How are green spaces associated with chronic disease incidence in Australia? Direct health benefits and interactive effects with socioeconomic status based on multiple green space indicators

• Green spaces directly benefit certain diseases such as dementia and diabetes. • Street-level greenness provides the most prevalent direct health benefits. • Parks offer notable health benefits when interacting with socioeconomic status. • Green spaces benefit socioeconomically disadvantaged areas, especially aging areas. • Neighborhood green spaces show more health benefits than suburb-level green spaces. The health benefits of urban greenery are well-documented, yet findings vary depending on the green space indicators used. Given the limited Australia-based research incorporating both traditional and emerging indicators, this study employs the proportion of parkland, the Normalized Difference Vegetation Index (NDVI), and Google Street View Greenness (SVG), to explore how green spaces and their interactions with socioeconomic status relate to chronic disease incidence rates in Sydney at Statistical Area Levels 1 and 2 (SA1 and SA2). The findings indicate that: (1) While green spaces are not significantly related to overall chronic diseases, they show strong associations with specific diseases, particularly dementia (SA1: Park: coef. = -0.004, p < 0.001; NDVI: coef. = -0.008, p < 0.001; SVG: coef. = -0.009, p < 0.001; SA2: SVG: coef. = -0.005, p < 0.05) and diabetes (SA1: SVG: coef. = -0.013, p < 0.001; SA2: Park: coef. = -0.009, p < 0.05; NDVI: coef. = -0.016, p < 0.01; SVG: coef. = -0.033, p < 0.001), with SVG being the most prevalent predictor. (2) Green spaces, particularly parkland, may mitigate chronic disease risks in lower socioeconomic regions, especially in aging areas (SA1: age#Park: coef. = -0.125, p < 0.001; age#NDVI: coef. = -0.081, p < 0.01; age#SVG: coef. = -0.078, p < 0.01). Additionally, these associations are more pronounced at the neighborhood scale than at the suburb scale. This study examines multiple green space indicators from an Australian perspective, offering insights for international comparisons and public health improvements.