The Health Consequences of Urban Scaling

新冠肺炎是自1918年流感大流行以来最严重的卫生紧急情况。然而， 这场大流行的影响被严重低估。第一，多人死亡 由于测试能力的差异，新冠肺炎直接导致的代码尚未如此编码， 了解临床表现等。第二，大流行也间接产生了 健康的后果，包括由于 旨在控制大流行的缓解措施。无论是直接影响还是间接影响 大流行的分布不均，作为社会经济地位较低的个人和 种族/族裔小数化的人口遭受了最大的直接和 大流行的间接影响。这些不平等在大城市可能会更广泛，因为它们往往 把财富和贫困都集中起来。然而，较大的城市也往往有更健康的 人口。这项研究的总体目标是检查超额死亡率和不平等现象 美国大都市统计地区(MSA)2020年和2021年的超额死亡率，以及 探索导致过高死亡率的因素及其不平等。我们将利用专业知识和数据 通过家长资助获得，并将指导一组不同的学员来发现 超额死亡率的不平等和这些不平等的预测因素将允许更好的 了解卫生不平等在哪里以及为什么更广泛，以及这些不平等是否 来自大流行的直接或间接影响。具体来说，我们的目标是(1)描述 2020年至2021年期间美国392个MSA的超额死亡率，并直接量化 (新冠肺炎)与疫情的间接影响；(2)通过以下方式衡量超额死亡率方面的不平等 2020年至2021年期间392个MSA的种族/族裔和教育状况，并量化 大流行对这些不平等的直接和间接影响的贡献；和(3)研究 城市规模、城市级收入不平等和城市级种族主义之间的关联 关于过高死亡率和过高死亡率不平等的居住隔离，以及 考察这些因素对经济增长的直接和间接影响的不同贡献 大流行。总而言之，拟议的研究将填补我们在以下方面的知识空白 新冠肺炎大流行在美国城市地区分布不均的影响， 特别强调在整个城市化过程中理解这些影响， 关注社会不平等问题。

COVID-19 is the most severe health emergency since the 1918 influenza pandemic. However, the impacts of the pandemic have been severely underestimated. First, a number of deaths directly caused by COVID-19 have not been coded as such due to differences in testing capacity, knowledge of clinical manifestations, etc. Second, the pandemic has also had indirect consequences of health, including potential increases or decreases in mortality due to the mitigation measures designed to control the pandemic. Both the direct and indirect impacts of the pandemic have been unequally distributed, as individuals of low socioeconomic status and racial/ethnic minoritized populations have suffered the highest burden of the direct and indirect impacts of the pandemic. These inequalities may be wider in larger cities, as they tend to concentrate both wealth and poverty. However, larger cities also tend to have a healthier population. The overall objective of this study is to examine excess mortality and inequities in excess mortality during 2020 and 2021 in US metropolitan statistical areas (MSAs), and to explore factors driving excess mortality and its inequities. We will leverage expertise and data acquired through the parent grant and will mentor a set of diverse trainees to uncover inequities and predictors of these inequities in excess mortality that will allow for a better of understanding where and why health inequities are wider and whether these inequities stemmed from direct or indirect impacts of the pandemic. Specifically, we aim to (1) describe excess mortality in the 392 MSAs of the US during 2020 and 2021, and to quantify direct (COVID-19) vs indirect impacts of the pandemic; (2) measure inequities in excess mortality by race/ethnicity and education in 392 MSAs during 2020 and 2021, and to quantify the contributions of direct and indirect impacts of the pandemic on these inequities; and (3) study the association between city size, city-level income inequality, and city-level racialized residential segregation on excess mortality and on inequities in excess mortality, and to examine the differential contribution of these factors to the direct and indirect impacts of the pandemic. In summary, the proposed study will fill significant gaps in our knowledge regarding the unequally distributed impacts of the COVID-19 pandemic in urban areas of the US, with a special emphasis on understanding these impacts across the continuum of urbanization, with a focus on social inequality.