The concept of a so-called urban advantage in health ignores the possibility of heterogeneity in health outcomes across cities. Using a harmonized dataset from the SALURBAL project, we describe variability and predictors of life expectancy and proportionate mortality in 363 cities across nine Latin American countries. Life expectancy differed substantially across cities within the same country. Cause-specific mortality also varied across cities, with some causes of death (unintentional and violent injuries and deaths) showing large variation within countries, whereas other causes of death (communicable, maternal, neonatal and nutritional, cancer, cardiovascular disease and other noncommunicable diseases) varied substantially between countries. In multivariable mixed models, higher levels of education, water access and sanitation and less overcrowding were associated with longer life expectancy, a relatively lower proportion of communicable, maternal, neonatal and nutritional deaths and a higher proportion of deaths from cancer, cardiovascular disease and other noncommunicable diseases. These results highlight considerable heterogeneity in life expectancy and causes of death across cities of Latin America, revealing modifiable factors that could be amenable to urban policies aimed toward improving urban health in Latin America and more generally in other urban environments.

所谓的城市健康优势的概念忽略了城市间健康结果存在异质性的可能性。使用来自 SALURBAL 项目的统一数据集，我们描述了 9 个拉丁美洲国家 363 个城市的预期寿命和成比例死亡率的可变性和预测因子。同一国家内不同城市的预期寿命差异很大。不同城市的特定死因死亡率也各不相同，一些死因（意外和暴力伤害和死亡）在国家内部差异很大，而其他死因（传染病、孕产妇、新生儿和营养、癌症、心血管疾病和其他非传染性疾病） ) 国家之间差异很大。在多变量混合模型中，更高的教育水平，获得水和卫生设施以及减少过度拥挤与更长的预期寿命、相对较低的传染病、孕产妇、新生儿和营养死亡比例以及较高比例的癌症、心血管疾病和其他非传染性疾病死亡有关。这些结果突出了拉丁美洲各城市的预期寿命和死亡原因的相当大的异质性，揭示了可改变的因素，这些因素可能适用于旨在改善拉丁美洲城市健康的城市政策，更普遍地适用于其他城市环境。