Dataset Information

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

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).

SUBMITTER: Moran MR

PROVIDER: S-EPMC8633763 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:BackgroundLatin America is one of the most unequal regions in the world, but evidence is lacking on the magnitude of health inequalities in urban areas of the region. Our objective was to examine inequalities in life expectancy in six large Latin American cities and its association with a measure of area-level socioeconomic status.MethodsIn this ecological analysis, we used data from the Salud Urbana en America Latina (SALURBAL) study on six large cities in Latin America (Buenos Aires, Argentina; Belo Horizonte, Brazil; Santiago, Chile; San José, Costa Rica; Mexico City, Mexico; and Panama City, Panama), comprising 266 subcity units, for the period 2011-15 (expect for Panama city, which was for 2012-16). We calculated average life expectancy at birth by sex and subcity unit with life tables using age-specific mortality rates estimated from a Bayesian model, and calculated the difference between the ninth and first decile of life expectancy at birth (P90-P10 gap) across subcity units in cities. We also analysed the association between life expectancy at birth and socioeconomic status at the subcity-unit level, using education as a proxy for socioeconomic status, and whether any geographical patterns existed in cities between subcity units.FindingsWe found large spatial differences in average life expectancy at birth in Latin American cities, with the largest P90-P10 gaps observed in Panama City (15·0 years for men and 14·7 years for women), Santiago (8·9 years for men and 17·7 years for women), and Mexico City (10·9 years for men and 9·4 years for women), and the narrowest in Buenos Aires (4·4 years for men and 5·8 years for women), Belo Horizonte (4·0 years for men and 6·5 years for women), and San José (3·9 years for men and 3·0 years for women). Higher area-level socioeconomic status was associated with higher life expectancy, especially in Santiago (change in life expectancy per P90-P10 change unit-level of educational attainment 8·0 years [95% CI 5·8-10·3] for men and 11·8 years [7·1-16·4] for women) and Panama City (7·3 years [2·6-12·1] for men and 9·0 years [2·4-15·5] for women). We saw an increase in life expectancy at birth from east to west in Panama City and from north to south in core Mexico City, and a core-periphery divide in Buenos Aires and Santiago. Whereas for San José the central part of the city had the lowest life expectancy and in Belo Horizonte the central part of the city had the highest life expectancy.InterpretationLarge spatial differences in life expectancy in Latin American cities and their association with social factors highlight the importance of area-based approaches and policies that address social inequalities in improving health in cities of the region.FundingWellcome Trust.

Project description:BackgroundIn Latin America, where climate change and rapid urbanization converge, non-optimal ambient temperatures contribute to excess mortality. However, little is known about area-level characteristics that confer vulnerability to temperature-related mortality.ObjectivesExplore city-level socioeconomic and demographic characteristics associated with temperature-related mortality in Latin American cities.MethodsThe dependent variables quantify city-specific associations between temperature and mortality: heat- and cold-related excess death fractions (EDF, or percentages of total deaths attributed to cold/hot temperatures), and the relative mortality risk (RR) associated with 1 °C difference in temperature in 325 cities during 2002-2015. Random effects meta-regressions were used to investigate whether EDFs and RRs associated with heat and cold varied by city-level characteristics, including population size, population density, built-up area, age-standardized mortality rate, poverty, living conditions, educational attainment, income inequality, and residential segregation by education level.ResultsWe find limited effect modification of cold-related mortality by city-level demographic and socioeconomic characteristics and several unexpected associations for heat-related mortality. For example, cities in the highest compared to the lowest tertile of income inequality have all-age cold-related excess mortality that is, on average, 3.45 percentage points higher (95% CI: 0.33, 6.56). Higher poverty and higher segregation were also associated with higher cold EDF among those 65 and older. Large, densely populated cities, and cities with high levels of poverty and income inequality experience smaller heat EDFs compared to smaller and less densely populated cities, and cities with little poverty and income inequality.DiscussionEvidence of effect modification of cold-related mortality in Latin American cities was limited, and unexpected patterns of modification of heat-related mortality were observed. Socioeconomic deprivation may impact cold-related mortality, particularly among the elderly. The findings of higher levels of poverty and income inequality associated with lower heat-related mortality deserve further investigation given the increasing importance of urban adaptation to climate change.

Project description:Despite the immigrant mortality advantage and the increasing share of the population born abroad, relatively little is known about how immigration has impacted trends in US life expectancy. How immigrants contribute to national life expectancy trends is of increasing interest, particularly in the context of an unprecedented stagnation in American mortality. We find that immigration increases US life expectancy by 1.5 years for men and 1.4 years for women. Over half of these contributions occur at the prime working ages of 25-64. The difference between foreign-born and US-born mortality has grown substantially since 1990, with the ratio of US-born to foreign-born mortality rates nearly doubling by 2017. In that year, foreign-born life expectancy reached 81.4 and 85.7 years for men and women, respectively-7.0 and 6.2 years higher than their US-origin counterparts. These life expectancy levels are remarkable by most standards. Foreign-born male life expectancy exceeds that of Swiss men, the world leaders in male life expectancy. Life expectancy for foreign-born women is close to that of Japanese women, the world leaders in female life expectancy. The widening mortality difference between the US-born and foreign-born populations, coupled with an increase in the share of the population born abroad, has been responsible for much of the increase in national life expectancy in recent years. Between 2007 and 2017, foreign-born men and women were responsible for 44% and 60% of national life expectancy improvements. Between 2010 and 2017, immigrants experienced gains while the US-born experienced declines in life expectancy. Thus, nearly all of the post-2010 mortality stagnation is due to adverse trends among the US-born. Without immigrants and their children, national life expectancy in 2017 would be reduced to its 2003 levels. These findings demonstrate that immigration acts to bolster American life expectancy, with particularly valuable contributions at the prime working ages.