Decision Tree Analyses to Explore the Relevance of Multiple Sex/Gender Dimensions for the Exposure to Green Spaces: Results from the KORA INGER Study.

Recently, attention has been drawn to the need to integrate sex/gender more comprehensively into environmental health research. Considering theoretical approaches, we define sex/gender as a multidimensional concept based on intersectionality. However, operationalizing sex/gender through multiple covariates requires the usage of statistical methods that are suitable for handling such complex data. We therefore applied two different decision tree approaches: classification and regression trees (CART) and conditional inference trees (CIT). We explored the relevance of multiple sex/gender covariates for the exposure to green spaces, measured both subjectively and objectively. Data from 3742 participants from the Cooperative Health Research in the Region of Augsburg (KORA) study were analyzed within the INGER (Integrating gender into environmental health research) project. We observed that the participants' financial situation and discrimination experience was relevant for their access to high quality public green spaces, while the urban/rural context was most relevant for the general greenness in the residential environment. None of the covariates operationalizing the individual sex/gender self-concept were relevant for differences in exposure to green spaces. Results were largely consistent for both CART and CIT. Most importantly we showed that decision tree analyses are useful for exploring the relevance of multiple sex/gender dimensions and their interactions for environmental exposures. Further investigations in larger urban areas with less access to public green spaces and with a study population more heterogeneous with respect to age and social disparities may add more information about the relevance of multiple sex/gender dimensions for the exposure to green spaces.