Socioeconomic status as a determinant of residential greenness: Systematic Review and Meta-analysis
Abstract
Background: Residential greenness is associated with multiple health benefits, yet its distribution across socioeconomic groups remains insufficiently synthesized, limiting understanding of environmental health inequalities.
Objectives: To quantify the magnitude and direction of the association between socioeconomic status (SES) and residential greenness, assess consistency across geographic regions, and identify research gaps.
Methods: We conducted a systematic review and meta-analysis of observational studies. PubMed, Web of Science, Scopus, and CINAHL were searched from inception to December 2025. Studies of predominantly urban populations (≥85%) assessing greenness using the Normalized Difference Vegetation Index (NDVI) were included. SES was defined by income and/or education. Two reviewers independently screened records, extracted data, and assessed quality using the Newcastle–Ottawa Scale. Random-effects models (DerSimonian and Laird) were used to pool standardized mean differences (SMD) and odds ratios (OR) with 95% confidence intervals (CI). Subgroup analyses by geographic region were conducted.
Results: Twenty-six studies (n = 9,411,596; 14 countries) were included. Higher income was associated with greater greenness (continuous NDVI: SMD=0.50; 95% CI: 0.31–0.69), as was higher education (SMD=0.34; 95% CI: 0.13–0.56). For categorical NDVI, higher income increased the likelihood of living in greener areas (OR = 1.54; 95% CI: 1.32–1.81), with a smaller effect for education (OR = 1.20; 95% CI: 1.06–1.35). No differences were observed across regions.
Conclusions: Socioeconomic inequalities are strongly associated with unequal distribution of residential greenness, particularly by income. These findings support equity-oriented urban planning to reduce environmental and health disparities.
Key messages: • Socioeconomic inequalities influence access to green spaces, with disadvantaged groups consistently exposed to fewer green environments, thereby exacerbating environmental and health disparities.
• Our findings highlight that greenness is unevenly distributed, favoring higher SES groups, underscoring the need for equitable urban planning to reduce social and health inequalities.
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BibTeX
@article{cekrezi2026socioeconomic,
title = {{Socioeconomic status as a determinant of residential greenness: Systematic Review and Meta-analysis}},
author = {S Cekrezi and M Martinez-Andres and B Notario-Pacheco and I Marcilla-Toribio and A Perez-Moreno and AM Caraballo-Betancort and P Garcia-Rubio and ML Moratalla-Cebrian and B Bizzozero-Peroni},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.2058},
url = {https://doi.org/10.1093/eurpub/ckag169.2058},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Socioeconomic status as a determinant of residential greenness: Systematic Review and Meta-analysis
AU - S Cekrezi
AU - M Martinez-Andres
AU - B Notario-Pacheco
AU - I Marcilla-Toribio
AU - A Perez-Moreno
AU - AM Caraballo-Betancort
AU - P Garcia-Rubio
AU - ML Moratalla-Cebrian
AU - B Bizzozero-Peroni
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.2058
UR - https://doi.org/10.1093/eurpub/ckag169.2058
AB - Background: Residential greenness is associated with multiple health benefits, yet its distribution across socioeconomic groups remains insufficiently synthesized, limiting understanding of environmental health inequalities. Objectives: To quantify the magnitude and direction of the association between socioeconomic status (SES) and residential greenness, assess consistency across geographic regions, and identify research gaps. Methods: We conducted a systematic review and meta-analysis of observational studies. PubMed, Web of Science, Scopus, and CINAHL were searched from inception to December 2025. Studies of predominantly urban populations (≥85%) assessing greenness using the Normalized Difference Vegetation Index (NDVI) were included. SES was defined by income and/or education. Two reviewers independently screened records, extracted data, and assessed quality using the Newcastle–Ottawa Scale. Random-effects models (DerSimonian and Laird) were used to pool standardized mean differences (SMD) and odds ratios (OR) with 95% confidence intervals (CI). Subgroup analyses by geographic region were conducted. Results: Twenty-six studies (n = 9,411,596; 14 countries) were included. Higher income was associated with greater greenness (continuous NDVI: SMD=0.50; 95% CI: 0.31–0.69), as was higher education (SMD=0.34; 95% CI: 0.13–0.56). For categorical NDVI, higher income increased the likelihood of living in greener areas (OR = 1.54; 95% CI: 1.32–1.81), with a smaller effect for education (OR = 1.20; 95% CI: 1.06–1.35). No differences were observed across regions. Conclusions: Socioeconomic inequalities are strongly associated with unequal distribution of residential greenness, particularly by income. These findings support equity-oriented urban planning to reduce environmental and health disparities. Key messages: • Socioeconomic inequalities influence access to green spaces, with disadvantaged groups consistently exposed to fewer green environments, thereby exacerbating environmental and health disparities. • Our findings highlight that greenness is unevenly distributed, favoring higher SES groups, underscoring the need for equitable urban planning to reduce social and health inequalities.
SN - 1101-1262
SN - 1464-360X
ER -