The equigenic effect of greenness on the association between education with life expectancy and mortality in 28 large Latin American cities

Mika R. Moran, Usama Bilal, Iryna Dronova, Yang Ju, Nelson Gouveia, Waleska Teixeira Caiaffa, Amélia Augusta de Lima Friche, Kari Moore, J. Jaime Miranda, Daniel A. Rodríguez

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Recent studies highlight the equigenic potential of greenspaces by showing narrower socioeconomic health inequalities in greener areas. However, results to date have been inconsistent and derived from high-income countries. We examined whether urban greenness modifies the associations between area-level education, as a proxy for socioeconomic status, and life expectancy and cause-specific mortality in Latin American cities. Methods: We included 28 large cities, >137 million inhabitants, in nine Latin American countries, comprising 671 sub-city units, for 2012–2016. Socioeconomic status was assessed through a composite index of sub-city level education, and greenness was calculated using the normalized difference vegetation index. We fitted multilevel models with sub-city units nested in cities, with life expectancy or log(mortality) as the outcome. Findings: We observed a social gradient, with higher levels of education associated with higher life expectancy and lower cause-specific mortality. There was weak evidence supporting the equigenesis hypothesis as greenness differentially modified the association between education and mortality outcomes. We observed an equigenic effect, with doubling magnitudes in the violence-related mortality reduction by education in areas with low greenness compared to medium-high greenness areas among men (16% [95% CI 12%–20%] vs 8% [95% CI 4%–11%] per 1 SD increase in area-level education). However, in contradiction to the equigenesis hypothesis, the magnitude in cardiovascular diseases (CVD) mortality reduction by education was stronger in areas with medium-high greenness compared to areas with low greenness (6% [95% CI 4%–7%] vs 1% [95% CI -1%–3%] and 5% [95% CI 3%–7%] vs 1% [95% CI -1%–3%] per 1 SD increase in area-level education, in women and men, respectively). Similarly, each 1-SD increase in greenness widened the educational inequality in life expectancy by 0.15 years and 0.20 years, in women and men, respectively. The equigenic effect was not observed in violence-related mortality among women and in mortality due to communicable diseases, maternal, neonatal and nutritional conditions (CMNN). Interpretation: Our results confirm socioeconomic health inequalities in Latin American cities and show that the equigenic properties of greenspace vary by health outcome. Although mixed, our findings suggest that future greening policies should account for local social and economic conditions to ensure that greenspaces provide health benefits for all, and do not further exacerbate existing health inequalities in the region. Funding: Wellcome Trust (Grant, 205177/Z/16/Z).

Original languageEnglish
Article number102703
JournalHealth and Place
Volume72
DOIs
StatePublished - Nov 2021
Externally publishedYes

Bibliographical note

Funding Information:
The Salud Urbana en América Latina (SALURBAL)/Urban Health in Latin America project is funded by the Wellcome Trust [ 205177/Z/16/Z ]. UB was supported by the Office of the Director of the National Institutes of Health under award number DP5OD26429 . The funding sources had no role in the analysis, writing or decision to submit the manuscript.

Funding Information:
The Salud Urbana en Am?rica Latina (SALURBAL)/Urban Health in Latin America project is funded by the Wellcome Trust [205177/Z/16/Z]. UB was supported by the Office of the Director of the National Institutes of Health under award number DP5OD26429. The funding sources had no role in the analysis, writing or decision to submit the manuscript.

Publisher Copyright:
© 2021

Keywords

  • Education
  • Latin America
  • Mortality
  • NDVI
  • Urban health

ASJC Scopus subject areas

  • Health(social science)
  • Life-span and Life-course Studies
  • Sociology and Political Science

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