Abstract 4371425: Green Space Engagement and Chronic Disease Prevalence Across Urban and Rural U.S. Communities: A Nationwide Analysis Using Mobility Data

Abstract

Background: Although greenspace coverage has been widely studied in relation to chronic disease risk, less is known about actual greenspace exposure, measured by time spent visiting these environments, and their impacts on health. Moreover, it remains unclear whether these potential health benefits vary between urban and rural settings—an important gap to address for advancing equitable public health strategies. Methods: Chronic disease prevalence was sourced from the 2022 CDC PLACES dataset. Green space engagement was measured using 2019 Dewey AdvanResearch mobility data, which estimates daily time spent in green and recreational areas at the census tract level. Tracts were classified as urban or rural using rural–urban commuting codes. Separate linear regression models were fit for urban and rural tracts to assess associations between green space exposure and eight chronic diseases: obesity, diabetes, coronary heart disease, hypertension, high cholesterol, kidney disease, stroke, and arthritis. Models adjusted for income, race/ethnicity, PM2.5, and social deprivation. Partial regression plots and interaction models (green space × urban status) were used to assess and visualize whether associations differed by urban/rural classification. Results: Greater average daily time spent in green spaces was consistently associated with lower prevalence of chronic diseases across both urban and rural census tracts. In stratified linear regression models, the coefficients for green space exposure were negative and highly significant for all outcomes. For example, each extra minute of green space time predicted a –0.20 (SE = 0.0067, p < 1e–197) point reduction in obesity prevalence in urban tracts and –0.23 (SE = 0.0123, p < 5e–76) in rural tracts. Consistent inverse associations were observed for all other chronic disease outcomes (all p < 1e–50). Interaction analyses revealed significant urban–rural effect modification for six of eight outcomes. Interaction analyses revealed significant urban–rural effect modification for six of eight outcomes, including hypertension, coronary heart disease, stroke, cholesterol, diabetes, and arthritis. Conclusion: Green space engagement was consistently associated with lower chronic disease prevalence across both urban and rural tracts. While some conditions showed stronger effects in rural areas, the protective relationship remained robust overall, supporting broad investment in green infrastructure.