Inequality in green space distribution and its association with preventable deaths across urban neighbourhoods in the UK, stratified by Index of Multiple Deprivation

BACKGROUND: This study investigated inequalities in the distribution of green space (GS) and the association between inequalities in amounts of GS and preventable deaths across urban neighbourhoods with different Index of Multiple Deprivation (IMD) scores in the UK. METHODS: Data on preventable deaths, IMD, percentage of grassland and woodland, urban/rural, population size, and density were sourced for each of 6791 middle-layer super output areas (MSOAs) in England, 410 MSOAs in Wales, 1279 intermediate zones (IZs) in Scotland, and 890 super output areas (SOAs) in Northern Ireland (NI). While appreciating the potential for ecological fallacy we related area-based measures of deprivation to deaths. Concentration curves, Lorenz dominance tests, and negative binomial regression models were used to analyse the data. RESULTS: In urban areas of England, Scotland, and NI, the percentage of grassland was significantly lower among the more deprived neighbourhoods (Lorenz test, p<0.0001). In England, a 1% increase in grassland area was associated with a 37% reduction in annual preventable deaths among the most deprived urban MSOAs (incidence rate ratio (IRR) 0.63, 95% CI 0.52 to 0.76). In NI and Scotland, a 1% increase in grassland area was associated with a 37% (IRR 0.63, 95% CI 0.43 to 0.91) and 41% (IRR 0.59, 95% CI 0.42 to 0.81) reduction in 5-year accumulated preventable deaths in the most deprived urban SOAs/IZs, respectively. CONCLUSIONS: Results suggest that investment in GS in urban areas may be an important public health prevention strategy. There is evidence that investments in the most deprived urban neighbourhoods where the highest inequality currently exists would see the largest effect on preventable deaths.