Health disparities in the relationship of neighborhood greenness to mental health outcomes in 249,405 U.S. medicare beneficiaries

Scott C. Brown, Tatiana Perrino, Joanna Lombard, Kefeng Wang, Matthew Toro, Tatjana Rundek, Carolina Marinovic Gutierrez, Chuanhui Dong, Elizabeth Plater-Zyberk, Maria I. Nardi, Jack Kardys, José Szapocznik

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44 Scopus citations


Prior studies suggest that exposure to the natural environment may be important for optimal mental health. The present study examines the association between block-level greenness (vegetative presence) and mental health outcomes, in a population-based sample of 249,405 U.S. Medicare beneficiaries aged ≥65 years living in Miami-Dade County, Florida, USA, whose location did not change from 2010 to 2011. Multilevel analyses examined relationships between greenness, as measured by mean Normalized Difference Vegetation Index from satellite imagery at the Census block level, and each of two mental health outcomes; Alzheimer’s disease and depression, respectively, after statistically adjusting for age, gender, race/ethnicity, and neighborhood income level of the individuals. Higher block-level greenness was linked to better mental health outcomes: There was a reduced risk of Alzheimer’s disease (by 18%) and depression (by 28%) for beneficiaries living in blocks that were 1 SD above the mean for greenness, as compared to blocks that were 1 SD below the mean. Planned post-hoc analyses revealed that higher levels of greenness were associated with even greater mental health benefits in low-income neighborhoods: An increase in greenness from 1 SD below to 1 SD above the mean was associated with 37% lower odds of depression in low-income neighborhoods, compared to 27% and 21% lower odds of depression in medium- and high-income neighborhoods, respectively. Greenness may be effective in promoting mental health in older adults, particularly in low-income neighborhoods, possibly as a result of the increased opportunities for physical activity, social interaction, or stress mitigation.

Original languageEnglish (US)
Article number430
JournalInternational journal of environmental research and public health
Issue number3
StatePublished - Mar 1 2018


  • Alzheimer’s disease
  • Depression
  • Health disparities
  • Mental health
  • Neighborhood greenness
  • Neighborhood income
  • Older adults
  • U.S. medicare beneficiaries

ASJC Scopus subject areas

  • Pollution
  • Public Health, Environmental and Occupational Health
  • Health, Toxicology and Mutagenesis


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