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

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dc.contributor.author Moran, M.R.
dc.contributor.author Bilal, U.
dc.contributor.author Dronova, I.
dc.contributor.author Ju, Y.
dc.contributor.author Gouveia, N.
dc.contributor.author Caiaffa, W.T.
dc.contributor.author Friche, A.A.D.L.
dc.contributor.author Moore, K.
dc.contributor.author Miranda, J. Jaime
dc.contributor.author Rodríguez, D.A.
dc.date.accessioned 2021-12-12T20:24:53Z
dc.date.available 2021-12-12T20:24:53Z
dc.date.issued 2021
dc.identifier.uri https://hdl.handle.net/20.500.12866/10194
dc.description.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 en_US
dc.language.iso eng
dc.publisher Elsevier
dc.relation.ispartofseries Health and Place
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Education en_US
dc.subject Latin America en_US
dc.subject Mortality en_US
dc.subject NDVI en_US
dc.subject Urban health en_US
dc.title The equigenic effect of greenness on the association between education with life expectancy and mortality in 28 large Latin American cities en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1016/j.healthplace.2021.102703
dc.relation.issn 1873-2054


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