea
- Kevin Martinez-Folgar and Usama Bilal are with the Department of Epidemiology and Biostatistics and the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Diego Alburez-Gutierrez is with the Laboratory of Digital and Computational Demography, Max Planck Institute for Demographic Research, Rostock, Germany. Alejandra Paniagua-Avila is with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Manuel Ramirez-Zea is with the INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Usama Bilal
- Kevin Martinez-Folgar and Usama Bilal are with the Department of Epidemiology and Biostatistics and the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Diego Alburez-Gutierrez is with the Laboratory of Digital and Computational Demography, Max Planck Institute for Demographic Research, Rostock, Germany. Alejandra Paniagua-Avila is with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Manuel Ramirez-Zea is with the INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| |
Collapse
|
6
|
Mullachery PH, Rodriguez DA, Miranda JJ, López-Olmedo N, Martinez-Folgar K, Barreto ML, Diez Roux AV, Bilal U. Mortality amenable to healthcare in Latin American cities: a cross-sectional study examining between-country variation in amenable mortality and the role of urban metrics. Int J Epidemiol 2021; 51:303-313. [PMID: 34339492 PMCID: PMC8856009 DOI: 10.1093/ije/dyab137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 06/22/2021] [Indexed: 11/14/2022] Open
Abstract
Background This study examined the variation in city-level amenable mortality, i.e. mortality due to conditions that can be mitigated in the presence of timely and effective healthcare, in 363 Latin American cities and measured associations between amenable-mortality rates and urban metrics. Methods We used death records from 363 cities with populations of >100 000 people in nine Latin American countries from 2010 to 2016. We calculated sex-specific age-adjusted amenable-mortality rates per 100 000. We fitted multilevel linear models with cities nested within countries and estimated associations between amenable mortality and urban metrics, including population size and growth, fragmentation of urban development and socio-economic status. Results Cities in Mexico, Colombia and Brazil had the highest rates of amenable mortality. Overall, >70% of the variability in amenable mortality was due to between-country heterogeneity. But for preventable amenable mortality, those for which the healthcare system can prevent new cases, most of the variability in rates occurred between cities within countries. Population size and fragmentation of urban development were associated with amenable mortality. Higher fragmentation of urban development was associated with lower amenable mortality in small cities and higher amenable mortality in large cities. Population growth and higher city-level socio-economic status were associated with lower amenable mortality. Conclusions Most of the variability in amenable mortality in Latin American cities was due to between-county heterogeneity. However, urban metrics such as population size and growth, fragmentation of urban development and city-level socio-economic status may have a role in the distribution of amenable mortality across cities within countries.
Collapse
Affiliation(s)
- Pricila H Mullachery
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Daniel A Rodriguez
- Department of City and Regional Planning and Institute for Transportation Studies, University of California Berkeley, Berkeley, CA, USA
| | - J Jaime Miranda
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru.,CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Nancy López-Olmedo
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Kevin Martinez-Folgar
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.,Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Mauricio L Barreto
- Center for Data and Knowledge Integration for Health (CIDACS), Fundação Oswaldo Cruz, Bahia, Brazil
| | - Ana V Diez Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.,Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Usama Bilal
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.,Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| |
Collapse
|
7
|
Gouveia N, Kephart JL, Dronova I, McClure L, Granados JT, Betancourt RM, O'Ryan AC, Texcalac-Sangrador JL, Martinez-Folgar K, Rodriguez D, Diez-Roux AV. Ambient fine particulate matter in Latin American cities: Levels, population exposure, and associated urban factors. Sci Total Environ 2021; 772:145035. [PMID: 33581538 PMCID: PMC8024944 DOI: 10.1016/j.scitotenv.2021.145035] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/04/2021] [Accepted: 01/04/2021] [Indexed: 05/06/2023]
Abstract
BACKGROUND Exposure to particulate matter (PM2.5) is a major risk factor for morbidity and mortality. Yet few studies have examined patterns of population exposure and investigated the predictors of PM2.5 across the rapidly growing cities in lower- and middle-income countries. OBJECTIVES Characterize PM2.5 levels, describe patterns of population exposure, and investigate urban factors as predictors of PM2.5 levels. METHODS We used data from the Salud Urbana en America Latina/Urban Health in Latin America (SALURBAL) study, a multi-country assessment of the determinants of urban health in Latin America, to characterize PM2.5 levels in 366 cities comprising over 100,000 residents using satellite-derived estimates. Factors related to urban form and transportation were explored. RESULTS We found that about 172 million or 58% of the population studied lived in areas with air pollution levels above the defined WHO-AQG of 10 μg/m3 annual average. We also found that larger cities, cities with higher GDP, higher motorization rate and higher congestion tended to have higher PM2.5. In contrast cities with higher population density had lower levels of PM2.5. In addition, at the sub-city level, higher intersection density was associated with higher PM2.5 and more green space was associated with lower PM2.5. When all exposures were examined adjusted for each other, higher city per capita GDP and higher sub-city intersection density remained associated with higher PM2.5 levels, while higher city population density remained associated with lower levels. The presence of mass transit was also associated with lower PM2.5 after adjustment. The motorization rate also remained associated with PM2.5 and its inclusion attenuated the effect of population density. DISCUSSION These results show that PM2.5 exposures remain a major health risk in Latin American cities and suggest that urban planning and transportation policies could have a major impact on ambient levels.
Collapse
Affiliation(s)
- Nelson Gouveia
- Department of Preventive Medicine, University of Sao Paulo Medical School, Sao Paulo, Brazil.
| | - Josiah L Kephart
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
| | - Iryna Dronova
- Department of Landscape Architecture & Environmental Planning, College of Environmental Design, University of California Berkeley, Berkeley, CA, USA
| | - Leslie McClure
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - José Tapia Granados
- Department of Politics, College of Arts & Sciences, Drexel University, Philadelphia, PA, USA
| | | | - Andrea Cortínez O'Ryan
- Pontificia Universidad Católica de Chile, Department of Public Health, School of Medicine, Chile; Universidad de La Frontera, Department of Physical Education, Sports and Recreation, Chile
| | | | - Kevin Martinez-Folgar
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA; Instituto de Nutrición de Centroamérica y Panamá (INCAP), Guatemala
| | - Daniel Rodriguez
- Department of City and Regional Planning and Institute for Transportation Studies, University of California, Berkeley, CA, USA
| | - Ana V Diez-Roux
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| |
Collapse
|
8
|
Henson RM, Ortigoza A, Martinez-Folgar K, Baeza F, Caiaffa W, Vives Vergara A, Diez Roux AV, Lovasi G. Evaluating the health effects of place-based slum upgrading physical environment interventions: A systematic review (2012-2018). Soc Sci Med 2020; 261:113102. [PMID: 32739786 PMCID: PMC7611465 DOI: 10.1016/j.socscimed.2020.113102] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/28/2020] [Accepted: 05/31/2020] [Indexed: 11/04/2022]
Abstract
Rapid urbanization in low- and middle-income countries (LMIC) is associated with increasing population living in informal settlements. Inadequate infrastructure and disenfranchisement in settlements can create environments hazardous to health. Placed-based physical environment upgrading interventions have potential to improve environmental and economic conditions linked to health outcomes. Summarizing and assessing evidence of the impact of prior interventions is critical to motivating and selecting the most effective upgrading strategies moving forward. Scientific and grey literature were systematically reviewed to identify evaluations of physical environment slum upgrading interventions in LMICs published between 2012 and 2018. Thirteen evaluations that fulfilled inclusion criteria were reviewed. Quality of evaluations was assessed using an adapted Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Findings were then pooled with those published prior to 2012. Narrative analysis was performed. Of thirteen evaluations, eight used a longitudinal study design (“primary evaluations”). All primary evaluations were based in Latin America and included two housing, two transportation, and four comprehensive intervention evaluations. Three supporting evaluations assessed housing interventions in Argentina and South Africa; two assessed a comprehensive intervention in India. Effects by intervention-type included improvements in quality of life and communicable diseases after housing interventions, possible improvements in safety after transportation and comprehensive interventions, and possible non-statistically significant effects on social capital after comprehensive interventions. Effects due to interventions may vary by regional context and intervention scope. Limited strong evidence and the diffuse nature of comprehensive interventions suggests a need for attention to measurement of intervention exposure and analytic approaches to account for confounding and selection bias in evaluation. In addition to health improvements, evaluators should consider unintended health consequences and environmental impact. Understanding and isolating the effects of place-based interventions can inform necessary policy decisions to address inadequate living conditions as rapid urban growth continues across the globe.
Collapse
Affiliation(s)
- Rosie Mae Henson
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3600 Market Street, 7th Floor, Philadelphia, PA, USA, 19104.
| | - Ana Ortigoza
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3600 Market Street, 7th Floor, Philadelphia, PA, USA, 19104
| | - Kevin Martinez-Folgar
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3600 Market Street, 7th Floor, Philadelphia, PA, USA, 19104; Instituto de Nutrición de Centroamérica y Panamá (INCAP), Guatemala
| | - Fernando Baeza
- Departamento de Salud Pública, Escuela de Medicina, Pontificia Universidad Católica de Chile, Chile
| | - Waleska Caiaffa
- Observatório de Saúde Urbana de Belo Horizonte, Universidade Federal de Minas Gerais, Brazil
| | - Alejandra Vives Vergara
- Departamento de Salud Pública, Escuela de Medicina, Pontificia Universidad Católica de Chile, Chile; Centro de Desarrollo Urbano Sustentable (CEDEUS), Pontificia Universidad Católica de Chile, Chile
| | - Ana V Diez Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3600 Market Street, 7th Floor, Philadelphia, PA, USA, 19104
| | - Gina Lovasi
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3600 Market Street, 7th Floor, Philadelphia, PA, USA, 19104
| |
Collapse
|
9
|
Fort MP, Paniagua-Avila A, Beratarrechea A, Cardona S, Figueroa JC, Martinez-Folgar K, Moyano D, Barrios E, Mazariegos BE, Palacios E, Irazola V, He J, Ramirez-Zea M. Stakeholder Engagement in the Translation of a Hypertension Control Program to Guatemala's Public Primary Health Care System: Lessons Learned, Challenges, and Opportunities. Glob Heart 2020; 14:155-163. [PMID: 31324370 DOI: 10.1016/j.gheart.2019.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 05/25/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND There is an urgent need to define appropriate intervention strategies to control blood pressure in low- and middle-income countries. In 2018, a program proven effective in Argentina was translated to Guatemala's public primary health care system in rural and primarily indigenous communities. OBJECTIVES This paper describes the stakeholder engagement process used to adapt the program to the Guatemalan rural context prior to implementing a type II hybrid effectiveness-implementation trial and shares lessons learned. METHODS We identified key differences in the 2 contexts that are relevant to translating the intervention to the Guatemalan context. Alongside interviews and focus group discussions, we conducted consultation workshops in July and August 2018, applying a participatory translation process involving patients, family members, community members, health care providers, and Ministry of Health officials. The process consisted of multiple meetings in Guatemala City, as well as meetings in each of the 5 departments where the study will be implemented, and 1 district per department. During the workshops, we presented the evidence-based experience from Argentina and then focused on the challenges and recommended solutions that the participants identified for each of the intervention's 6 components. The process concluded with a meeting in which the research team and Ministry of Health officials defined specific details of the intervention. RESULTS The outcome of the process is an adapted approach appropriate to integrate into Guatemala's public primary health care system in the trial phase. The approach considers the challenges and recommended strategies for each of the 6 intervention components. CONCLUSIONS We identified lessons learned, challenges, and opportunities during the adaptation process. Findings will inform ongoing stakeholder engagement during the study implementation and future scale-up and efforts to translate evidence-based hypertension control strategies to low- and middle-income countries globally.
Collapse
Affiliation(s)
- Meredith P Fort
- Department of Health Systems, Management and Policy, Centers for American Indian and Alaska Native Health, Colorado School of Public Health, Aurora, CO, USA; Institute of Nutrition of Central America and Panama (INCAP) Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala.
| | - Alejandra Paniagua-Avila
- Institute of Nutrition of Central America and Panama (INCAP) Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Andrea Beratarrechea
- Department of Research in Chronic Diseases, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Sayra Cardona
- Institute of Nutrition of Central America and Panama (INCAP) Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Juan Carlos Figueroa
- Institute of Nutrition of Central America and Panama (INCAP) Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Kevin Martinez-Folgar
- Institute of Nutrition of Central America and Panama (INCAP) Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Daniela Moyano
- Department of Research in Chronic Diseases, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Edgar Barrios
- Ministry of Health and Social Welfare, Guatemala City, Guatemala
| | | | - Eduardo Palacios
- Ministry of Health and Social Welfare, Guatemala City, Guatemala
| | - Vilma Irazola
- Department of Research in Chronic Diseases, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Manuel Ramirez-Zea
- Institute of Nutrition of Central America and Panama (INCAP) Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| |
Collapse
|
10
|
Bilal U, Alazraqui M, Caiaffa WT, Lopez-Olmedo N, Martinez-Folgar K, Miranda JJ, Rodriguez DA, Vives A, Diez-Roux AV. Inequalities in life expectancy in six large Latin American cities from the SALURBAL study: an ecological analysis. Lancet Planet Health 2019; 3:e503-e510. [PMID: 31836433 PMCID: PMC6926471 DOI: 10.1016/s2542-5196(19)30235-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 05/26/2023]
Abstract
BACKGROUND Latin America is one of the most unequal regions in the world, but evidence is lacking on the magnitude of health inequalities in urban areas of the region. Our objective was to examine inequalities in life expectancy in six large Latin American cities and its association with a measure of area-level socioeconomic status. METHODS In this ecological analysis, we used data from the Salud Urbana en America Latina (SALURBAL) study on six large cities in Latin America (Buenos Aires, Argentina; Belo Horizonte, Brazil; Santiago, Chile; San José, Costa Rica; Mexico City, Mexico; and Panama City, Panama), comprising 266 subcity units, for the period 2011-15 (expect for Panama city, which was for 2012-16). We calculated average life expectancy at birth by sex and subcity unit with life tables using age-specific mortality rates estimated from a Bayesian model, and calculated the difference between the ninth and first decile of life expectancy at birth (P90-P10 gap) across subcity units in cities. We also analysed the association between life expectancy at birth and socioeconomic status at the subcity-unit level, using education as a proxy for socioeconomic status, and whether any geographical patterns existed in cities between subcity units. FINDINGS We found large spatial differences in average life expectancy at birth in Latin American cities, with the largest P90-P10 gaps observed in Panama City (15·0 years for men and 14·7 years for women), Santiago (8·9 years for men and 17·7 years for women), and Mexico City (10·9 years for men and 9·4 years for women), and the narrowest in Buenos Aires (4·4 years for men and 5·8 years for women), Belo Horizonte (4·0 years for men and 6·5 years for women), and San José (3·9 years for men and 3·0 years for women). Higher area-level socioeconomic status was associated with higher life expectancy, especially in Santiago (change in life expectancy per P90-P10 change unit-level of educational attainment 8·0 years [95% CI 5·8-10·3] for men and 11·8 years [7·1-16·4] for women) and Panama City (7·3 years [2·6-12·1] for men and 9·0 years [2·4-15·5] for women). We saw an increase in life expectancy at birth from east to west in Panama City and from north to south in core Mexico City, and a core-periphery divide in Buenos Aires and Santiago. Whereas for San José the central part of the city had the lowest life expectancy and in Belo Horizonte the central part of the city had the highest life expectancy. INTERPRETATION Large spatial differences in life expectancy in Latin American cities and their association with social factors highlight the importance of area-based approaches and policies that address social inequalities in improving health in cities of the region. FUNDING Wellcome Trust.
Collapse
Affiliation(s)
- Usama Bilal
- Department of Epidemiology and Biostatistics, Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA.
| | - Marcio Alazraqui
- Instituto de Salud Colectiva, Universidad Nacional de Lanús, Buenos Aires, Argentina
| | - Waleska T Caiaffa
- Observatório de Saúde Urbana de Belo Horizonte, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Nancy Lopez-Olmedo
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Kevin Martinez-Folgar
- Department of Epidemiology and Biostatistics, Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA; Instituto de Nutrición de Centroamérica y Panamá (INCAP), Guatemala
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases and School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Daniel A Rodriguez
- Department of City and Regional Planning and Institute for Transportation Studies, University of California Berkeley, Berkeley, CA, USA
| | - Alejandra Vives
- Departamento de Salud Pública, Escuela de Medicina, and CEDEUS, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ana V Diez-Roux
- Department of Epidemiology and Biostatistics, Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
| |
Collapse
|
11
|
Martinez-Folgar K. [Diagnostic methods: Utopia in Guatemala's rural public service?]. Rev Calid Asist 2017; 32:111. [PMID: 27575404 DOI: 10.1016/j.cali.2016.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 06/16/2016] [Indexed: 06/06/2023]
|