{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T02:03:00Z","timestamp":1789351380876,"version":"build-2803163510"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"vor","delay-in-days":24,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Assessing the health of urban populations and its determinants is crucial to ensure sustainable urban living. Burden of disease studies and health impact assessments are often used and city-level baseline mortality rates are a key parameter. However, studies tend to use unrepresentative estimates, with regional or national estimates typically applied at city-level, particularly for large-scale studies. We developed a standardized method for age- and sex-specific mortality rate estimation for 825 European cities, using open-source data. To fill for missing data, linear mixed-effects models with natural cubic splines modelled mortality and population data for 2011\u201319, based on city-specific trends. By generating a publicly available dataset of city-level mortality rates, and a replicable approach for other years, we sought to overcome many of the existing shortcomings in baseline mortality estimates. The highest age-standardized natural-cause mortality rates in 2018 were observed in cities in Hungary, Poland, Croatia, and Czech Republic while the lowest rates were in cities in Spain, France, and Italy. Variation between city-level and national rates was observed, with a median relative deviation of \u223c16%. Our method addresses many of the common data quality and harmonization challenges associated with city-level mortality rate estimation. Advancement of effective policies and interventions necessitates robust baseline health data across cities, with good temporal coverage. To achieve this, requires strengthened efforts to improve data accuracy and consistency from regional sources to ensure accurate city-level representation. We fully documented the process and provide the code and data to be used in other studies.<\/jats:p>","DOI":"10.1093\/eurpub\/ckag155","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T15:58:31Z","timestamp":1787932711000},"source":"Crossref","is-referenced-by-count":0,"title":["Improving mortality rate estimation in 825 European cities: a linear mixed-effects modelling approach using Urban Audit data"],"prefix":"10.1093","volume":"36","author":[{"given":"Georgia M C","family":"Dyer","sequence":"first","affiliation":[{"name":"Barcelona Institute for Global Health (ISGlobal) , Barcelona,","place":["Spain"]},{"name":"Universitat Pompeu Fabra (UPF) Department of Experimental and Health Sciences, , Barcelona,","place":["Spain"]},{"name":"CIBER Epidemiolog\u00eda y Salud P\u00fablica (CIBERESP) , Madrid,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7326-1290","authenticated-orcid":false,"given":"Pierre","family":"Masselot","sequence":"additional","affiliation":[{"name":"Environment & Health Modelling (EHM) Lab, Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine , London,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Cirach","sequence":"additional","affiliation":[{"name":"Barcelona Institute for Global Health (ISGlobal) , Barcelona,","place":["Spain"]},{"name":"Universitat Pompeu Fabra (UPF) Department of Experimental and Health Sciences, , Barcelona,","place":["Spain"]},{"name":"CIBER Epidemiolog\u00eda y Salud P\u00fablica (CIBERESP) , Madrid,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sasha","family":"Khomenko","sequence":"additional","affiliation":[{"name":"Barcelona Institute for Global Health (ISGlobal) , Barcelona,","place":["Spain"]},{"name":"Universitat Pompeu Fabra (UPF) Department of Experimental and Health Sciences, , Barcelona,","place":["Spain"]},{"name":"CIBER Epidemiolog\u00eda y Salud P\u00fablica (CIBERESP) , Madrid,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuan","family":"Chen","sequence":"additional","affiliation":[{"name":"Institute for Risk Assessment Sciences, Utrecht University , Utrecht,","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrike","family":"Gehring","sequence":"additional","affiliation":[{"name":"Institute for Risk Assessment Sciences, Utrecht University , Utrecht,","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kees","family":"de Hoogh","sequence":"additional","affiliation":[{"name":"Institute for Risk Assessment Sciences, Utrecht University , Utrecht,","place":["Netherlands"]},{"name":"Swiss Tropical and Public Health Institute , Allschwil,","place":["Switzerland"]},{"name":"University of Basel , Basel,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"M\u00e1rquez","sequence":"additional","affiliation":[{"name":"Barcelona Institute for Global Health (ISGlobal) , Barcelona,","place":["Spain"]},{"name":"Universitat Pompeu Fabra (UPF) Department of Experimental and Health Sciences, , Barcelona,","place":["Spain"]},{"name":"CIBER Epidemiolog\u00eda y Salud P\u00fablica (CIBERESP) , Madrid,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"No\u00e9","family":"Moreno","sequence":"additional","affiliation":[{"name":"\u00c9cole Normale Sup\u00e9rieure de Lyon, Universit\u00e9 Claude Bernard Lyon 1, Universit\u00e9 de Lyon , Lyon,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cathryn","family":"Tonne","sequence":"additional","affiliation":[{"name":"Barcelona Institute for Global Health (ISGlobal) , Barcelona,","place":["Spain"]},{"name":"Universitat Pompeu Fabra (UPF) Department of Experimental and Health Sciences, , Barcelona,","place":["Spain"]},{"name":"CIBER Epidemiolog\u00eda y Salud P\u00fablica (CIBERESP) , Madrid,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8457-1489","authenticated-orcid":false,"given":"Xavier","family":"Basaga\u00f1a","sequence":"additional","affiliation":[{"name":"Barcelona Institute for Global Health (ISGlobal) , Barcelona,","place":["Spain"]},{"name":"Universitat Pompeu Fabra (UPF) Department of Experimental and Health Sciences, , Barcelona,","place":["Spain"]},{"name":"CIBER Epidemiolog\u00eda y Salud P\u00fablica (CIBERESP) , Madrid,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Nieuwenhuijsen","sequence":"additional","affiliation":[{"name":"Barcelona Institute for Global Health (ISGlobal) , Barcelona,","place":["Spain"]},{"name":"Universitat Pompeu Fabra (UPF) Department of Experimental and Health Sciences, , Barcelona,","place":["Spain"]},{"name":"CIBER Epidemiolog\u00eda y Salud P\u00fablica (CIBERESP) , Madrid,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"key":"2026091321121512200_ckag155-B1","author":"European Commission","year":":"},{"key":"2026091321121512200_ckag155-B2","doi-asserted-by":"publisher","first-page":"1693","DOI":"10.1016\/S0140-6736(24)01934-2","article-title":"Climate crisis, cities, and health","volume":"404","author":"Nieuwenhuijsen","year":"2024","journal-title":"Lancet"},{"key":"2026091321121512200_ckag155-B3","doi-asserted-by":"crossref","first-page":"e121","DOI":"10.1016\/S2542-5196(20)30272-2","article-title":"Premature mortality due to air pollution in European cities: a health impact assessment","volume":"5","author":"Khomenko","year":"2021","journal-title":"Lancet Planet Heal"},{"key":"2026091321121512200_ckag155-B4","doi-asserted-by":"crossref","first-page":"110988","DOI":"10.1016\/j.envres.2021.110988","article-title":"The impact of urban and transport planning on health: assessment of the attributable mortality burden in Madrid and Barcelona and its distribution by socioeconomic status","volume":"196","author":"Iungman","year":"2021","journal-title":"Environ Res"},{"key":"2026091321121512200_ckag155-B5","doi-asserted-by":"crossref","first-page":"105340","DOI":"10.1016\/j.cities.2024.105340","article-title":"Commentary: a road map for future data-driven urban planning and environmental health research","volume":"155","author":"Dyer","year":"2024","journal-title":"Cities"},{"key":"2026091321121512200_ckag155-B6","doi-asserted-by":"crossref","first-page":"119324","DOI":"10.1016\/j.envres.2024.119324","article-title":"Exploring the nexus of urban form, transport, environment and health in large-scale urban studies: a state-of-the-art scoping review","volume":"257","author":"Dyer","year":"2024","journal-title":"Environ Res"},{"key":"2026091321121512200_ckag155-B7","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.socscimed.2017.02.034","article-title":"Multi-scalar influences on mortality change over time in 274 european cities","volume":"179","author":"Richardson","year":"2017","journal-title":"Soc Sci Med"},{"key":"2026091321121512200_ckag155-B8","doi-asserted-by":"crossref","first-page":"1204","DOI":"10.1016\/S0140-6736(20)30925-9","article-title":"Global burden of 369 diseases and injuries in 204 countries and territories, 1990\u20132019: a systematic analysis for the Global Burden of Disease study 2019","volume":"396","author":"Abbafati","year":"2020","journal-title":"Lancet"},{"key":"2026091321121512200_ckag155-B9","doi-asserted-by":"publisher","first-page":"e139","DOI":"10.1016\/S2542-5196(21)00350-8","article-title":"Global urban temporal trends in fine particulate matter (PM2\u00b75) and attributable health burdens: estimates from global datasets","volume":"6","author":"Southerland","year":"2022","journal-title":"Lancet Planet Health"},{"key":"2026091321121512200_ckag155-B10","doi-asserted-by":"publisher","first-page":"e958","DOI":"10.1016\/S2542-5196(22)00260-1","article-title":"Global trends in ozone concentration and attributable mortality for urban, peri-urban, and rural areas between 2000 and 2019: a modelling study","volume":"6","author":"Malashock","year":"2022","journal-title":"Lancet Planet Health"},{"key":"2026091321121512200_ckag155-B11","doi-asserted-by":"publisher","first-page":"e49","DOI":"10.1016\/S2542-5196(21)00255-2","article-title":"Long-term trends in urban NO2 concentrations and associated paediatric asthma incidence: estimates from global datasets","volume":"6","author":"Anenberg","year":"2022","journal-title":"Lancet Planet Health"},{"key":"2026091321121512200_ckag155-B12","author":"Eurostat"},{"key":"2026091321121512200_ckag155-B13","doi-asserted-by":"crossref","first-page":"e271","DOI":"10.1016\/S2542-5196(23)00023-2","article-title":"Excess mortality attributed to heat and cold: a health impact assessment study in 854 cities in Europe","volume":"7","author":"Masselot","year":"2023","journal-title":"Lancet Planet Heal"},{"key":"2026091321121512200_ckag155-B14","author":"Eurostat"},{"key":"2026091321121512200_ckag155-B15","author":"European Commission"},{"key":"2026091321121512200_ckag155-B16","author":"Eurostat"},{"key":"2026091321121512200_ckag155-B17","author":"Eurostat"},{"key":"2026091321121512200_ckag155-B18","author":"European Commission"},{"key":"2026091321121512200_ckag155-B19","unstructured":"Dyer GMC. \u00a0Improving mortality rate estimation in 825 European cities: a linear mixed-effects modelling approach using Urban Audit data\u2014output data [Dataset]. Zenodo. Available from: 10.5281\/zenodo.20394741."},{"key":"2026091321121512200_ckag155-B20","author":"Dyer"},{"key":"2026091321121512200_ckag155-B21","author":"The Urban Burden of Disease Estimation for Policy Making"},{"key":"2026091321121512200_ckag155-B22","author":"Copernicus"},{"key":"2026091321121512200_ckag155-B23","author":"Office for National Statistics"},{"key":"2026091321121512200_ckag155-B24","author":"Eurostat","year":"2013"},{"key":"2026091321121512200_ckag155-B25","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1038\/s41586-022-05522-2","article-title":"The WHO estimates of excess mortality associated with the COVID-19 pandemic","volume":"613","author":"Msemburi","year":"2023","journal-title":"Nature"},{"key":"2026091321121512200_ckag155-B26","doi-asserted-by":"publisher","first-page":"100996","DOI":"10.1016\/j.lanepe.2024.100996","article-title":"Impact of COVID-19 on total excess mortality and geographic disparities in Europe, 2020\u20132023: a spatio-temporal analysis","volume":"44","author":"Pizzato","year":"2024","journal-title":"Lancet Reg Heal"},{"key":"2026091321121512200_ckag155-B27","author":"StatBank Denmark"},{"key":"2026091321121512200_ckag155-B28","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.1093\/ije\/dyy117","article-title":"Analysis of multicentre epidemiological studies: contrasting fixed or random effects modelling and meta-analysis","author":"Basaga\u00f1a","year":"2018","journal-title":"Int J Epidemiol"},{"key":"2026091321121512200_ckag155-B29","doi-asserted-by":"publisher","first-page":"428","DOI":"10.5094\/APR.2011.049","article-title":"Generalized linear mixed models in time series studies of air pollution","volume":"2","author":"Chuang","year":"2011","journal-title":"Atmos Pollut Res"},{"key":"2026091321121512200_ckag155-B30","doi-asserted-by":"crossref","first-page":"1802","DOI":"10.1016\/j.aap.2011.04.013","article-title":"Socio-economic inequalities in mortality due to injuries in small areas of ten cities in Spain (MEDEA Project)","volume":"43","author":"Gotsens","year":"2011","journal-title":"Accid Anal Prev"},{"key":"2026091321121512200_ckag155-B31","doi-asserted-by":"publisher","first-page":"679","DOI":"10.1038\/s41467-019-08539-w","article-title":"Effect of the great recession on regional mortality trends in Europe","volume":"10","author":"Ballester","year":"2019","journal-title":"Nat Commun"},{"key":"2026091321121512200_ckag155-B32","doi-asserted-by":"crossref","DOI":"10.1186\/s41118-019-0071-0","article-title":"Socioeconomic development and life expectancy relationship: evidence from the EU accession candidate countries","volume":"76","author":"Miladinov","year":"2020","journal-title":"Genus"},{"key":"2026091321121512200_ckag155-B33","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1177\/14034948211049979","article-title":"Is there a link between all-cause mortality and economic fluctuations?","volume":"50","author":"Dadgar","year":"2022","journal-title":"Scand J Public Health"},{"key":"2026091321121512200_ckag155-B34","author":"Eurostat"},{"key":"2026091321121512200_ckag155-B35","doi-asserted-by":"publisher","first-page":"103600","DOI":"10.1016\/j.cities.2022.103600","article-title":"Removing spatial autocorrelation in urban scaling analysis","volume":"124","author":"Xiao","year":"2022","journal-title":"Cities"},{"key":"2026091321121512200_ckag155-B36","doi-asserted-by":"publisher","first-page":"100272","DOI":"10.1016\/j.spasta.2017.11.004","article-title":"Visualization and assessment of spatio-temporal covariance properties","volume":"34","author":"Huang","year":"2019","journal-title":"Spat Stat"},{"key":"2026091321121512200_ckag155-B37","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1007\/s11524-024-00952-x","article-title":"Indicators from the lancet countdown on health and climate change: perspectives and experience of city leaders from 118 cities","volume":"102","author":"Ickovics","year":"2025","journal-title":"J Urban Health"}],"container-title":["European Journal of Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/eurpub\/article-pdf\/36\/5\/ckag155\/70828538\/ckag155.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eurpub\/article-pdf\/36\/5\/ckag155\/70828538\/ckag155.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T01:12:27Z","timestamp":1789348347000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eurpub\/article\/doi\/10.1093\/eurpub\/ckag155\/8772378"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,4]]},"references-count":37,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,8,4]]}},"URL":"https:\/\/doi.org\/10.1093\/eurpub\/ckag155","relation":{},"ISSN":["1101-1262","1464-360X"],"issn-type":[{"value":"1101-1262","type":"print"},{"value":"1464-360X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,10]]},"published":{"date-parts":[[2026,8,4]]},"article-number":"ckag155"}}