Journal article
Associations between social and built environments and cardiovascular disease mortality across 342 Latin American cities: results from the SALURBAL study
Journal of global health, v 15, 04262
31 Oct 2025
PMID: 41171138
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Background
Latin American cities have heterogeneous mortality and urban environment profiles. We aim to describe the variability in cardiovascular disease (CVD) mortality across and within cities, and within and between Latin American countries, and investigate the associations between urban environmental features and CVD mortality in these areas.
Methods
Using harmonised data from the Salud Urbana en América Latina (i.e. Urban Health in Latin America) project, we investigated associations between urban features and CVD mortality in 342 Latin American cities encompassing 1252 sub-city units in nine Latin American countries. We obtained CVD mortality data from vital statistics and population denominators from national census bureaus. We evaluated the social environment through an educational attainment index from national censuses. Built environment indicators covered urban form, landscape, street design, transportation, and greenness. We applied multilevel negative binomial models with random intercepts for sub-city units nested within cities to describe the associations of social and built environmental features with CVD mortality adjusted by age and sex in each country.
Results
CVD death rates varied across sub-cities within and between Latin American countries, with greater variability in age-adjusted CVD death rates between sub-cities within cities (60%) than between cities within countries (21%) and between countries (19%). In fully adjusted models, higher educational attainment in sub-cities (rate ratio (RR) = 0.95; 95% confidence interval (CI) = 0.94–0.96) and higher landscape fragmentation in cities (RR = 0.97; 95% CI = 0.95–0.99) were associated with lower CVD mortality. Conversely, higher street connectivity in sub-cities (RR = 1.02; 95% CI = 1.01–1.04) was associated with higher CVD mortality. No clear associations were observed for sub-city greenness, population density, and the presence of mass transport infrastructure in cities.
Conclusions
Our findings emphasise the impact of urban inequalities on cardiovascular health, while also identifying education as an important and modifiable urban environmental feature that could be amenable to public health policies aimed at addressing disparities in CVD mortality within Latin American cities.
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Details
- Title
- Associations between social and built environments and cardiovascular disease mortality across 342 Latin American cities: results from the SALURBAL study
- Creators
- Dayan Carvalho Ramos Salles De Oliveira - Fundação Oswaldo CruzNelson Gouveia - Universidade de São PauloNatalia Tumas - UPF Barcelona School of ManagementCarolina Nazzal - University of ChileTania Alfaro - University of ChileMaria Fernanda Kroker-Lobos - Institute of Nutrition of Central America and PanamaJaime Miranda - Universidad Peruana Cayetano HerediaManuel Ramirez-Zea - Institute of Nutrition of Central America and PanamaThais Oliveira - Universidade Federal de Minas GeraisWaleska Caiaffa - Universidade Federal de Minas GeraisGoro Yamada - Drexel UniversityUsama Bilal - Drexel UniversityLetícia De Oliveira Cardoso (Corresponding Author) - National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Publication Details
- Journal of global health, v 15, 04262
- Publisher
- International Society of Global Health
- Number of pages
- 15
- Grant note
- National Institutes of Health (100000002) 205177/Z/16/Z / Wellcome Trust (100010269)
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Urban Health Collaborative; Epidemiology and Biostatistics
- Web of Science ID
- WOS:001609371800001
- Scopus ID
- 2-s2.0-105020651067
- Other Identifier
- 991022130777804721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Public, Environmental & Occupational Health