Browsing by Author "Bilal, Usama"

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    Building a Data Platform for Cross-Country Urban Health Studies: the SALURBAL Study
    (2019) Diez Roux, Ana V.; Bilal, Usama; Moore, Karia; Ortigoza, Ana; Rodriguez, Daniel A.; Sarmiento, Olga; Frenz, Patriciae; Friche, Amélia Augustaf; Caiaffa, Waleska Teixeiraf; Vives, Alejandrag; Miranda, J. Jaimeh; Alazraqui, Marcio; Spinelli, Hugoi; Guevel, Carlosi; Di Cecco, Vanessai; Tisnés, Adelai; Leveau, Carlos; Santoro, Adrián; Vives Vergara, Alejandra
    Studies examining urban health and the environment must ensure comparability of measures across cities and countries. We describe a data platform and process that integrates health outcomes together with physical and social environment data to examine multilevel aspects of health across cities in 11 Latin American countries. We used two complementary sources to identify cities with 100,000 inhabitants as of 2010 in Argentina, Brazil, Chile, Colombia, Costa Rica, El Salvador, Guatemala, Mexico, Nicaragua, Panama, and Peru. We defined cities in three ways: administratively, quantitatively from satellite imagery, and based on country-defined metropolitan areas. In addition to cities, we identified sub-city units and smaller neighborhoods within them using census hierarchies. Selected physical environment (e.g., urban form, air pollution and transport) and social environment (e.g., income, education, safety) data were compiled for cities, sub-city units, and neighborhoods whenever possible using a range of sources. Harmonized mortality and health survey data were linked to city and sub-city units. Finer georeferencing is underway. We identified 371 cities and 1436 sub-city units in the 11 countries. The median city population was 234,553 inhabitants (IQR 141,942; 500,398). The systematic organization of cities, the initial task of this platform, was accomplished and further ongoing developments include the harmonization of mortality and survey measures using available sources for between country comparisons. A range of physical and social environment indicators can be created using available data. The flexible multilevel data structure accommodates heterogeneity in the data available and allows for varied multilevel research questions related to the associations of physical and social environment variables with variability in health outcomes within and across cities. The creation of such data platforms holds great promise to support researching with greater granularity the field of urban health in Latin America as well as serving as a resource for the evaluation of policies oriented to improve the health and environmental sustainability of cities.
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    COVID-19 and the worsening of health inequities in Santiago, Chile
    (OXFORD UNIV PRESS, 2021) Bilal, Usama; Alfaro, Tania; Vives, Alejandra; CEDEUS (Chile)
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    Excess Mortality during the COVID-19 Pandemic in Cities of Chile: Magnitude, Inequalities, and Urban Determinants
    (SPRINGER, 2022) Alfaro, Tania; Martinez-Folgar, Kevin; Vives, Alejandra; Bilal, Usama; CEDEUS (Chile)
    We estimated excess mortality in Chilean cities during the COVID-19 pandemic and its association with city-level factors. We used mortality, and social and built environment data from the SALURBAL study for 21 Chilean cities, composed of 81 municipalities or "comunas", grouped in 4 macroregions. We estimated excess mortality by comparing deaths from January 2020 up to June 2021 vs 2016-2019, using a generalized additive model. We estimated a total of 21,699 (95%CI 21,693 to 21,704) excess deaths across the 21 cities. Overall relative excess mortality was highest in the Metropolitan (Santiago) and the North regions (28.9% and 22.2%, respectively), followed by the South and Center regions (17.6% and 14.1%). At the city-level, the highest relative excess mortality was found in the Northern cities of Calama and Iquique (around 40%). Cities with higher residential overcrowding had higher excess mortality. In Santiago, capital of Chile, municipalities with higher educational attainment had lower relative excess mortality. These results provide insight into the heterogeneous impact of COVID-19 in Chile, which has served as a magnifier of preexisting urban health inequalities, exhibiting different impacts between and within cities. Delving into these findings could help prioritize strategies addressed to prevent deaths in more vulnerable communities.
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    Gender inequality, women's empowerment, and adolescent birth rates in 363 Latin American cities
    (2023) Braverman-Bronstein, Ariela; Ortigoza, Ana F.; Vidaña-Pérez, Dèsirée; Barrientos-Gutiérrez, Tonatiuh; Baldovino-Chiquillo, Laura; Bilal, Usama; Friche, Amélia Augusta de Lima; Diez-Canseco, Francisco; Maslowsky, Julie; Vives Vergara, Alejandra; Diez Roux, Ana V.; CEDEUS (Chile)
    Background: Gender inequality is high in Latin America (LA). Empowering girls and young women and reducing gender gaps has been proposed as a pathway to reduce adolescent pregnancy. We investigated the associations of urban measures of women's empowerment and gender inequality with adolescent birth rates (ABR) in 366 Latin American cities in nine countries. Methods: We created a gender inequality index (GII) and three Women Achievement scores reflecting domains of women's empowerment (employment, education, and health care access) using censuses, surveys, and political participation data at city and sub-city levels. We used 3-level negative binomial models (sub-city-city-countries) to assess the association between the GII and scores, with ABR while accounting for other city and sub-city characteristics. Results: We found within country heterogeneity in gender inequality and women's empowerment measures. The ABR was 4% higher for each 1 standard deviation (1-SD) higher GII (RR 1.04; 95%CI 1.01,1.06), 8% lower for each SD higher autonomy score (RR 0.92; 95%CI 0.86, 0.99), and 12% lower for each SD health care access score (RR 0.88; 95%CI 0.82,0.95) after adjustment for city level population size, population growth, homicide rates, and sub-city population educational attainment and living conditions scores. Conclusion: Our findings show the key role cities have in reducing ABR through the implementation of strategies that foster women's socioeconomic progress such as education, employment, and health care access.
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    Inequalities in life expectancy in six large Latin American cities from the SALURBAL study: an ecological analysis
    (ELSEVIER SCI LTD, 2019) Bilal, Usama; Alazraqui, Marcio; Caiaffa, Waleska T.; Lopez Olmedo, Nancy; Martinez Folgar, Kevin; Miranda, J. Jaime; Rodriguez, Daniel A.; Vives, Alejandra; Diez Roux, Ana V.; CEDEUS (Chile)
    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.
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    Using community-based system dynamics modeling to understand the complex systems that influence health in cities: The SALURBAL study
    (ELSEVIER SCI LTD, 2019) Langellier, Brent A.; Kuhlberg, Jill A.; Ballard, Ellis A.; Slesinski, S. Claire; Stankov, Ivana; Gouveia, Nelson; Meisel, Jose D.; Kroker Lobos, Maria F.; Sarmiento, Olga L.; Caiaffa, Waleska Teixeira; Roux, Ana V. Diez; Alazraqui, Marcio; Spinelli, Hugo; Guevel, Carlos; Di Cecco, Vanessa; Tisnes, Adela; Leveau, Carlos; Santoro, Adrian; Herkovits, Damian; Gouveia, Nelson; Barreto, Mauricio; Santos, Gervasio; Cardoso, Leticia; de Menezes, Mariana Carvalho; de Pina, Maria de Fatima; Caiaffa, Waleska Teixeira; de Lima Friche, Amelia Augusta; de Souza Andrade, Amanda Cristina; Frenz, Patricia; Alfaro, Tania; Cordova, Cynthia; Ruiz, Pablo; Fuentes, Mauricio; Vives Vergara, Alejandra; Salazar, Alejandro; Cortinez O'Ryan, Andrea; Schmitt, Cristian; Gonzalez, Francisca; Baeza, Fernando; Angelini, Flavia; Sarmiento Duenas, Olga Lucia; Higuera, Diana; Gonzalez, Catalina; Montes, Felipe; Useche, Andres F.; Guaje, Oscar; Maria Jaramillo, Ana; Angel Guzman, Luis; Hessel, Philipp; Lucumi, Diego; David Meisel, Jose; Martinez, Eliana; Kroker Lobos, Maria F.; Ramirez Zea, Manuel; Martinez Folgar, Kevin; Barrientos Gutierrez, Tonatiuh; Perez Ferrer, Carolina; Prado Galbarro, Javier; de Castro, Filipa; Rojas Martinez, Rosalba; Jaime Miranda, J.; Hernandez Vasquez, Akram; Diez Canseco, Francisco; Hammond, Ross; Rodriguez, Daniel; Dronova, Iryna; Wang, Xize; Moran, Mika; Hovmand, Peter; Fuchs, Ricardo Jordan; Braslow, Juliet; Siri, Jose; Roux, Ana Diez; Auchincloss, Amy; Bilal, Usama; Garcia Espana, Felipe; Langellier, Brent; Lovasi, Gina; McClure, Leslie; Michael, Yvonne; Moore, Kari; Quick, Harrison; Quistberg, D. Alex; Sanchez, Brisa N.; Stankov, Ivana; Granados, Jose Tapia; SALURBAL Grp
    We discuss the design, implementation, and results of a collaborative process designed to elucidate the complex systems that drive food behaviors, transport, and health in Latin American cities and to build capacity for systems thinking and community-based system dynamics (CBSD) methods among diverse research team members and stakeholders. During three CB SD workshops, 62 stakeholders from 10 Latin American countries identified 98 variables and a series of feedback loops that shape food behaviors, transportation and health, along with 52 policy levers. Our findings suggest that CBSD can engage local stakeholders, help them view problems through the lens of complex systems and use their insights to prioritize research efforts and identify novel solutions that consider mechanisms of complexity.