Objectives. The goals of this study were to estimate prospective mortality
risks of city residence, specify how these risks vary by population subgrou
p, and explore possible explanations.
Methods. Data were derived from a probability sample of 3617 adults in the
coterminous United States and analyzed via cross-tabular and Cox proportion
al hazards methods.
Results. After adjustment for baseline sociodemographic and health variable
s, city residents had a mortality hazard rate ratio of 1.62 (95% confidence
interval [CI]= 1.21,2.18) relative to rural/small-town residents; suburban
ites had an intermediate but not significantly elevated hazard rate ratio.
This urban mortality risk was significant among men (hazard rate ratio: 2.2
5), especially non-Black men. but not among women. Among Black men, and to
some degree Black women. suburban residence carried the greatest risk. All
risks were most evident for those younger than 65 years.
Conclusions. The mortality risk of city residence. at least among men, riva
ls that of major psychosocial risk factors such as race, low income, smokin
g, and social isolation and merits comparable attention in research and pol
icy.