Mortality Patterns Among Urban Poor Populations: A Scoping Review of Social Determinants, Disease Burden, and Healthcare Access
Article Sidebar
Main Article Content
Abstract
This scoping review examines the causes of death among urban poor populations, with a focus on the interplay between infectious and non-communicable diseases, social determinants of health, and external factors. Based on a synthesis of 29 empirical studies, it identifies how overcrowded, unhygienic environments contribute to infectious diseases like HIV/AIDS and COVID-19 (prevalence ranging from 15% to 35%). In contrast, non-communicable diseases such as cardiovascular conditions and diabetes stem from systemic barriers to healthcare. This study highlights the importance of enhancing healthcare services, bolstering social support systems, and addressing economic and environmental disparities. Collaborative efforts among governments, communities, and organizations are crucial to achieving sustainable public health solutions.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
• Adebayo, A. M., Obembe, T. A., & Adebayo, B. E. (2020). Morbidity pattern and choice of care in an urban slum of a metropolitan state, southwestern Nigeria. West African Journal of Medicine, 37(3), 268–274.
• Ahmed, S., Adams, A. M., Islam, R., Hasan, S. M., & Panciera, R. (2019). Impact of traffic variability on geographic accessibility to 24/7 emergency healthcare for the urban poor: A GIS study in Dhaka, Bangladesh. PLOS ONE, 14(9), Article e0222488. https://doi.org/10.1371/journal.pone.0222488
• Alarcão, A. C., Dell’ Agnolo, C. M., Vissoci, J. R., Carvalho, E. C. A., Staton, C. A., de Andrade, L., Fontes, K. B., Pelloso, S. M., Nievola, J. C., & Carvalho, M. D. (2020). Suicide mortality among youth in southern Brazil: A spatiotemporal evaluation of socioeconomic vulnerability. Brazilian Journal of Psychiatry, 42(1), 46–53. https://doi.org/10.1590/1516-4446-2018-0352
• Aleemi, A. R., Khaliqui, H., & Faisal, A. (2018). Challenges and patterns of seeking primary health care in slums of Karachi: A disaster lurking in urban shadows. Asia Pacific Journal of Public Health, 30(5), 479–490. https://doi.org/10.1177/1010539518772132
• Alegre Díaz, J., Herrington, W., López Cervantes, M., Gnatiuc, L., Ramírez, R., Hill, M., Baigent, C., McCarthy, M. I., Lewington, S., Collins, R., Whitlock, G., Tapia Conyer, R., Peto, R., Kuri Morales, P., & Emberson, J. R. (2016). Diabetes and cause-specific mortality in Mexico City. New England Journal of Medicine, 375(20), 1961–1971. https://doi.org/10.1056/NEJMoa1605368
• Ángel, S.-B., Ana, E.-G., & Adolfo, F. (2014). Efecto del nivel socioeconómico sobre la mortalidad en áreas urbanas: Revisión crítica y sistemática [Effect of socioeconomic status on mortality in urban areas: Critical and systematic review]. Cadernos de Saúde Pública, 30(8), 1609–1621. https://doi.org/10.1590/0102-311X00152513
• Arksey, H., & O'Malley, L. (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 8(1), 19–32. https://doi.org/10.1080/1364557032000119616
• Bahadur, K. (2023). Social determinants of health in rural and urban communities. Prāgyik Prabāha, 11(1), 44–50. https://doi.org/10.3126/pp.v11i1.55505
• Baptiste, D.-L. (2018). Who you are and where you live can determine how long you live: What nurses need to know about cardiovascular disease among low-income urban-dwelling minority communities. Journal of Clinical Nursing, 27(19–20), 3441–3442. https://doi.org/10.1111/jocn.14486
• Bawah, A. T., Edufia, F., Yussif, F. N., Adu, A., & Yakubu, Y. A. (2021). Chronic kidney diseases among homeless and slum dwellers in Accra, Ghana. Pan African Medical Journal, 38, Article 340. https://doi.org/10.11604/pamj.2021.38.340.27106
• Calabias, J. K. C. B. (2022). Death’s Capital: Urban poor political ecology and the aesthetics of salvaging by the Nightcrawlers of Manila. In J. P. Telles, J. C. Ryan, & J. L. Dreisbach (Eds.), Environment, Media, and Popular Culture in Southeast Asia (pp. 119–133). Springer Singapore. https://doi.org/10.1007/978-981-19-1130-9_7
• Castro-Alves, J., Silva, L. S., Lima, J. P., & Ribeiro-Alves, M. (2022). Were the socioeconomic determinants of municipalities relevant to the increment of COVID-19 related deaths in Brazil in 2020? PLOS ONE, 17(4), Article e0266109. https://doi.org/10.1371/journal.pone.0266109
• Centers for Disease Control and Prevention (CDC). (2012, May). Principles of epidemiology in public health practice (3rd ed.). U.S. Department of Health and Human Services.
• Chakrabarty, K. (2023). Exploring the factors affecting health outcomes among urban poor communities in Bangladesh. Journal of Community Health Provision, 3(1), 20–26. https://doi.org/10.55885/jchp.v3i1.213
• Chandola, T., Mikkilineni, S., Chandran, A., Bandyopadhyay, S. K., Zhang, N., & Bassanesi, S. L. (2018). Is socioeconomic segregation of the poor associated with higher premature mortality under the age of 60? A cross-sectional analysis of survey data in major Indian cities. BMJ Open, 8(2), Article e018885. https://doi.org/10.1136/bmjopen-2017-018885
• Chaudhary, S., Benzaquen, S., Woo, J. G., Rubinstein, J., Matta, A., Albano, J., De Joy, R., 3rd, Lo, K. B., & Patarroyo-Aponte, G. (2021). Clinical characteristics, respiratory mechanics, and outcomes in critically ill individuals with COVID-19 infection in an underserved urban population. Respiratory Care, 66(6), 897–908. https://doi.org/10.4187/respcare.08319
• Christian, C., Hensel, L., & Roth, C. (2019). Income shocks and suicides: Causal evidence from Indonesia. Review of Economics and Statistics, 101(5), 905–920. https://doi.org/10.1162/rest_a_00777
• Commission on Social Determinants of Health. (2008, August 27). Closing the gap in a generation: Health equity through action on the social determinants of health (Final report). World Health Organization. https://www.who.int/publications/i/item/WHO-IER-CSDH-08.1
• Cross, S. H., & Warraich, H. J. (2019). Changes in the place of death in the United States. The New England Journal of Medicine, 381(24), 2369–2370. https://doi.org/10.1056/NEJMC1911892
• Dahlgren, G., & Whitehead, M. (1991). Policies and strategies to promote social equity in health: Background document to WHO strategy paper for Europe (Working paper). Institute for Futures Studies. https://core.ac.uk/download/pdf/6472456.pdf
• Daniella, D., Gayatri, A. A., & Somia, I. K. (2025). Non-communicable diseases in patients with human immunodeficiency virus and their risk factors. Infection & Chemotherapy, 57(1), 131–137. https://doi.org/10.3947/ic.2024.0123
• De Maio, F. G. (2011). Understanding chronic non-communicable diseases in Latin America: Towards an equity-based research agenda. Globalization and Health, 7, 36. https://doi.org/10.1186/1744-8603-7-36
• De Vita, M. V., Scolfaro, C., Santini, B., Lezo, A., Gobbi, F., Buonfrate, D., Kimani-Murage, E. W., Macharia, T., Wanjohi, M., Rovarini, J. M., & Morino, G. (2019). Malnutrition, morbidity and infection in the informal settlements of Nairobi, Kenya: An epidemiological study. Italian Journal of Pediatrics, 45(1), Article 12. https://doi.org/10.1186/s13052-019-0607-0
• DeGuzman, P. B., Cohn, W. F., Camacho, F., Edwards, B. L., Sturz, V. N., & Schroen, A. T. (2017). Impact of urban neighborhood disadvantage on late-stage breast cancer diagnosis in Virginia. Journal of Urban Health, 94(2), 199–210. https://doi.org/10.1007/s11524-017-0142-5
• Diez Roux, A. V., & Mair, C. (2010). Neighborhoods and health. Annals of the New York Academy of Sciences, 1186, 125–145. https://doi.org/10.1111/j.1749-6632.2009.05333.x
• Eisenstein, M. (2016). Disease: Poverty and pathogens. Nature, 531(7594), S61-S63. https://doi.org/10.1038/531S61a
• Erhardt, C. L. (1958). What is “the cause of death”? Journal of the American Medical Association, 168(2), 161–168. https://doi.org/10.1001/jama.1958.03000020023005
• Escobar Carías, M. S., Johnston, D. W., Knott, R., & Sweeney, R. (2022). Flood disasters and health among the urban poor. Health Economics, 31(9), 2072–2089. https://doi.org/10.1002/hec.4566
• Ferdous, F., Das, S. K., Ahmed, S., Farzana, F. D., Malek, M. A., Das, J., Latham, J. R., Faruque, A. S., & Chisti, M. J. (2014). Diarrhoea in slum children: Observation from a large diarrhoeal disease hospital in Dhaka, Bangladesh. Tropical Medicine & International Health, 19(10), 1170–1176. https://doi.org/10.1111/tmi.12357
• Gadallah, M., Megid, S. A., Mohsen, A., & Kandil, S. (2018). Hypertension and associated cardiovascular risk factors among urban slum dwellers in Egypt: A population-based survey. Eastern Mediterranean Health Journal, 24(5), 435–442. https://doi.org/10.26719/2018.24.5.435
• Girardin, J. L., Seixas, A., Ramos Cejudo, J., Osorio, R. S., Avirappattu, G., Reid, M., & Parthasarathy, S. (2021). Contribution of pulmonary diseases to COVID-19 mortality in a diverse urban community of New York. Chronic Respiratory Disease, 18. https://doi.org/10.1177/1479973120986806
• Green, D. R., & Llambi, F. (2015). Cell death signaling. Cold Spring Harbor Perspectives in Biology, 7(12), a006080. https://doi.org/10.1101/cshperspect.a006080
• Hall, J. M., Mkuu, R. S., Cho, H. D., Woodard, J. N., Kaye, F. J., Bian, J., Shenkman, E. A., & Guo, Y. (2023). Disparities contributing to late-stage diagnosis of lung, colorectal, breast, and cervical cancers: Rural and urban poverty in Florida. Cancers (Basel), 15(21), Article 5226. https://doi.org/10.3390/cancers15215226
• Jaadla, H., Puur, A., & Rahu, K. (2017). Socioeconomic and cultural differentials in mortality in a late 19th century urban setting: A linked records study from Tartu, Estonia, 1897-1900. Demographic Research, 36(1), 1–40. https://doi.org/10.4054/DemRes.2017.36.1
• Kamran, S., & Helen, E. (2017). Supporting the urban poor to quit tobacco: Adding years to lives. Thorax, 72(2), 105–106. https://doi.org/10.1136/THORAXJNL-2016-209435
• Klimas, J., O'Reilly, M., Egan, M., Tobin, H., & Bury, G. (2014). Urban overdose hotspots: A 12-month prospective study in Dublin ambulance services. American Journal of Emergency Medicine, 32(10), 1168–1173. https://doi.org/10.1016/j.ajem.2014.07.017
• Kochanek, K. D., Xu, J., Murphy, S. L., Miniño, A. M., & Kung, H.-C. (2011, December 29). Deaths: Final data for 2009 (National Vital Statistics Reports, Vol. 60, No. 3). U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics. https://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_03.pdf
• Kum, F., Mahmalji, W., Hale, J., Thomas, K., Bultitude, M., & Glass, J. (2016). Do stones still kill? An analysis of death from stone disease 1999-2013 in England and Wales. BJU International, 118(1), 140–144. https://doi.org/10.1111/BJU.13409
• Kumar, R., Kaur, N., & Pilania, M. (2018). Morbidity pattern of patients attending a primary healthcare facility in an urban slum of Chandigarh, India. Journal of Clinical and Diagnostic Research, 12(1), LC10–LC13. https://doi.org/10.7860/jcdr/2018/31331.11297
• Li, X., Yu, Y., Guan, X., & Feng, R. (2022). Overview of the special issue on applications of remote sensing imagery for urban areas. Remote Sensing, 14(5), Article 1204. https://www.mdpi.com/2072-4292/14/5/1204
• Liao, R., Hu, L., Liao, Q., Zhu, T., Yang, H., & Zhang, T. (2022). Analysis of death causes of residents in poverty-stricken areas in 2020: Take Liangshan Yi Autonomous Prefecture in China as an example. BMC Public Health, 22(1), Article 89. https://doi.org/10.1186/s12889-022-12504-6
• Lin, C., Cousins, S. J., Zhu, Y., Clingan, S. E., Mooney, L. J., Kan, E., Wu, F., & Hser, Y. I. (2024). A scoping review of social determinants of health's impact on substance use disorders over the life course. Journal of substance use and addiction treatment, 166, 209484. https://doi.org/10.1016/j.josat.2024.209484
• Macchia, A., Ferrante, D., Battistella, G., Mariani, J., & Gonzalez Bernaldo de Quiros, F. (2021). COVID-19 among the inhabitants of the slums in the city of Buenos Aires: A population-based study. BMJ Open, 11(1), Article e044592. https://doi.org/10.1136/bmjopen-2020-044592
• Marí-Dell'Olmo, M., Gotsens, M., Palència, L., Burström, B., Corman, D., Costa, G., Deboosere, P., Díez, È., Domínguez-Berjón, F., Dzúrová, D., Gandarillas, A., Hoffmann, R., Kovács, K., Martikainen, P., Demaria, M., Pikhart, H., Rodríguez-Sanz, M., Saez, M., Santana, P., ... Borrell, C. (2015). Socioeconomic inequalities in cause-specific mortality in 15 European cities. Journal of Epidemiology and Community Health, 69(5), 432–441. https://doi.org/10.1136/jech-2014-204312
• Marmot, M. (2005). The status syndrome: How social standing affects our health and longevity. Bloomsbury Press.
• Mberu, B., Wamukoya, M., Oti, S., & Kyobutungi, C. (2015). Trends in causes of adult deaths among the urban poor: Evidence from Nairobi Urban Health and Demographic Surveillance System, 2003–2012. Journal of Urban Health, 92(3), 422–445. https://doi.org/10.1007/s11524-015-9943-6
• Menashe-Oren, A., & Stecklov, G. (2018). Urban–rural disparities in adult mortality in sub-Saharan Africa. Demographic Research, 39(5), 136–176. https://doi.org/10.4054/DemRes.2018.39.5
• Mode, N. A., Evans, M. K., & Zonderman, A. B. (2016). Race, neighborhood economic status, income inequality and mortality. PLOS ONE, 11(5), Article e0154535. https://doi.org/10.1371/journal.pone.0154535
• Mutembo, S., Mutanga, J. N., Musokotwane, K., Kanene, C., Dobbin, K., Yao, X., Li, C., Marconi, V. C., & Whalen, C. C. (2019). Urban–rural disparities in treatment outcomes among recurrent TB cases in Southern Province, Zambia. BMC Infectious Diseases, 19(1), Article 1087. https://doi.org/10.1186/s12879-019-4709-5
• Navya, C. J., Sulekha, T., & Johnson, A. R. (2018). A cross-sectional study on childhood injuries in an urban underprivileged area in Bangalore City. Indian Journal of Public Health Research & Development, 9(2), 140–145. https://doi.org/10.5958/0976-5506.2018.00108.0
• Nolasco, A., Fernández-Alcántara, M., Pereyra-Zamora, P., Cabañero-Martínez, M. J., Copete, J. M., Oliva-Arocas, A., & Cabrero-García, J. (2020). Socioeconomic inequalities in the place of death in urban small areas of three Mediterranean cities. International Journal for Equity in Health, 19(1), Article 214. https://doi.org/10.1186/s12939-020-01324-y
• Nolasco, A., Moncho, J., Quesada, J. A., Melchor, I., Pereyra-Zamora, P., Tamayo-Fonseca, N., Martínez-Beneito, M. A., Zurriaga, O., Ballesta, M., Daponte, A., Gandarillas, A., Domínguez-Berjón, M. F., Marí-Dell’Olmo, M., Gotsens, M., Izco, N., Moreno, M. C., Sáez, M., Martos, C., Sánchez-Villegas, P., & Borrell, C. (2015). Trends in socioeconomic inequalities in preventable mortality in urban areas of 33 Spanish cities, 1996–2007 (MEDEA project). International Journal for Equity in Health, 14(1), Article 33. https://doi.org/10.1186/s12939-015-0164-0
• Pakhale, S., Tariq, S., Huynh, N., Jama, S., Kaur, T., Charron, C., Florence, K., Nur, F., Bustamante-Bawagan, M. E., Bignell, T., Boyd, R., Haddad, J., Kendzerska, T., & Alvarez, G. (2021). Prevalence and burden of obstructive lung disease in the urban poor population of Ottawa, Canada: A community-based mixed-method, observational study. BMC Public Health, 21(1), Article 183. https://doi.org/10.1186/s12889-021-10209-w
• Pinto, M., Bardach, A., Palacios, A., Biz, A., Alcaraz, A., Rodriguez, B., Augustovski, F., & Pichon-Riviere, A. (2015). The rise of noncommunicable diseases in Latin America and the Caribbean: Challenges for public health policies. Latin American Economic Review, 24, 25. https://doi.org/10.1007/s40503-015-0025-7
• Rangan, P., N. Singh, S., J. Landau, M., & Choi, J. (2015). Impact of death-related television programming on advertising evaluation. Journal of Advertising, 44(4), 326–337. https://doi.org/10.1080/00913367.2015.1077490
• Rawal, L. B., Biswas, T., Khandker, N. N., Saha, S. R., Bidat, C. M. M., Khan, A. N. S., Chowdhury, E. H., & Renzaho, A. (2017). Non-communicable disease (NCD) risk factors and diabetes among adults living in slum areas of Dhaka, Bangladesh. PLOS ONE, 12(10), Article e0184967. https://doi.org/10.1371/journal.pone.0184967
• Salguero-Linares, J., & Coll, N. S. (2023). Cell death as a defense strategy against pathogens in plants and animals. PLOS Pathogens, 19(4), Article e1011253. https://doi.org/10.1371/journal.ppat.1011253
• Santosa, A., Rosengren, A., Ramasundarahettige, C., Rangarajan, S., Gulec, S., Chifamba, J., Lear, S. A., Poirier, P., Yeates, K. E., Yusuf, R., Orlandini, A., Weida, L., Sidong, L., Yibing, Z., Mohan, V., Kaur, M., Zatonska, K., Ismail, N., Lopez-Jaramillo, P., ... Yusuf, S. (2021). Psychosocial risk factors and cardiovascular disease and death in a population-based cohort from 21 low-, middle-, and high-income countries. JAMA Network Open, 4(12), Article e2138920. https://doi.org/10.1001/jamanetworkopen.2021.38920
• Selim, A. M., Mazurek, J. A., Iqbal, M., Wang, D., Negassa, A., & Zolty, R. (2015). Mortality and readmission rates in patients hospitalized for acute decompensated heart failure: A comparison between cardiology and general-medicine service outcomes in an underserved population. Clinical Cardiology, 38(3), 131–138. https://doi.org/10.1002/clc.22372
• Snyder, R. E., Marlow, M. A., Phuphanich, M. E., Riley, L. W., & Maciel, E. L. (2016). Risk factors for differential outcome following directly observed treatment (DOT) of slum and non-slum tuberculosis patients: A retrospective cohort study. BMC Infectious Diseases, 16, Article 494. https://doi.org/10.1186/s12879-016-1835-1
• Soumya, C., Arasu, S., Ramesh, N., Goud, R., & Joseph, B. (2023). Morbidity profile of migrant workers attending health camps in Bangalore urban during the COVID-19 pandemic. International Journal of Occupational Safety and Health, 13(1), 78–86. https://doi.org/10.3126/ijosh.v13i1.43081
• Ssensamba, J. T., Nakafeero, M., Ssemakula, D. M., Ssenyonga, R., & Nnakate, J. B. (2019). The burden of HIV/AIDS among slum-dwelling school-age children in Kampala, Uganda. HIV and AIDS Review, 18(4), 267–272. https://doi.org/10.5114/hivar.2019.89455
• Vlahov, D., & Galea, S. (2002). Urbanization, urbanicity, and health. Journal of Urban Health, 79(4 Suppl 1), S1–S12. https://doi.org/10.1093/jurban/79.suppl_1.s1
• Wilson, R. F., Liu, S. G., Lyons, B. H., Petrosky, E., Harrison, D. D., Betz, C. J., & Blair, J. M. (2022). Surveillance for violent deaths — National Violent Death Reporting System, 42 states, the District of Columbia, and Puerto Rico, 2019. Morbidity and Mortality Weekly Report, 71(6), 1–40. https://doi.org/10.15585/mmwr.ss7106a1
• Wong, E. B., Olivier, S., Gunda, R., Koole, O., Surujdeen, A., Gareta, D., Munatsi, D., Modise, T. H., Dreyer, J., Nxumalo, S., Smit, T. K., Ording-Jespersen, G., Mpofana, I. B., Khan, K., Sikhosana, Z. E. L., Moodley, S., Shen, Y.-J., Khoza, T., Mhlongo, N., … Pillay, D., & the Vukuzazi Team. (2021). Convergence of infectious and non-communicable disease epidemics in rural South Africa: A cross-sectional, population-based multimorbidity study. The Lancet Global Health, 9(7), e967–e976. https://doi.org/10.1016/S2214-109X(21)00176-5
• World Health Organization. (2006). International statistical classification of diseases and related health problems: 10th revision (ICD-10) (10th ed.). World Health Organization. https://icd.who.int
• World Health Organization. (2020, May 13). World health statistics 2020: Monitoring health for the SDGs, sustainable development goals (Global report). World Health Organization. https://www.who.int/publications/i/item/9789240005105
• World Health Organization (WHO), United Nations Development Programme (UNDP), & Ministry of Public Health, Thailand. (2021). Prevention and control of noncommunicable diseases in Thailand: The case for investment. United Nations Inter-Agency Task Force on the Prevention and Control of NCDs.
• Zaidi, A. K., Awasthi, S., & deSilva, H. J. (2004). Burden of infectious diseases in South Asia. BMJ (Clinical research ed.), 328(7443), 811–815. https://doi.org/10.1136/bmj.328.7443.811
• Zhou, X., Sho, K., Qiu, H., Chang, S., & Cen, Q. (2025). Association between exposure to urban neighborhood natural environments and human health: A systematic review of multiple exposure indicators. Environmental and Sustainability Indicators, 25, Article 100548. https://doi.org/10.1016/j.indic.2024.100548
