Analyses of health and mortality disparities between today's urban and rural populations appear to be exclusively focused on vastly urbanising countries. By incorporating environmental data at census tract level and accounting for within‐area homogeneity, this work attempts to extend classic rural–urban comparisons. Geographical information is linked to a register‐based mortality follow up and Spanish census data for the autonomous community of Andalusia. We then apply mixed effects Cox proportional hazards models to estimate individual mortality differences and account for area variations between residential areas. Estimated effects suggest that the shared degree of “urbanicity” does not affect individual hazards of mortality, whereas environmental‐ and population‐based measures influence the relative risk of dying despite controlling for individual‐level risk factors. Although we do not find an impact of physical urban measures, our results reveal persistent that area‐related mortality disparities which can help to explain the mechanisms behind prevalent spatial‐temporal inequalities such as those in Andalusia.

The objective of this article is to study the changes that have occurred in the mortality pattern of women of fertile age in Spain throughout the 20th century, the significance of maternal mortality in the development of this pattern, and the other causes of death that have contributed most to such changes. Female mortality has most often been approached from the perspective of the genetic differences from males–particularly from the sexual-biological, basically reproductive, aspect–without considering other possible (social) differences. We have studied the female mortality pattern from the double incline of date of death (period) and of date of birth (cohort). Using the mortality theory of competing risks as our basis, we excluded in turn maternal mortality and mortality due to tuberculosis from overall mortality, and analyzed the transformations produced in the mortality pattern. Our results show that maternal mortality alone cannot be held responsible for the excess female mortality of the 1910s and 1920s, or for the mortality pattern among women of fertile age during the first half of this century. We suggest that the social discrimination against females from infancy has been responsible for most of the differences observed in mortality patterns.

Area-based policies (ABIs) aim to improve the quality of life and health of residents in socio-economically disadvantaged areas of cities. Although health impact evaluations of ABIs have proliferated in the last decade, several weaknesses have been identified in these evaluations. Inspired by the propositions of the fundamental cause theory (FCT), this paper attempts to address some of these weaknesses by investigating the possible impacts of different combinations of ABIs on premature mortality in vulnerable urban areas of Andalusia (Spain). We conducted a quasi-experimental cohort study, based on the longitudinal statistics on survival and longevity of a population aged 40–70 during the period from 2002 to 2016. Hazard ratios for individuals living in targeted areas relative to control areas were estimated using quasi-Poisson regressions, and the impact was evaluated using a difference-in-difference approach. Most of the ABIs studied do not seem to generate a visible impact on premature mortality. However, the combination of ARB and URBAN interventions is associated with a significant decrease in preventable and all-cause mortality in the targeted versus control areas. The flexible resources proposed by FCT can operate at both the contextual and individual levels, since more comprehensive interventions seem to contribute to achieving health impacts on vulnerable populations. Future evaluations should consider the nature of the intervened areas themselves in relation to the dynamics of the city and the degree of comprehensiveness of the policies, to elucidate what may constitute “fundamental interventions” to reduce health disparities between urban places.