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Abstract
Background
Exposure to green spaces is associated with improved mental health and may reduce risk of suicide. Here, we investigate the association between long-term exposure to residential surrounding greenness and suicide mortality.
Methods
We used data from the 2001 Belgian census linked to mortality register data (2001–2011). We included all registered individuals aged 18 years or older at baseline (2001) residing in the five largest urban areas in Belgium (n = 3,549,514). Suicide mortality was defined using the tenth revision of the World Health Organisation International Classification of Diseases (ICD-10) codes X60-X84, Y10–Y34, and Y870. Surrounding greenness was measured using the Normalized Difference Vegetation Index (NDVI) within a 300 m and 1,000 m buffer around the residential address at baseline. To assess the association between residential surrounding greenness and suicide mortality, we applied Cox proportional hazards models with age as the underlying time scale. Models were adjusted for age, sex, living arrangement, migrant background, educational attainment, neighbourhood socio-economic position. We additionally explored potential mediation by residential outdoor nitrogen dioxide (NO2) concentrations. Finally, we assessed potential effect modification by various socio-demographic characteristics of the population (sex, age, educational attainment, migrant background, and neighbourhood socio-economic position). Associations are expressed as hazard ratios and their 95% confidence intervals (CI) for an interquartile range (IQR) increase in residential surrounding greenness.
Results
We observed a 7% (95%CI 0.89–0.97) and 6% (95%CI 0.90–0.98) risk reduction of suicide mortality for an IQR increase in residential surrounding greenness for buffers of 300 m and 1,000 m, respectively. Furthermore, this association was independent of exposure to NO2. After stratification, the inverse association was only apparent among women, and residents of Belgian origin, and that it was stronger among residents aged 36 or older, those with high level of education, and residents of most deprived neighbourhoods.
Conclusion
Our results suggest that urban green spaces may protect against suicide mortality, but this beneficial effect may not be equally distributed across all strata of the population.
Exposure to green spaces is associated with improved mental health and may reduce risk of suicide. Here, we investigate the association between long-term exposure to residential surrounding greenness and suicide mortality.
Methods
We used data from the 2001 Belgian census linked to mortality register data (2001–2011). We included all registered individuals aged 18 years or older at baseline (2001) residing in the five largest urban areas in Belgium (n = 3,549,514). Suicide mortality was defined using the tenth revision of the World Health Organisation International Classification of Diseases (ICD-10) codes X60-X84, Y10–Y34, and Y870. Surrounding greenness was measured using the Normalized Difference Vegetation Index (NDVI) within a 300 m and 1,000 m buffer around the residential address at baseline. To assess the association between residential surrounding greenness and suicide mortality, we applied Cox proportional hazards models with age as the underlying time scale. Models were adjusted for age, sex, living arrangement, migrant background, educational attainment, neighbourhood socio-economic position. We additionally explored potential mediation by residential outdoor nitrogen dioxide (NO2) concentrations. Finally, we assessed potential effect modification by various socio-demographic characteristics of the population (sex, age, educational attainment, migrant background, and neighbourhood socio-economic position). Associations are expressed as hazard ratios and their 95% confidence intervals (CI) for an interquartile range (IQR) increase in residential surrounding greenness.
Results
We observed a 7% (95%CI 0.89–0.97) and 6% (95%CI 0.90–0.98) risk reduction of suicide mortality for an IQR increase in residential surrounding greenness for buffers of 300 m and 1,000 m, respectively. Furthermore, this association was independent of exposure to NO2. After stratification, the inverse association was only apparent among women, and residents of Belgian origin, and that it was stronger among residents aged 36 or older, those with high level of education, and residents of most deprived neighbourhoods.
Conclusion
Our results suggest that urban green spaces may protect against suicide mortality, but this beneficial effect may not be equally distributed across all strata of the population.
| Original language | English |
|---|---|
| Article number | 114517 |
| Number of pages | 7 |
| Journal | Environmental Research |
| Volume | 216 |
| DOIs | |
| Publication status | Published - 1 Jan 2023 |
Bibliographical note
Funding Information:This research was funded by the Brussels Institute for Research and Innovation (INNOVIRIS), project number: 2019-ANTICIPATE-26100. The funding organization had no involvement in the study design; in the analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.Firstly, the authors greatly acknowledge the contribution of Ms. Mariska Bauwelinck for operationalization of the included environmental indicators. Secondly, we acknowledge IRCEL-CELINE (Belgian Interregional Environment Agency) for providing the ambient air pollution estimates. Thirdly, we are grateful for the support of stable (Directorate-general statistics-Statistics Belgium) for geocoding the census data and data linkages. Lastly, the computational resources and services used in this work were provided by the VSC (Flemish Supercomputer Centre), funded by the Research Foundation–Flanders (FWO) and the Flemish Government.
Funding Information:
Firstly, the authors greatly acknowledge the contribution of Ms. Mariska Bauwelinck for operationalization of the included environmental indicators. Secondly, we acknowledge IRCEL-CELINE (Belgian Interregional Environment Agency) for providing the ambient air pollution estimates. Thirdly, we are grateful for the support of stable (Directorate-general statistics-Statistics Belgium) for geocoding the census data and data linkages. Lastly, the computational resources and services used in this work were provided by the VSC (Flemish Supercomputer Centre), funded by the Research Foundation–Flanders (FWO) and the Flemish Government .
Funding Information:
This research was funded by the Brussels Institute for Research and Innovation (INNOVIRIS), project number: 2019-ANTICIPATE-26100. The funding organization had no involvement in the study design; in the analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.
Publisher Copyright:
© 2022 Elsevier Inc.
Copyright:
Copyright 2022 Elsevier B.V., All rights reserved.
Keywords
- suicide, green spaces , Belgium
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SRP76: SRP-Onderzoekszwaartepunt: Demographic and Societal Challenges of the 21st Century
Bircan, T., Vanroelen, C., Vanroelen, C., Vandenheede, H., Verhaeghe, P., Gadeyne, S., Bircan, T., Baró Porras, F., Spruyt, B., Vandebroeck, D., Schreurs, B., Van Belle, E., De Moortel, D., Schirmer, W. & Buffel, V.
1/11/22 → 31/10/27
Project: Fundamental