Association between Residential Greenness and Incidence of Parkinson’s Disease: A Population-Based Cohort Study in South Korea

Abstract

It is widely known that exposure to residential greenness is beneficial for health. However, few studies have analyzed the association between greenery and Parkinson’s disease (PD). We selected 313,355 participants who matched the inclusion criteria from the National Health Insurance Service-National Sample Cohort, followed up from 2007 to 2015. Residential greenness, represented by the normalized difference vegetation index (NDVI), was obtained from satellite measurements. We estimated hazard ratios of PD associated with a 0.1-unit increase in long-term greenness exposure at the district level for the previous 1 year of each year until a censoring/event occurred, using time-varying Cox proportional hazard models, adjusted for individual- and area-level characteristics. During the 2,745,389 person-years of follow-up, 2621(0.8%) participants developed PD. Exposure to higher levels of residential greenness was found to be associated with a decreased risk of PD incidence (21% per 0.1-unit increase, 95% confidence interval (CI): 0.74–0.84). In subgroup analyses, stronger protective effects were observed in participants aged over 50 years, females, overweight/obese participants, non-urban residents, non-smokers, alcoholics, and those with comorbidities. Long-term exposure to greenness was beneficial to incident PD, and our findings could aid in the development of public-health strategies.

Associations of street-view greenspace with Parkinson’s disease hospitalizations in an open cohort of elderly US Medicare beneficiaries

“…We previously reported protective associations of NDVI and park cover with PD-involved hospitalization in a cohort of Medicare beneficiaries from 2000 to 2016 ( Klompmaker et al, 2022 ). Studies in Canada, China and South Korea showed protective associations of NDVI with PD incidence, consistent with our findings for PD-involved hopsitalization ( Yu et al, 2021 ; Yuchi et al, 2020 ; Jung et al, 2022 ; Zhu et al, 2023 ). We found protective associations of trees and other green, and harmful associations of grass, indicating differential associations of greenspace features on PD-involved hospitalization that would have been obscured by coarse vegetation indices like NDVI.…”

“…Exposure to greenspace may protect against several adverse health outcomes, such as cardiovascular disease and mortality ( Fong et al, 2018 ; Twohig-Bennett and Jones, 2018 ). Some studies have also found protective associations with neurological disorders, including Parkinson’s Disease (PD) ( Yu et al, 2021 ; Yuchi et al, 2020 ; Klompmaker et al, 2022 ; Jung et al, 2022 ; Zhu et al, 2023 ). Several pathways could explain these associations: greenspace can help to reduce stress and restore attention; it provides a setting for physical activity and social interactions; and may reduce exposure to harmful environmental exposures (e.g., air pollution, noise) ( Fong et al, 2018 ; Markevych et al, 2017 ).…”

“…Visual exposure to greenspace is hypothesized to be important for some of the proposed pathways underlying the health effects of greenspace, such as stress reduction and attention restoration ( Larkin and Hystad, 2018 ). However, prior epidemiologic studies that examined associations of greenspace with PD have relied on satellite imagery or land-classification data to assess greenspace ( Yu et al, 2021 ; Yuchi et al, 2020 ; Klompmaker et al, 2022 ; Jung et al, 2022 ; Zhu et al, 2023 ). A major limitation of these indicators is that they are overhead-view measures and likely differ from people’s visual greenspace perception, i.e., the most common view people have of greenspace is from a street-view perspective ( Larkin and Hystad, 2018 ).…”

Unraveling the Decline: Search for Factors Behind the Trend in Parkinson’s Disease Incidence Rates – A Cohort Study of German Health Claims Data

“…Similar results were obtained in a study sample from Korea that took place between 2007 and 2015 42 , as well as in China between 2015 and 2018 43 . These studies demonstrate how the presence of greenness in residential areas may have a protective role in neurodegenerative disorders, and the degree to which governments should consider such effects in their public health and more general strategies.…”