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Associations between greenspace and mortality vary across contexts of community change: a longitudinal ecological study
  1. Terry Hartig1,
  2. Thomas Astell-Burt2,
  3. Zara Bergsten1,
  4. Jan Amcoff3,
  5. Richard Mitchell4,
  6. Xiaoqi Feng2,5
  1. 1Institute for Housing and Urban Research, Uppsala University, Uppsala, Sweden
  2. 2School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
  3. 3Department of Social and Economic Geography, Uppsala University, Uppsala, Sweden
  4. 4MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
  5. 5School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
  1. Correspondence to Professor Terry Hartig, Institute for Housing and Urban Research, Uppsala University, Uppsala 75120, Sweden; terry.hartig{at}


Background Concerns about loss of greenspace with urbanisation motivate much research on nature and health; however, contingency of greenspace-health associations on the character of community change remains understudied.

Methods With aggregate data from governmental sources for 1432 Swedish parishes, we used negative binomial regression to estimate incidence rate ratios (IRRs) for all-cause and cardiovascular disease (CVD) mortality during 2000–2008 in relation to percentage area (in 2000) of urban residential greenspace, urban parks and rural greenspace, looking across parishes with decrease, stability or increase in population density. We also assessed interactions between land use and population change.

Results Parishes with ≥1 decile increase in population density had lower incidence of all-cause (IRR=0.91, 95% CI 0.87 to 0.95) and CVD mortality (IRR=0.89, 95% CI 0.84 to 0.94) compared with parishes with stable populations. In stable parishes, all-cause mortality was lower with higher percentages of urban green (IRR=0.998, 95% CI 0.996 to 1.000) and rural green land uses (IRR=0.997, 95% CI 0.996 to 0.999). These results were inverted in densifying parishes; higher all-cause mortality attended higher initial percentages of urban (IRR=1.081, 95% CI 1.037 to 1.127) and rural greenspace (IRR=1.042, 95% CI 1.007 to 1.079) as measured in 2000. Similar associations held for CVD mortality.

Conclusions More greenspace was associated with lower all-cause and CVD mortality in communities with relatively stable populations. In densifying communities, population growth per se may reduce mortality, but it may also entail harm through reductions in amount per capita and/or quality of greenspace.

  • cardiovascular disease
  • environmental epidemiology
  • psychological stress
  • urbanisation

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  • Contributors TH, TAB and XF led the design of the study, analyses of the data and wrote the initial draft of the manuscript. ZB and JA prepared the land use and sociodemographic data and contributed to the interpretation of findings and redrafting of the manuscript. RM contributed to the study design, interpretation of findings and redrafting of the manuscript. All authors have confirmed the final version of the manuscript.

  • Funding RM's contribution was supported by the Neighbourhoods and Communities research programme (MC_UU_12017/10) at the MRC/CSO Social & Public Health Sciences Unit.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The Swedish National Board of Health and Welfare provided the aggregated mortality data after in-house review regarding privacy concerns (Dnr 28216/2012). Use of the aggregated sociodemographic data required no ethical review beyond that already done for creation of the database from which it was extracted.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available. The aggregate sociodemographic data are available from Statistics Sweden. The land use data are available from the Swedish Mapping, Cadastral and Land Registration Authority. The aggregate mortality data may be obtained from the Swedish National Board of Health and Welfare, subject to their internal review.