Urban greenspace exposure and inequality are associated with mortality in cities across multiple countries
Abstract
Abstract Background Urban greenspace is recognized as a key component of healthy cities, yet evidence linking greenspace to mortality remains geographically fragmented, while the association between unequal greenspace distribution and mortality remains poorly understood. We aim to examine associations of greenspace exposure and inequality with all-cause, cardiovascular, and respiratory mortality across cities in multiple countries. Methods We analyzed annual mortality and satellite-derived vegetation data from 624 urban locations across 22 countries during 2001–2020. Greenspace exposure was characterized using the population-weighted Enhanced Vegetation Index, and greenspace inequality using a Gini-based metric. We estimated country-specific associations with all-cause, cardiovascular, and respiratory mortality using negative binomial regression models. Country-specific estimates were pooled using random-effects meta-analysis, and heterogeneity by income level, climate zone, and geographical region was examined. Results A 0.1-unit increase in greenspace exposure was associated with lower risks of all-cause mortality (RR = 0.89, 95% CI = 0.83–0.95), cardiovascular mortality (0.92, 0.82–1.00), and respiratory mortality (0.89, 0.78–1.01). In contrast, a 0.1-unit increase in greenspace inequality was associated with a higher risk of all-cause mortality (1.14, 0.99–1.31), with no significant associations observed for cardiovascular or respiratory mortality. These associations varied across income levels, climate zones, and geographical regions. Conclusion Our findings indicate that both the amount and spatial distribution of urban greenspace are associated with population health, underscoring the need for urban planning strategies that prioritize not only greening but also equitable access.
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Authors: Tian Ma, Éric Lavigne, Ben Armstrong, Pierre Masselot, Antonio Gasparrini, Francesco Sera, Raanan Raz, Alexandra Schneider, Veronika Huber, Francesca de’Donato, Paul Lester Carlos Chua, Micheline de Sousa Zanotti Stagliorio Coêlho, Malcolm Mistry, Antonella Zanobetti, Joel Schwartz, Michelle L. Bell, Ana Maria Vicedo-Cabrera, Aurelio Tobias, Bertil Forsberg, Carmen Íñiguez, Claire Demoury, Ene Indermitte, Eunice Elizabeth Félix Arellano, Fiorella Acquaotta, Hans Orru, Ho Kim, Iulian Horia Holobaca, Ivana Cvijanovic, Jouni J. K. Jaakkola, Lina Madaniyazi, Magali Hurtado Diaz, Marek Maasikmets, Masahiro Hashizume, Massimo Stafoggia, Mathilde Pascal, Matteo Scortichini, Mariska Bauwelinck, Martina S. Ragettli, Niilo Ryti, Paola Michelozzi, Paulo Hilário Nascimento Saldiva, Rebecca M. Garland, Rosana Abrutzky, Shilu Tong, Susanne Breitner, Whanhee Lee, Xerxes Seposo, Yasushi Honda, Yoonhee Kim, Yuming Guo
Institutions: Universidade de São Paulo, London School of Hygiene & Tropical Medicine, Harvard University, Consejo Superior de Investigaciones Científicas, Universitat de València, Vrije Universiteit Brussel, Ludwig-Maximilians-Universität München, The University of Tokyo, Monash University, University of Pretoria, Yale University, Hokkaido University, University of Bern, Universidad de Buenos Aires, University of Oulu, University of Florence, University of Ottawa, Queensland University of Technology, Tel Aviv University, University of Turin, Seoul National University, Pusan National University, Institut de Recherche pour le Développement, University of Tartu, Santé Publique France, Babeș-Bolyai University, National Institute for Environmental Studies, Umeå University, Helmholtz Munich, Ca' Foscari University of Venice, Estación Biológica de Doñana, Health Canada, Nagasaki University, Estonian Environmental Research Center (Estonia), Swiss Tropical and Public Health Institute, Institute of Environmental Assessment and Water Research, Sciensano (Belgium), Instituto Nacional de Salud Pública, Regione Lazio, Instituto de Investigaciones Gino Germani