This paper examines whether sprawl, featured by low development density, segregated land uses, lack of significant centers, and poor street connectivity, contributes to a widening mortality gap between urban and suburban residents. We employ two mortality datasets, including a national cross-sectional dataset examining the impact of metropolitan-level sprawl on urban–suburban mortality gaps and a longitudinal dataset from Portland examining changes in urban–suburban mortality gaps over time. The national and Portland studies provide the only evidence to date that (1) across metropolitan areas, the size of urban–suburban mortality gaps varies by the extent of sprawl: in sprawling metropolitan areas, urban residents have significant excess mortality risks than suburban residents, while in compact metropolitan areas, urbanicity-related excess mortality becomes insignificant; (2) the Portland metropolitan area not only experienced net decreases in mortality rates but also a narrowing urban–suburban mortality gap since its adoption of smart growth regime in the past decade; and (3) the existence of excess mortality among urban residents in US sprawling metropolitan areas, as well as the net mortality decreases and narrowing urban–suburban mortality gap in the Portland metropolitan area, is not attributable to sociodemographic variations. These findings suggest that health threats imposed by sprawl affect urban residents disproportionately compared to suburban residents and that efforts curbing sprawl may mitigate urban–suburban health disparities.
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