Research note: Natural environments and prescribing in England

Studies using routinely gathered data increasingly show associations between area-level green space and health. However, the environment exposure measures often include only urban green space and there has been limited use of prescribing data as a proxy health indicator. This brief report presents a small-area ecological study of associations between natural environment (including private gardens and water) and the volume and cost of prescribing for cardiovascular conditions and depression in England, with confirmatory analysis using all-cause mortality (in adults aged 15-65 years). Using Besag, York and Molliè (BYM) models to adjust for known confounders and unaccounted-for spatial autocorrelation, we found a statistically significant association of lower mortality in areas with higher area density of natural environment, which was strongest in more deprived areas. There was some evidence of a positive association between cardiovascular prescribing and area density of natural environment, with a non-significant trend towards lower anti-depressant prescribing in areas with higher natural environment density. Apparently beneficial relationships between all-cause mortality and natural environment were not observed for prescribing data, but we advocate further exploration focusing on prescribing for mental health and other conditions with plausible links.