Urban greenspace exposure and inequality are associated with mortality in cities across multiple countries

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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Publication Details

Journal
Communications Health
Published
2026-11-04
DOI
https://doi.org/10.1038/s44528-026-00038-x
Primary Topic
Urban Green Space and Health
Type
article
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article

Urban greenspace exposure and inequality are associated with mortality in cities across multiple countries

Éric Lavigne, Masahiro Hashizume, Malcolm Mistry, Shilu Tong et al.
2 links
Communications Health
Urban Green Space and Health
article

Urban greenspace exposure and inequality are associated with mortality in cities across multiple countries

Éric Lavigne, Masahiro Hashizume, Malcolm Mistry, Shilu Tong, Claire Demoury, Rosana Abrutzky, Fiorella Acquaotta, Ana Maria Vicedo-Cabrera, Paola Michelozzi, Antonio Gasparrini, Massimo Stafoggia, Martina S. Ragettli, Rebecca M. Garland, Ene Indermitte, Bertil Forsberg, Pierre Masselot, Francesco Sera, Marek Maasikmets, Antonella Zanobetti, Micheline de Sousa Zanotti Stagliorio Coêlho, Raanan Raz, Yasushi Honda, Mathilde Pascal, Matteo Scortichini, Ben Armstrong, Yoonhee Kim, Veronika Huber, Aurelio Tobias, Eunice Elizabeth Félix Arellano, Paulo Hilário Nascimento Saldiva, Tian Ma, Ho Kim, Joel Schwartz, Whanhee Lee, Yuming Guo, Magali Hurtado Diaz, Xerxes Seposo, Lina Madaniyazi, Paul Lester Carlos Chua, Susanne Breitner, Ivana Cvijanovic, Carmen Íñiguez, Niilo Ryti, Jouni J. K. Jaakkola, Alexandra Schneider, Mariska Bauwelinck, Iulian Horia Holobaca, Francesca de’Donato, Hans Orru, Michelle L. Bell
article en

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.

Communications HealthVol. 1(1)
University of Bern (CH), Health Canada (CA), Vrije Universiteit Brussel (BE), Consejo Superior de Investigaciones Científicas (ES), Harvard University (US), Seoul National University (KR), Ca' Foscari University of Venice (IT), University of Ottawa (CA), Swiss Tropical and Public Health Institute (CH), Universitat de València (ES), Queensland University of Technology (AU), Tel Aviv University (IL), Universidade de São Paulo (BR), National Institute for Environmental Studies (JP), Hokkaido University (JP), Universidad de Buenos Aires (AR), Helmholtz Zentrum München (DE), Babeș-Bolyai University (RO), Yale University (US), Estación Biológica de Doñana (ES), London School of Hygiene & Tropical Medicine (GB), Santé Publique France (FR), Estonian Environmental Research Center (Estonia) (EE), Instituto Nacional de Salud Pública (MX), Institute of Environmental Assessment and Water Research (ES), Sciensano (Belgium) (BE), Institut de Recherche pour le Développement (FR), Nagasaki University (JP), Regione Lazio (IT), Instituto de Investigaciones Gino Germani (AR), University of Florence (IT), Pusan National University (KR), University of Turin (IT), University of Tartu (EE), Monash University (AU), University of Pretoria (ZA), The University of Tokyo (JP), Ludwig-Maximilians-Universität München (DE), Umeå University (SE), University of Oulu (FI)
Good health and well-being, Reduced inequalities, Sustainable cities and communities
Openalex Percentile: Top 97%
Urban Green Space and Health
DOIOpen Access PDFOpenAlex
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