Variation in youth and young adult homicide rates and their association with city characteristics in Latin America: the SALURBAL study

Amélia Augusta de Lima Friche; Uriel Moreira Silva; Usama Bilal; Olga L Sarmiento; Maria Angélica de Salles Dias; Francisco Javier Prado-Galbarro; Roberto Briceño-León; Marcio Alazraqui; Ana V Diez-Roux; Waleska Teixeira Caiaffa

doi:10.1016/j.lana.2023.100476

Variation in youth and young adult homicide rates and their association with city characteristics in Latin America: the SALURBAL study

Lancet Reg Health Am. 2023 Mar 20:20:100476. doi: 10.1016/j.lana.2023.100476. eCollection 2023 Apr.

Affiliations

¹ Observatory for Urban Health in Belo Horizonte, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
² Department of Speech, Language and Hearing Sciences, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
³ Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
⁴ Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA.
⁵ School of Medicine, Universidad de los Andes, Bogotá, Colombia.
⁶ Population Health Research Center, National Institute of Public Health, Cuernavaca, Mexico.
⁷ Department of Research, Hospital Infantil de México Federico Gómez, Mexico City, Mexico.
⁸ Federal University of Ceará, Fortaleza, Brazil & Venezuelan Observatory of Violence, Caracas, Venezuela.
⁹ Instituto de Salud Colectiva, Universidad Nacional de Lanús, Buenos Aires, Argentina.

Abstract

Background: Latin America and the Caribbean (LAC) is one of the most urbanized and violent regions worldwide. Homicides in youth (15-24 years old, yo) and young adults (25-39yo) are an especially pressing public health problem. Yet there is little research on how city characteristics relate to homicide rates in youth and young adults. We aimed to describe homicide rates among youth and young adults, as well as their association with socioeconomic and built environment factors across 315 cities in eight LAC countries.

Methods: This is an ecological study. We estimated homicide rates in youth and young adults for the period 2010-2016. We investigated associations of homicide rates with sub-city education and GDP, Gini, density, landscape isolation, population and population growth using sex-stratified negative binomial models with city and sub-city level random intercepts, and country-level fixed effects.

Findings: The mean sub-city homicide rate per 100,000 in persons aged 15-24 was 76.9 (SD = 95.9) in male and 6.7 (SD = 8.5) in female, and in persons aged 25-39 was 69.4 (SD = 68.9) in male and 6.0 (SD = 6.7) in female. Rates were higher in Brazil, Colombia, Mexico and El Salvador than in Argentina, Chile, Panama and Peru. There was significant variation in rates across cities and sub-cities, even after accounting for the country. In fully adjusted models, higher sub-city education scores and higher city GDP were associated with a lower homicide rate among male and female (rate ratios (RR) per SD higher value in male and female, respectively, 0.87 (CI 0.84-0.90) and 0.90 (CI 0.86-0.93) for education and 0.87 (CI 0.81-0.92) and 0.92 (CI 0.87-0.97) for GDP). A higher city Gini index was associated with higher homicide rates (RR 1.28 (CI 1.10-1.48) and 1.21 (CI 1.07-1.36) in male and female, respectively). Greater isolation da was also associated with higher homicide rates (RR 1.13 (CI 1.07-1.21) and 1.07 (CI 1.02-1.12) in male and female, respectively).

Interpretation: City and sub-city factors are associated with homicide rates. Improvements to education, social conditions and inequality and physical integration of cities may contribute to the reduction of homicides in the region.

Funding: The Wellcome Trust [205177/Z/16/Z].

Keywords: Homicide; Latin America; Mortality; Social factors; Urban form; Urban health.