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Inequalities in life expectancy in six large Latin American cities from the SALURBAL study: an ecological analysis
Open accessAbstract
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.
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“Although urban areas are generally wealthier than rural areas, wide disparities in socioeconomic status (SES) and segregation into wealthy and poor sub-city units mean that cities contain a microcosm of social gradients – and inequities in health – present in the rest of the country [7–9].”
From Social epidemiology of urban COVID-19 inequalities in Latin America and Canada (2024) · cites this paper as [9]
Experimental — accuracy not yet measuredIn the citing paper
“The lack of association between IFR and SES in the oldest age group can be attributed to a lower life expectancy (23), which is factored into the estimation of SES (see methods for details), and the fact that elderly people might be, in general, healthier enough to survive until that age.”
From Socioeconomic status determines COVID-19 incidence and related mortality in Santiago, Chile (2021) · cites this paper as [23]
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Kavanagh, M. M., Norato, L. F., Friedman, E., & Armbrister, A. N. (2021) · Revista Panamericana de Salud Pública · doi:10.26633/rpsp.2021.29 · Cited by 10
Rosário, E., Severo, M., Francisco, D., Brito, M., & Costa, D. (2021) · BMC Public Health · doi:10.1186/s12889-021-11003-4 · Cited by 12
“Overcrowding conditions were considered when there were more than three people per room [47].”
BackgroundYu, J., Dwyer‐Lindgren, L., Bennett, J. E., Ezzati, M., Gustafson, P., Tran, M., & Brauer, M. D. (2021) · Health & Place · doi:10.1016/j.healthplace.2021.102692 · Cited by 10
“These results on wide intra-urban gaps in Metro Vancouver, along with previously reported studies in the USA (12,39), UK (17,18), Netherlands (22), and Latin America (21), can be combined with spatially varying data on built environment, socioeconomic and municipal services to evaluate mechanisms underlying these obse…”
InfluentialSocioeconomic inequities of COVID-19 mortality in vulnerable Comunas of the City of Buenos Aires
Marconi, A., Salgado, C. C., Sarrouf, E. B., Zamora, R. J., Irurzun, A. M., & Islam, N. (2023) · Scientific Reports · doi:10.1038/s41598-023-40911-1 · Cited by 9
López, S. R., Tumas, N., Bilal, U., Moore, K., Acharya, B., Quick, H. S., Quistberg, D. A., Acevedo, G. E., & Roux, A. V. D. (2022) · BMJ Open · doi:10.1136/bmjopen-2022-061277 · Cited by 9
“These within-cities heterogeneity that are likely present or emerging in many small-sized and middle-sized cities all over the world are of major relevance for urban policies to promote health and achieve health equity in low-income and middle-income countries.”
InfluentialSelf-citationThe need for data describing the surgical population in Latin America
Stefani, L. P. C., Hajjar, L. A., Biccard, B. M., & Pearse, R. M. (2022) · British Journal of Anaesthesia · doi:10.1016/j.bja.2022.02.029 · Cited by 9
Wei, L., Jia, H., Geng, Y., Dou, Z., Zhao, D., Gan, X., & Zhao, Y. (2025) · China CDC Weekly · doi:10.46234/ccdcw2025.136 · Cited by 8
Advancing equitable and sustainable urban health
Roux, A. V. D., & Bilal, U. (2025) · Nature Medicine · doi:10.1038/s41591-025-04031-9 · Cited by 11
Self-citationSpatial Inequities in Life Expectancy in Small Areas of Buenos Aires, Argentina 2015–2017
Trotta, A., Bilal, U., Acharya, B., Quick, H. S., Moore, K., Perner, M. S., Alazraqui, M., & Roux, A. V. D. (2023) · Journal of Urban Health · doi:10.1007/s11524-023-00730-1 · Cited by 8
“The median of the posterior distribution of LE at birth serves as the point estimate of LE, while the 2.5th and 97.5th percentiles of the posterior distribution of LE serve as the lower and upper credible intervals, respectively”
InfluentialSelf-citationCosta, A. C. D. O., Ramos, D. D. O., & Paes-Sousa, R. (2024) · Ciência & Saúde Coletiva · doi:10.1590/1413-81232024298.19602022 · Cited by 7
Urban Environments, Health, and Environmental Sustainability: Findings From the SALURBAL Study
Roux, A. V. D., Alazraqui, M., Alfaro, T., Barrientos‐Gutiérrez, T., Caiaffa, W. T., Kroker-Lobos, M. F., Miranda, J. J., Rodrı́guez, D. A., Sarmiento, O. L., Vives, A., et al. (2024) · Journal of Urban Health · doi:10.1007/s11524-024-00932-1 · Cited by 7
Self-citationElderly Walking Access to Street Markets in Chile: An Asset for Food Security in an Unequal Country
Vecchio, G., Castillo, B., Rodrigo Villegas, R., Rojas, C., Steiniger, S., & Carrasco, J. A. (2023) · Sustainability · doi:10.3390/su15053893 · Cited by 7
Health inequalities in a middle-income country: a systematic review of the Costa Rican case
Barboza‐Solís, C., Herrero, R., & Fantin, R. (2024) · Frontiers in Public Health · doi:10.3389/fpubh.2024.1397576 · Cited by 7
“For instance, Bilal et al. (12) described geographical disparities but did not find a significant link between ecological socioeconomic level and life expectancy.”
BackgroundHealth inequalities in cause-specific mortality in Costa Rica: a population-based cohort study
Fantin, R., Delpierre, C., & Barboza‐Solís, C. (2023) · Revista de Saúde Pública · doi:10.11606/s1518-8787.2023057004331 · Cited by 7
Analysis of Latin American Theme Parks in a Tourism Context
Florido‐Benítez, L. (2024) · Tourism and Hospitality · doi:10.3390/tourhosp5010009 · Cited by 6
“Latin America is one of the most unequal regions in the world in terms of income and social inequalities relating to gender, education, race and indigenous origin [64].”
BackgroundGullón, P., Bilal, U., Sánchez, P., Díez, J., Lovasi, G. S., & Franco, M. (2020) · Cities & Health · doi:10.1080/23748834.2020.1715117 · Cited by 6
“[39] In fact, following Geoffrey Rose’s population approach, comparing cities could uncover relationships that were non-significant in previous studies as all populations lived under the same mass influence.”
Self-citationFantin, R., Delpierre, C., Kelly‐Irving, M., & Barboza‐Solís, C. (2021) · Odovtos - International Journal of Dental Sciences · doi:10.15517/ijds.2021.46128 · Cited by 6
“In Latin America, a recent study using an ecological approach showed that higher area-level socioeconomic position was associated with higher life expectancy, especially in Santiago (Chile) and Panama City (Panama) (11).”
BackgroundVecchio, G. (2022) · REGION · doi:10.18335/region.v9i2.390 · Cited by 6
“For example, in Latin America, more attention has been given to issues such as life expectancy, pensions and welfare services (Bilal et al. 2019, Jeong 2013, Rotarou, Sakellariou 2019), in comparison to the spatial dimensions of ageing (Sánchez González 2015).”
BackgroundIntraurban Geographic and Socioeconomic Inequalities of Mortality in Four Cities in Colombia
Rodríguez-Villamizar, L. A., Marín, D., Piñeros, J. G., Rojas-Sánchez, O. A., Serrano-Lomelin, J. A., & Herrera, V. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20020992 · Cited by 7
“Environmental and socioeconomic attributes are important determinants of health at the intra-urban level; however, the richness and high heterogeneity of most Latin American cities’ landscapes translates into complex, difficult to unveil spatial patterns [19].”
BackgroundResultInfluentialTiznado-Aitken, I., Vecchio, G., Mora, R., Gonzalez, L., & Marshall, C. (2023) · Area Development and Policy · doi:10.1080/23792949.2023.2261530 · Cited by 6
“The inequality of the city is visible in objective indicators such as the income of its inhabitants (Fuentes et al., 2017) or their life expectancy (Bilal et al., 2019), leading to significant differences both among and inside municipalities (Candia Cid et al., 2021), and influencing also how local…”
Estimaciones de esperanza de vida al nacer en áreas menores de la región pampeana
Sacco, N., Williams, I., & Queiroz, B. L. (2021) · Revista Brasileira de Estudos de População · doi:10.20947/s0102-3098a0160 · Cited by 6
“La Agenda 2030 y los Objetivos de Desarrollo Sostenible: una oportunidad para América Latina y el Caribe (LC/G.2681-”
BackgroundInfluentialKavanagh, M. M., Norato, L. F., Friedman, E., & Armbrister, A. N. (2021) · Revista Panamericana de Salud Pública · doi:10.26633/rpsp.2021.106 · Cited by 6
Social epidemiology of urban COVID-19 inequalities in Latin America and Canada
Poirier, M. J., Morales Caceres, A., Dykstra, T. E., Dayrell Ferreira Sales, A., & Caiaffa, W. T. (2024) · International Journal for Equity in Health · doi:10.1186/s12939-024-02301-5 · Cited by 5
“Although urban areas are generally wealthier than rural areas, wide disparities in socioeconomic status (SES) and segregation into wealthy and poor sub-city units mean that cities contain a microcosm of social gradients – and inequities in health – present in the rest of the country [7–9].”
BackgroundSelf-citationDecoloniality as the Only Pathway to the Right to Development in Latin America
Beghin, N. (2022) · Development · doi:10.1057/s41301-022-00349-w · Cited by 5
Accessibility and ageing neighbourhoods: a cluster-based taxonomy to promote ageing in place
Vecchio, G., Medina, D., & Steiniger, S. (2025) · Cities & Health · doi:10.1080/23748834.2025.2501721 · Cited by 5
Comodificação dos climas urbanos e criação de injustiças socioclimáticas em Santiago do Chile
Aravena, H. I. R., & Mendes, F. H. (2020) · ENTRE-LUGAR · doi:10.30612/el.v11i22.12868 · Cited by 5
Amado, J., Oscanoa, T. J., Ponce, R. A. L., & Delgado-Guay, M. O. (2024) · BMC Palliative Care · doi:10.1186/s12904-024-01596-z · Cited by 4
“Having an aging population growing faster than Europe and North America, Latin America faces a population with increasing burden of chronic illness and a health care system suffering from several shortcomings and significant inequalities [12].”
Mortalidad juvenil, marginación social e inequidad en salud en México
Pérez, G. J. G., & López, M. G. V. (2021) · Ciência & Saúde Coletiva · doi:10.1590/1413-81232021267.08292021 · Cited by 4
“Rev Panam Salud Publica 2013; 33(2):122-130.”
Social inequalities and COVID-19 mortality between neighborhoods of Bariloche city, Argentina
Perner, M. S., Trotta, A., Bilal, U., Acharya, B., Quick, H. S., Pacífico, N., Berazategui, R., Alazraqui, M., & Roux, A. V. D. (2023) · International Journal for Equity in Health · doi:10.1186/s12939-023-02019-w · Cited by 4
“This assumption was studied in previous work for other countries from SALURBAL project, and found that socioeconomic rankings did not change much across time [48].”
ResultSelf-citationSocio-spatial trajectories and health disparities among older adults in Chile
Vidal, S., Madero-Cabib, I., Bogolasky, F., & Valente, R. (2024) · Health & Place · doi:10.1016/j.healthplace.2024.103324 · Cited by 4
“As for health, a comparative analysis of six large Latin American cities presented by Bilal et al. (2019) showed that life expectancy at birth in Santiago varies significantly according to area-level socio-economic status and education attainment.”
BackgroundThe Cross-Provincial Data of Life Expectancy Effect on Pension Fund in Indonesia
Ridho, S. L. Z., Sabli, H. B. H. M., & Setiawan, H. (2021) · International Journal of Social Science and Business · doi:10.23887/ijssb.v5i2.33672 · Cited by 4
Yannone, I. J., Alazraqui, M., Hernandez, J. R., Sarmiento, O. L., Rodríguez, D. A., Ferrer, C. P., Guzmán, L. A., Perner, M. S., Trotta, A., Roux, A. V. D., et al. (2025) · Injury Epidemiology · doi:10.1186/s40621-025-00611-y · Cited by 3
“To account for incomplete death registration, population projections were corrected using an ensemble of death distribution methods [20, 22], multiplying the population estimate for each year by a year-specific correction factor.”
Self-citationInclusive Cities: Healthy Cities for All
de Duren, N. R. L., Benítez, B. L., Bonilla, J. P., Regalía, F., Bilal, U., Ibáñez, A. M., Schady, N., Chauvin, J. P., Pinillos, J., Hoffmann, B., et al. (2022) · Inter-American Development Bank eBooks · doi:10.18235/0004459 · Cited by 5
Self-citationTrends in socioeconomic inequalities in life expectancy and lifespan variation in Chile
Silva-Illanes, N. (2024) · Frontiers in Public Health · doi:10.3389/fpubh.2024.1404410 · Cited by 4
“Using area-level information in Santiago to compare life expectancy at birth between the first and ninth deciles of subcity units in terms of socioeconomic status, Bilal et al. (7) found a 8.9-year gap for men and a 17.7-year gap for women.”
MethodInfluentialCuidar el territorio que envejece: Envejecimiento demográfico y marginalidad territorial en Chile
Vecchio, G. (2022) · Eídos · doi:10.29019/eidos.v14i19.1028 · Cited by 3
Gender differences in life expectancy free of depressive symptoms in Chile between 2003 and 2016
Moreno, X., Monsalves, M. J., Rueda, S., Dagnino, P., & Borghero, F. (2024) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2024.9 · Cited by 3
“Additionally, a marked socioeconomic gap in life expectancy among women in Chile has been reported, which is broader than that observed among men (Bilal et al., 2019).”
ResultEarly-life external exposome in children 2–5 years old in Colombia
Marín, D., Basagaña, X., Amaya-Fernández, F. O., Aristizábal, L. M., Muñoz, D. A., Domínguez, A., Molina, F., Ramos-Contreras, C. D., Morales, R., Hincapie, R. C., et al. (2024) · Environmental Research · doi:10.1016/j.envres.2024.118913 · Cited by 3
Valentino, G., Auchincloss, A. H., Acharya, B., Tumas, N., López‐Olmedo, N., Ortigoza, A. F., de Menezes, M. C., Kroker-Lobos, M. F., & Carolina Nazzal, N. (2025) · Journal of Nutritional Science · doi:10.1017/jns.2024.93 · Cited by 3
“Education is an important determinant of overall health (30) ; however, across varied Latin American contexts, educational advancements do not necessarily confer economic growth, development, and lower inequality (31) .”
The impact of standardized disease-specific healthcare coverage
Menares, F., & Muñoz, P. (2025) · Journal of Public Economics · doi:10.1016/j.jpubeco.2025.105312 · Cited by 4
Murillo, J. P., Campillay, M. L., & Pesse-Sorensen, K. (2019) · Anales de la Facultad de Medicina · doi:10.15381/anales.v80i4.17250 · Cited by 3
Cities and Public Health in Latin America
Chauvin, J. P. (2021) · doi:10.18235/0003692 · Cited by 3
Chandio, A. A., Amin, A., Sethi, N., Haouas, I., & Ahmad, F. (2024) · Journal of Public Affairs · doi:10.1002/pa.2963 · Cited by 2
Metadata
- Authors
- Bilal, U., Alazraqui, M., Caiaffa, W. T., Lopez-Olmedo, N., Martinez-Folgar, K., Miranda, J. J., Rodriguez, D. A., Vives, A., & Diez-Roux, A. V.
- Affiliations
- Drexel University (US)
- Universidad Nacional de Lanús (AR)
- Universidade Federal de Minas Gerais (BR)
- Universidad Peruana Cayetano Heredia (PE)
- Pontificia Universidad Católica de Chile (CL)
- Corresponding author
- Bilal, Usama
- Venue
- The Lancet Planetary Health
- Publisher
- Elsevier BV
- Published
- 2019-12
- Volume
- 3
- Issue
- 12
- Pages
- e503-e510
- ISSN
- 2542-5196 (ISSN-L)
- PMC
- PMC6926471
- OpenAlex
- W2994707839
- Cited by
- 153
- References
- 27
- Citations by year
- 2026: 11 · 2025: 18 · 2024: 22 · 2023: 24 · 2022: 23 · 2021: 45 · 2020: 8 · 2019: 2
- FWCI
- 18.94
- Type
- journal article
- Language
- en
- Update notices
- erratum (2020-01-01)
- Open access
- gold
- doi.org
- Licence
- Locations
- The Lancet Planetary Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Florida International University Digital Commons (Florida International University) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Institutes of Health (DP5OD26429)
- Wellcome Trust (205177/Z/16/Z)
- Topics
- Social Sciences › Health › Health disparities and outcomes
- Social Sciences › Health › Public Health and Social Inequalities
- Social Sciences › Demography › Insurance, Mortality, Demography, Risk Management
- Keywords
- life expectancy, health disparities, urban health, area-level socioeconomic status, educational attainment, regional variation in mortality, Latin American cities, sex differences in longevity, life tables, Panama City, Santiago, Mexico City, Buenos Aires, Belo Horizonte
- MeSH terms
- Adolescent, Adult, Aged, Argentina, Brazil, Child, Child, Preschool, Chile, Cities, Costa Rica, Female, Humans, Infant, Infant, Newborn, Life Expectancy, Male, Mexico, Middle Aged, Panama, Socioeconomic Factors, Young Adult
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