Age-adjusted mortality and its association to variations in urban conditions in Shanghai

The objective of this study was to explore the association between health and urbanization in a megacity, Shanghai, by calculating the age-adjusted mortality ratio by ward-unit of Shanghai and by examining relationships between mortalities and urban indicators. Crude mortality rates and age-adjusted mortality ratios by ward-unit were calculated. Demographic, residential environment, healthcare, and socioeconomic indicators were formulated for each of the ward-units between 1995 and 1998. Correlation and Poisson regression analyses were performed to examine the association between urban indicators and mortalities. The crude mortality rate by ward-unit in 1997 varied from 6.3 to 9.4 deaths per 1000 population. The age-adjusted mortality ratio in 1997 by ward-units as reference to the average mortality of urban China varied from 57.8 to 113.3 within Shanghai. Age-adjusted mortalities were inversely related with indicators of a larger floor space of dwellings per population, a larger proportion of parks, gardens, and green areas to total land area; a greater number of health professionals per population; and a greater number of employees in retail business per population. Spacious living showed independent association to a higher standard of community health in Shanghai (P < 0.05). Consequences of health policy and the developments of urban infrastructural resources from the viewpoint of the Healthy Cities concept were discussed.