Impacts of social deprivation on mortality and protective effects of greenness exposure in Hong Kong, 1999–2018: A spatiotemporal perspective

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Addressing health inequality is crucial for fostering healthy city development. However, there is a dearth of literature simultaneously investigating the effects of social deprivation and greenness exposure on mortality risks, as well as how greenness exposure may mitigate the adverse effect of social deprivation on mortality risks from a spatiotemporal perspective. Drawing on socioeconomic, remote sensing, and mortality record data, this study presents spatiotemporal patterns of social deprivation, population weighted greenness exposure, and all-cause and cause-specific mortality in Hong Kong. A Bayesian regression model was applied to investigate the impacts of social deprivation and greenness exposure on mortality and examine how socioeconomic inequalities in mortality may vary across areas with different greenness levels in Hong Kong from 1999 to 2018. We observed a decline in social deprivation (0.67–0.56), and an increase in greenness exposure (0.34–0.41) in Hong Kong during 1999–2018. Areas with high mortality gradually clustered in the Kowloon Peninsula and the northern regions of Hong Kong Island. Adverse impacts of social deprivation on all-cause mortality weakened in recent years (RR from 2009 to 2013: 1.103, 95%CI: 1.051–1.159, RR from 2014 to 2018: 1.041 95%CI: 0.950–1.139), while the protective impacts of greenness exposure consistently strengthened (RR from 1999 to 2003: 0.903, 95%CI: 0.827–0.984, RR from 2014 to 2018: 0.859, 95%CI: 0.763–0.965). Moreover, the adverse effects of social deprivation on mortality risks were found to be higher in areas with lower greenness exposure. These findings provide evidence of associations between social deprivation, greenness exposure, and mortality risks in Hong Kong over the past decades, and highlight the potential of greenness exposure to mitigate health inequalities. Our study provides valuable implications for policymakers to develop a healthy city.