<p>Cities are central to economic development, climate adaptation and social stability, yet globally consistent evidence on how city populations are changing remains limited. Here we analyze annual age- and sex-structured population estimates for more than 10,000 cities worldwide from 2000 to 2020 and show that urban demographic change was highly uneven. Globally, the ratio of children and older adults to working-age adults declined from 0.87 to 0.59, but smaller cities remained consistently younger than larger cities, especially in Africa. We also find pronounced spatial variation in urban sex ratios, including strong male surpluses in parts of the Middle East and North Africa, consistent with patterns of labor migration. Finally, we estimate that 45% of urban population growth was attributable to net migration and 55% to natural increase. These results show that national averages can obscure substantial differences between cities, and highlight the value of globally consistent city-level demographic estimates for understanding regional demographic change and informing locally tailored urban planning.</p>