Exposure to Residential Greenness as a Predictor of Cause-Specific Mortality and Stroke Incidence in the Rome Longitudinal Study

Abstract

Background:Living in areas with higher levels of surrounding greenness and access to urban green areas have been associated with beneficial health outcomes. Some studies suggested a beneficial influence on mortality, but the evidence is still controversial.Objectives:We used longitudinal data from a large cohort to estimate associations of two measures of residential greenness exposure with cause-specific mortality and stroke incidence.Methods:We studied a population-based cohort of 1,263,721 residents in Rome aged ≥30y, followed from 2001 to 2013. As greenness exposure, we utilized the leaf area index (LAI), which expresses the tree canopy as the leaf area per unit ground surface area, and the normalized difference vegetation index (NDVI) within 300- and 1,000-m buffers around home addresses. We estimated the association between the two measures of residential greenness and the outcomes using Cox models, after controlling for relevant individual covariates and contextual characteristics, and explored potential mediation by air pollution [fine particulate matter with aerodynamic diameter ≤2.5μm (PM2.5) and NO2] and road traffic noise.Results:We observed 198,704 deaths from nonaccidental causes, 81,269 from cardiovascular diseases [CVDs; 29,654 from ischemic heart disease (IHD)], 18,090 from cerebrovascular diseases, and 29,033 incident cases of stroke. Residential greenness, expressed as interquartile range (IQR) increase in LAI within 300 m, was inversely associated with stroke incidence {hazard ratio (HR) 0.977 [95% confidence interval (CI): 0.961, 0.994]} and mortality for nonaccidental [HR 0.988 (95% CI: 0.981, 0.994)], cardiovascular [HR 0.984 (95% CI: 0.974, 0.994)] and cerebrovascular diseases [HR 0.964 (95% CI: 0.943, 0.985)]. Similar results were obtained using NDVI with 300- or 1,000-m buffers.Conclusions:Living in greener areas was associated with better health outcomes in our study, which could be partly due to reduced exposure to environmental hazards. Further research is required to understand the underlying mechanisms. https://doi.org/10.1289/EHP2854

The Modifying Role of Socioeconomic Position and Greenness on the Short-Term Effect of Heat and Air Pollution on Preterm Births in Rome, 2001–2013

“…For NDVI, we considered a single satellite image taken at a single day in July. Although we did not account for the potential temporal variation in greenness, a previous study conducted in Rome showed negligible changes in the quantity of greenness during the study period [40]. Neither of the chosen indicators allowed us to distinguish between different types of vegetation, vegetation volumes, and types of green space (street trees or gardens).…”

“…NDVI ranges from −1 to 1 (with higher numbers indicating more greenness) is based on land surface reflectance of visible (red) and near infrared radiation [33,36,37,38,39]. We downloaded a Landsat 8-OLI/TIRS remote sensing image of NDVI from the USGS database (), with a spatial resolution of 30 m × 30 m (Figure 1C), for the 17/07/2015, assuming this image was representative of the overall follow-up period exposure [40]. We were confident that this assumption could not bias our greenness indicator since Orioli et al demonstrated that the correlations between NDVI summer values across the period from 2001 to 2013 plus 2015 were always very high (about 0.80), denoting no substantially changes in the amount of greenness in the city of Rome [40].…”

“…We downloaded a Landsat 8-OLI/TIRS remote sensing image of NDVI from the USGS database (), with a spatial resolution of 30 m × 30 m (Figure 1C), for the 17/07/2015, assuming this image was representative of the overall follow-up period exposure [40]. We were confident that this assumption could not bias our greenness indicator since Orioli et al demonstrated that the correlations between NDVI summer values across the period from 2001 to 2013 plus 2015 were always very high (about 0.80), denoting no substantially changes in the amount of greenness in the city of Rome [40]. We selected a summer day, chosen as it had the least amount of cloud cover at the time of year when leaf development would be at a maximum.…”

Association Between Residential Greenness, Cardiometabolic Disorders, and Cardiovascular Disease Among Adults in China

“…Accumulating data indicate that a higher amount of neighborhood vegetation (referred to as residential greenness) is associated with a range of beneficial health outcomes. 3 , 4 A large number of studies have examined the cardiovascular associations of greenness, 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 but more than 50% of those focused on CVD mortality. In addition, most of the previous studies were conducted in middle- and high-income countries, and only a few studies were performed in low-income countries.…”

Effects of greenspace morphology on mortality at the neighbourhood level: a cross-sectional ecological study

“…The association between greenspace and mortality risk has been identified by studies done in Australia, Canada, China, France, Italy (Rome), Japan, Korea, the Netherlands, the UK, and the USA. [3][4][5][6][7][8][9][10][11][12] Studies in these areas, however, have focused mainly on the effects of greenness per se. Few studies have investigated greenspace morphologyrelated metrics in predicting mortality.…”