Is green space associated with opioid-related mortality? An ecological study at the U.S. county level

Becker, Douglas A.; Browning, Matthew H.E.M.; McAnirlin, Olivia; Yuan, Shuai; Helbich, Marco

doi:10.1016/j.ufug.2022.127529

Cited by 12 publications

(3 citation statements)

References 106 publications

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“…Substance abuse encompasses the use of illegal drugs, misuse of prescription medications, excessive alcohol use, and potential consequences of substance use disorder (Rowe and Liddle, 2003). For instance, one study from the U.S. found positive associations between green space and rates of opioidrelated mortality at the county-level (Becker et al, 2022) despite other evidence suggesting green space should be associated with less opioid use disorder as a consequence of better pain management, mental and physical health, ability to delay rewards, social connectedness, and substance cravings (Berry et al, 2021). These unexpected findings could be explained by dense forests co-occurring in areas with high rates of opioid prescriptions due to a confluence of factors, including high rates of poverty and unemployment, lack of comprehensive health insurance coverage, and high rates of employment in manual labor industries, such as lumber and mining (Moody, Satterwhite and Bickel, 2017;Becker et al, 2022).…”

Section: Additional Mechanisms and Factorsmentioning

confidence: 99%

The economics of nature’s healing touch: A systematic review and conceptual framework of green space, pharmaceutical prescriptions, and healthcare expenditure associations

Patwary,

Bardhan,

Browning

et al. 2023

Preprint

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Green spaces play a crucial role in promoting sustainable and healthy lives. Recent evidence shows that green space also may reduce the need for healthcare, prescription medications, and associated costs. This systematic review provides the first comprehensive assessment of the available literature examining green space exposure and its associations with healthcare prescriptions and expenditures. We applied Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to search MEDLINE, Scopus, and Web of Science for observational studies published in English through May 6, 2023. A quality assessment of the included studies was conducted using the Office of Health Assessment and Translation (OHAT) tool, and the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) assessment was used to evaluate the overall quality of evidence. Our search retrieved 26 studies that met the inclusion criteria and were included in our review. Among these, 20 studies (77% of the total) showed beneficial associations of green space exposure with healthcare prescriptions or expenditures. However, most studies had risks of bias, and the overall strength of evidence for both outcomes was limited. Based on our findings and related bodies of literature, we present a conceptual framework to explain the possible associations and complex mechanisms underlying green space and healthcare outcomes. The framework differs from existing green space and health models by including upstream factors related to healthcare access (i.e., rurality and socioeconomic status), which may flip the direction of associations. Additional research with lower risks of bias is necessary to validate this framework and better understand the potential for green space to reduce healthcare prescriptions and expenditures.

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Section: Additional Mechanisms and Factorsmentioning

confidence: 99%

The economics of nature’s healing touch: A systematic review and conceptual framework of green space, pharmaceutical prescriptions, and healthcare expenditure associations

Patwary,

Bardhan,

Browning

et al. 2023

Preprint

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“… 13 Another US study found that living in a county with more greenness did not reduce drug-related health problems but increased opioid mortality. 16 …”

Section: Introductionmentioning

confidence: 99%

Individual-level and neighborhood-level shifts in mortality patterns among drug poisoning deaths in a high-density Asian city: a territory-wide, case-only analysis

Wong

Cheung

2023

International Health

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Background The shifts in individual-level and neighborhood-level patterns of drug poisoning deaths in a high-density Asian city over time have been underestimated, although they provide essential information for community-based surveillance and interventions. Methods A case-only analysis with a 16-y, territory-wide, population-based registry in Hong Kong was applied to compare drug poisoning deaths from 2001 to 2010 with 2011 to 2016. Drug poisoning deaths, deaths from heroin and deaths from other opioids (codeine or morphine) were extracted (ICD codes: T36-T50, T40.1, T40.2). Binomial regressions were used to estimate the shifts in mortality patterns. Results Among 3069 drug poisoning deaths, a significant shift in mortality patterns was found despite a decreasing mortality trend in Hong Kong. Overall, drug poisoning deaths shifted towards middle-aged/young-old, widowed/divorced, economically active, white collar and non-local born. Since 2011, more deaths from heroin were in older ages and non-local born, but less were never married and economically inactive. More deaths from other opioids were middle-aged, young-old and divorced. In particular, most decedents shifted towards young-old, especially deaths from other opioids. Compared with deaths during 2001–2010, there were 3.72- and 6.50-fold more deaths from heroin and deaths from other opioids in those aged ≥60 y since 2021 (ORs: 3.72 [2.37, 5.86], 6.50 [3.97, 10.65]), respectively. Additionally, drug poisoning deaths shifted towards areas with less neighborhood deprivation (more high-education individuals and a mix of private/public housing residents), especially deaths from other opioids. Conclusion Misuse of registered drugs (e.g. opioid pain relievers) could be a rising trend among vulnerable subpopulations in Hong Kong other than illegal drug use (heroin). Health officials should provide more advice and support on drug information. Specifically, an improved health system with education regarding the appropriate use of registered drugs for medical treatments should be provided to mid-/high-income and local-born individuals.

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“…Nieuwenhuijsen et al, 2017). In contrast, green spaces in rural areas may be used for resource extraction or conservation without opportunities for recreation and therefore provide little health benefits (Becker et al, 2022). Similarly, green spaces in urban areas can be used for ecosystem services such as stormwater runoff, cooling, and noise/air pollution mitigation but have not been strongly linked to health (Nieuwenhuijsen, 2020).Researchers are beginning to use some spatial nationwide datasets for measuring park cover in the U.S. (Table 1).…”

mentioning

confidence: 99%

Curation of new green space indicator for the U.S.: Accessible & recreational park cover (PAD-US-AR)

Browning¹,

Rigolon²,

Ogletree³

et al. 2022

Preprint

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Most spatial epidemiological studies of nature-health relationships use generalized green space measures. For instance, the normalized difference vegetative index (NDVI) is prominent despite its criticisms, such as its inability to differentiate more public (accessible) vs. private (largely inaccessible) land. Green space’s capacity to improve health includes building capacities for health-promoting behaviors (e.g., physical activity). Such behaviors may be best activated by recreational and accessible parks. We curated the Parks and Protected Areas Database of the U.S. (PAD-US) to identify parks that are accessible for outdoor recreation. Our title adds “AR” to “PAD-US” where A=Accessible and R=Recreational. We validated the PAD-US-AR by comparisons with other datasets and demonstrated its uniqueness from other metrics through correlational analyses.The PAD-US-AR presents a reliable estimate for exposure to parks accessible for outdoor recreation. It has strong associations with home prices, shares of female residents, and shares of older residents, which should be considered as covariates/confounders. The dataset can be a companion to other green space metrics in environmental epidemiology and allied fields of research.

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Is green space associated with opioid-related mortality? An ecological study at the U.S. county level

Cited by 12 publications

References 106 publications

The economics of nature’s healing touch: A systematic review and conceptual framework of green space, pharmaceutical prescriptions, and healthcare expenditure associations

The economics of nature’s healing touch: A systematic review and conceptual framework of green space, pharmaceutical prescriptions, and healthcare expenditure associations

Individual-level and neighborhood-level shifts in mortality patterns among drug poisoning deaths in a high-density Asian city: a territory-wide, case-only analysis

Curation of new green space indicator for the U.S.: Accessible & recreational park cover (PAD-US-AR)

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Is green space associated with opioid-related mortality? An ecological study at the U.S. county level

Cited by 12 publications

References 106 publications

The economics of nature’s healing touch: A systematic review and conceptual framework of green space, pharmaceutical prescriptions, and healthcare expenditure associations

The economics of nature’s healing touch: A systematic review and conceptual framework of green space, pharmaceutical prescriptions, and healthcare expenditure associations

Individual-level and neighborhood-level shifts in mortality patterns among drug poisoning deaths in a high-density Asian city: a territory-wide, case-only analysis

Curation of new green space indicator for the U.S.: Accessible &amp; recreational park cover (PAD-US-AR)

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Product

Resources

About

Curation of new green space indicator for the U.S.: Accessible & recreational park cover (PAD-US-AR)