Objective

Previous research has reported beneficial effects of greenness on various health outcomes. However, few studies have explored the potential of greenness to reduce health disparities. Furthermore, there has been notable neglect of persons with disabilities in this discourse. This study aims to investigate the association between greenness and non-accidental mortality in persons with and without disabilities in South Korea.

Material and Methods

We conducted a national cohort study using the National Health Insurance Service-National Sample Cohort data from 2008 to 2019. Greenness was measured using the annual average Enhanced Vegetation Index (EVI) based on the district code of individual’s residence during 12 years of follow-up. Time-varying Cox proportional hazards models were employed to estimate associations between greenness and non-accidental mortality by the existence of disability. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) were estimated per 1 unit increase in EVI, adjusting for sex, age, individual socioeconomic status, regional-level deprivation index, population density, calendar year, and city indicators. Analyses were also stratified by disability type and severity.

Results

The data consisted of 912,902 individuals at baseline who contributed 7,045,537 person-years. The results showed a decreased risk of mortality in persons without disabilities (HR: 0.88, 95% CI: 0.68, 1.16) but an increased risk of mortality in persons with disabilities (HR: 1.18, 95% CI: 0.74, 1.89). Among persons with disabilities, the association with greenness varied by disability type and severity.

Conclusion

This study found potential disparities in the beneficial effects of greenness on mortality in persons with disabilities. A disability-inclusive perspective is needed to ensure that going green saves all.

Acknowledgements

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. RS-2023-00219289).