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We investigated the association of urban landscape profiles with health and environmental outcomes, and whether those profiles are linked to environmental and health co-benefits. In this ecological study, we used data from 208 cities in 8 Latin American countries of the SALud URBana en América Latina (SALURBAL) project. Four urban landscape profiles were defined with metrics for the fragmentation, isolation, and shape of patches (contiguous area of urban development). Four environmental measures (lack of greenness, PM2.5, NO2, and carbon footprint), two cause-specific mortality rates (non-communicable diseases and unintentional injury mortality), and prevalence of three risk factors (hypertension, diabetes, and obesity) for adults were used as the main outcomes. We used linear regression models to evaluate the association of urban landscape profiles with environmental and health outcomes. In addition, we used finite mixture modeling to create co-benefit classes. Cities with the scattered pixels profile (low fragmentation, high isolation, and compact shaped patches) were most likely to have positive co-benefits. Profiles described as proximate stones (moderate fragmentation, moderate isolation, and irregular shape) and proximate inkblots (moderate-high fragmentation, moderate isolation, and complex shape) were most likely to have negative co-benefits. The contiguous large inkblots profile (low fragmentation, low isolation, and complex shape) was most likely to have mixed benefits.

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.

AimsTo evaluate the burden of cardiovascular risk factors and disease (CVD) among five Asian groups living in Catalonia (Spain): Indian, Pakistani, Bangladeshi, Filipino, and Chinese.Methods and resultsRetrospective cohort study using the Catalan Health Surveillance System database including 42 488 Pakistanis, 40 745 Chinese, 21 705 Indians, 9544 Filipinos, and 6907 Bangladeshis; and 5.3 million native individuals ('locals'). We estimated the age-adjusted prevalence (as of 31 December 2019) and incidence (during 2019) of diabetes, hypertension, hyperlipidaemia, obesity, tobacco use, coronary heart disease (CHD), cerebrovascular disease, atrial fibrillation, and heart failure (HF). Bangladeshis had the highest prevalence of diabetes (17.4% men, 22.6% women) followed by Pakistanis. Bangladeshis also had the highest prevalence of hyperlipidaemia (23.6% men, 18.3% women), hypertension among women (24%), and incident tobacco use among men. Pakistani women had the highest prevalence of obesity (28%). For CHD, Bangladeshi men had the highest prevalence (7.3%), followed by Pakistanis (6.3%); and Pakistanis had the highest prevalence among women (3.2%). For HF, the prevalence in Pakistani and Bangladeshi women was more than twice that of locals. Indians had the lowest prevalence of diabetes across South Asians, and of CHD across South Asian men, while the prevalence of CHD among Indian women was twice that of local women (2.6% vs. 1.3%). Filipinos had the highest prevalence of hypertension among men (21.8%). Chinese men and women had the lowest prevalence of risk factors and CVD.ConclusionsIn Catalonia, preventive interventions adapted to the risk profile of different Asian immigrant groups are needed, particularly for Bangladeshis and Pakistanis.

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.

BACKGROUND: Recent studies highlight the equigenic potential of greenspaces by showing narrower socioeconomic health inequalities in greener areas. However, results to date have been inconsistent and derived from high-income countries. We examined whether urban greenness modifies the associations between area-level education, as a proxy for socioeconomic status, and life expectancy and cause-specific mortality in Latin American cities. METHODS: We included 28 large cities, >137 million inhabitants, in nine Latin American countries, comprising 671 sub-city units, for 2012-2016. Socioeconomic status was assessed through a composite index of sub-city level education, and greenness was calculated using the normalized difference vegetation index. We fitted multilevel models with sub-city units nested in cities, with life expectancy or log(mortality) as the outcome. FINDINGS: We observed a social gradient, with higher levels of education associated with higher life expectancy and lower cause-specific mortality. There was weak evidence supporting the equigenesis hypothesis as greenness differentially modified the association between education and mortality outcomes. We observed an equigenic effect, with doubling magnitudes in the violence-related mortality reduction by education in areas with low greenness compared to medium-high greenness areas among men (16% [95% CI 12%-20%] vs 8% [95% CI 4%-11%] per 1 SD increase in area-level education). However, in contradiction to the equigenesis hypothesis, the magnitude in cardiovascular diseases (CVD) mortality reduction by education was stronger in areas with medium-high greenness compared to areas with low greenness (6% [95% CI 4%-7%] vs 1% [95% CI -1%-3%] and 5% [95% CI 3%-7%] vs 1% [95% CI -1%-3%] per 1 SD increase in area-level education, in women and men, respectively). Similarly, each 1-SD increase in greenness widened the educational inequality in life expectancy by 0.15 years and 0.20 years, in women and men, respectively. The equigenic effect was not observed in violence-related mortality among women and in mortality due to communicable diseases, maternal, neonatal and nutritional conditions (CMNN). INTERPRETATION: Our results confirm socioeconomic health inequalities in Latin American cities and show that the equigenic properties of greenspace vary by health outcome. Although mixed, our findings suggest that future greening policies should account for local social and economic conditions to ensure that greenspaces provide health benefits for all, and do not further exacerbate existing health inequalities in the region. FUNDING: Wellcome Trust (Grant, 205177/Z/16/Z).

South Asian (SA) individuals represent a large, growing population in a number of European countries. These individuals, particularly first-generation SA immigrants, are at higher risk of developing type 2 diabetes, atherogenic dyslipidaemia, and coronary heart disease than most other racial/ethnic groups living in Europe. SAs also have an increased risk of stroke compared to European-born individuals. Despite a large body of conclusive evidence, SA-specific cardiovascular health promotion and preventive interventions are currently scarce in most European countries, as well as at the European Union level. In this narrative review, we aim to increase awareness among clinicians and healthcare authorities of the public health importance of cardiovascular disease among SAs living in Europe, as well as the need for tailored interventions targeting this group - particularly, in countries where SA immigration is a recent phenomenon. To this purpose, we review key studies on the epidemiology and risk factors of cardiovascular disease in SAs living in the United Kingdom, Italy, Spain, Denmark, Norway, Sweden, and other European countries. Building on these, we discuss potential opportunities for multi-level, targeted, tailored cardiovascular prevention strategies. Because lifestyle interventions often face important cultural barriers in SAs, particularly for first-generation immigrants; we also discuss features that may help maximise the effectiveness of those interventions. Finally, we evaluate knowledge gaps, currently available risk stratification tools such as QRISK-3, and future directions in this important field.

BackgroundOur aim was to describe alcohol consumption trajectories in a cohort of people living with HIV and determine clinical and sociodemographic predictors of each trajectory.MethodsThis is a prospective cohort study of 7,906 patients in the 7 Centers for AIDS Research Network of Integrated Clinical Systems sites. Alcohol consumption was categorized as none, moderate, and alcohol misuse. Predictors included age, race/ethnicity, depressive or anxiety symptoms, illicit drug use (opioids, methamphetamines, cocaine/crack), marijuana use, hepatitis C virus (HCV) infection, HIV transmission risk factor, and HIV disease progression. We estimated sex-stratified alcohol consumption trajectories and their predictors.ResultsWe found 7 trajectories of alcohol consumption in men: stable nondrinking and increased drinking (71% and 29% of initial nondrinking); stable moderate, reduced drinking, and increased alcohol misuse (59%, 21%, and 21% of initial moderate alcohol use); and stable alcohol misuse and reduced alcohol misuse (75% and 25% of initial alcohol misuse). Categories were similar in women, except lack of an increase to alcohol misuse trajectory among women that begin with moderate use. Older men and women were more likely to have stable nondrinking, while younger men were more likely to increase to or remain in alcohol misuse. Minorities, people with depressive or anxiety symptoms, HCV-infected individuals, and people who injected drugs were more likely to reduce use. Illicit drug use was associated with a reduction in overall drinking, while marijuana use was associated with stable moderate drinking or misuse.ConclusionsLongitudinal trajectories of increasing alcohol use and stable misuse highlight the need to integrate routine screening and alcohol misuse interventions into HIV primary care.