Abstract
Despite mounting evidence that urban greenspace protects against mortality in adults, few studies have explored the relationship between greenspace and death among infants. Here, we describe results from an analysis of associations between greenness and infant mortality in Philadelphia, PA. We used images of the normalized difference vegetation index (NDVI), derived from processed satellite data, to estimate greenness density in each census tract. We linked these data with census tract level counts of total infant mortality cases (n = 963) and births (n = 113,610) in years 2010-2014, and used Bayesian spatial areal unit, conditional autoregressive models to estimate associations between greenness and infant mortality. The models included a set of random effects to account for spatial autocorrelation between neighboring census tracts. Infant mortality counts were modeled using a Poisson distribution, and the logarithm of total births in each census tract was specified as the offset term. The following variables were included as potential confounders and effect modifiers: percentage non-Hispanic black, percentage living below the poverty line, an indicator of housing quality, and population density. In adjusted models, the rate of infant mortality was 27% higher in less green compared to more green tracts (95% CI 1.02-1.59). These results contribute further evidence that greenspace may be a health promoting environmental asset.