Does Vertical Density Affect Lung Cancer Mortality Differently for Men and Women?

This study examines the relationship between lung and bronchus cancer mortality, vertical urban density, and smoking prevalence across 48 U.S. states from 1999 to 2022. Using 2034 state-year observations, skyscraper counts are employed as a proxy for vertical urban density, together with sex-specific, age-adjusted mortality and smoking data. A fully interacted empirical model identifies a non-linear, inverted U-shaped relationship between vertical density and lung cancer mortality for both men and women: mortality initially increases with greater vertical density but declines at higher levels, consistent with offsetting effects of environmental exposure and improved access to healthcare in highly dense urban environments. Importantly, the shape and magnitude of this relationship differ by gender. While smoking prevalence is strongly associated with lung cancer mortality for both sexes, mortality rates are consistently higher among males, and the marginal effect of smoking on mortality is more pronounced for men than for women. These findings highlight the importance of accounting for both non-linearity and gender heterogeneity when assessing the public health implications of urban form.