# The Health Consequences of Urban Scaling

> **NIH NIH DP5** · DREXEL UNIVERSITY · 2022 · $357,179

## Abstract

COVID-19 is the most severe health emergency since the 1918 influenza pandemic. However,
the impacts of the pandemic have been severely underestimated. First, a number of deaths
directly caused by COVID-19 have not been coded as such due to differences in testing capacity,
knowledge of clinical manifestations, etc. Second, the pandemic has also had indirect
consequences of health, including potential increases or decreases in mortality due to the
mitigation measures designed to control the pandemic. Both the direct and indirect impacts of
the pandemic have been unequally distributed, as individuals of low socioeconomic status and
racial/ethnic minoritized populations have suffered the highest burden of the direct and
indirect impacts of the pandemic. These inequalities may be wider in larger cities, as they tend
to concentrate both wealth and poverty. However, larger cities also tend to have a healthier
population. The overall objective of this study is to examine excess mortality and inequities in
excess mortality during 2020 and 2021 in US metropolitan statistical areas (MSAs), and to
explore factors driving excess mortality and its inequities. We will leverage expertise and data
acquired through the parent grant and will mentor a set of diverse trainees to uncover
inequities and predictors of these inequities in excess mortality that will allow for a better of
understanding where and why health inequities are wider and whether these inequities
stemmed from direct or indirect impacts of the pandemic. Specifically, we aim to (1) describe
excess mortality in the 392 MSAs of the US during 2020 and 2021, and to quantify direct
(COVID-19) vs indirect impacts of the pandemic; (2) measure inequities in excess mortality by
race/ethnicity and education in 392 MSAs during 2020 and 2021, and to quantify the
contributions of direct and indirect impacts of the pandemic on these inequities; and (3) study
the association between city size, city-level income inequality, and city-level racialized
residential segregation on excess mortality and on inequities in excess mortality, and to
examine the differential contribution of these factors to the direct and indirect impacts of the
pandemic. In summary, the proposed study will fill significant gaps in our knowledge regarding
the unequally distributed impacts of the COVID-19 pandemic in urban areas of the US, with a
special emphasis on understanding these impacts across the continuum of urbanization, with a
focus on social inequality.

## Key facts

- **NIH application ID:** 10605734
- **Project number:** 3DP5OD026429-05S1
- **Recipient organization:** DREXEL UNIVERSITY
- **Principal Investigator:** Usama Bilal
- **Activity code:** DP5 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $357,179
- **Award type:** 3
- **Project period:** 2018-09-07 → 2024-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10605734

## Citation

> US National Institutes of Health, RePORTER application 10605734, The Health Consequences of Urban Scaling (3DP5OD026429-05S1). Retrieved via AI Analytics 2026-06-01 from https://api.ai-analytics.org/grant/nih/10605734. Licensed CC0.

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