Scaling of cardiovascular risk factors in 230 Latin American cities

Urbanization results in increased numbers of people living in cities and poses challenges and opportunities to public health policies. Studies of urban scaling have unveiled how cities' socio-economic and infrastructural attributes vary systematically with city size. Previous studies have explored the scaling properties of health outcomes across metropolitan areas in different countries, but chronic diseases have been infrequently examined. This paper examines scaling behaviors of 4 cardiovascular risk factors: hypertension, diabetes, tobacco smoking, and obesity across 230 cities in six countries of Latin America. In analyses pooled across countries, diabetes and hypertension showed weakly superlinear scaling (higher prevalence in larger cities). In comparison, obesity showed linear scaling, and tobacco showed weakly sublinear scaling (lower prevalence in larger cities), although most coefficients did not differ significantly from the null. In country-specific analyses, hypertension and diabetes tended to show a superlinear pattern across most countries, obesity tended to show a sublinear pattern in most countries, and tobacco tended to be superlinear (in contrast to the analysis pooled across countries where it was sublinear). Results suggest the need to examine further the drivers of this varying scaling of risk factors.