Abstract Rationale The Tree Equity Score (TES) is a nationally available metric that quantifies neighborhood-level tree canopy relative to environmental and socioeconomic need. Lower TES values indicate fewer trees in communities that would benefit most from tree expansion. Although, tree canopy relationship with mortality from major pulmonary diseases has not been systematically evaluated at the national level. Objectives To evaluate the ecological correlation between Tree Equity Score and age-adjusted mortality rates from asthma, chronic obstructive pulmonary disease (COPD), and interstitial lung disease (ILD) across U.S. counties. Methods We conducted a county-level analysis using publicly available datasets. Tree Equity Scores were obtained from the national database released by American Forests. Crude mortality rates (1999-2024) and Age-adjusted mortality rates (1999-2020) for all-cause mortality, and cause-specific mortality with asthma, COPD, and ILD were extracted from CDC WONDER Multiple Cause-of-Death files for the study duration and also separately for most recent period to improve stability. ICD-10 codes used to identify cause-specific mortality rates were asthma (J45-46), COPD (J41-44), and ILD (J84). Primary analyses used Spearman correlation to evaluate associations between TES and disease-specific mortality. The primary TES is calculated at the block group level to generate a single, representative score for an entire county, for which we calculated a population-weighted average of all the block groups using the formula: County Score = Σ (TES * clipped block group population) / Σ (total population for the county), which is the total weighted score of each canopy block divided by the total population for each county. Results There were a total of 69,714,059 deaths reported over the study period (1999-2024), out of whom 282,650 were attributable to asthma, another 7,237,291 patients had COPD, and about 699,741 had ILD as one of the listed cause of mortality on death certificates. Lower Tree Equity Scores were consistently associated with higher age-adjusted mortality rates for asthma and COPD, but not with ILD and all-cause mortality at the county level. The strongest unadjusted correlations were observed for asthma mortality except for the year 2024 (with spearman’s rho = -0.069, p = 0.394), followed by COPD. ILD mortality was non-significant with TES except for the most recent year 2024 when it became significant (r= -0.159, p 0.001). Conclusions Counties with lower Tree Equity Scores experience higher mortality from asthma and COPD, and is likely not affecting ILD and all-cause mortality. These findings highlight tree canopy inequity as a potentially modifiable environmental determinant of respiratory mortality. This abstract is funded by: N/A
Yousaf et al. (Fri,) studied this question.