Residential Greenness and Cardiovascular Disease Incidence, Readmission, and Mortality

Abstract

BACKGROUND: Living in greener areas of cities was linked to increased physical activity levels, improved mental well-being, and lowered harmful environmental exposures, all of which may affect human health. However, whether living in greener areas may be associated with lower risk of cardiovascular disease incidence, progression, and premature mortality is unclear. OBJECTIVES: We conducted a cohort study to examine the associations between residential green spaces and the incidence of acute myocardial infarction (AMI) and heart failure (HF), post-AMI and HF hospital readmissions, and mortality. METHODS: We simultaneously followed four large population-based cohorts in Ontario, Canada, including the entire adult population, adults free of AMI and HF, and survivors of AMI or HF from 2000 to 2014. We estimated residential exposure to green spaces using satellite-derived observations and ascertained health outcomes using validated disease registries. We estimated the associations using spatial random-effects Cox proportional hazards models. We conducted various sensitivity analyses, including further adjusting for property values and performing exploratory mediation analysis. RESULTS: Each interquartile range increase in residential greenness was associated with a 7% [95% confidence interval (CI): 4%, 9%] decrease in incident AMI and a 6% (95% CI: 4%, 7%) decrease in incident HF. Residential greenness was linked to a ∼ 10% decrease in cardiovascular mortality in both adults free of AMI and HF and the entire adult population. These associations remained consistent in sensitivity analyses and were accentuated among younger adults. Additionally, we estimated that the decreases in AMI and HF incidence associated with residential greenness explained ∼ 53% of the protective association between residential greenness and cardiovascular mortality. Conversely, residential greenness was not associated with any delay in readmission or mortality among AMI and HF patients. CONCLUSIONS: Living in urban areas with more green spaces was associated with improved cardiovascular health in people free of AMI and HF but not among individuals who have already developed these conditions.

The Effects of Greenness Exposure on Hypertension Incidence Among Chinese Oldest Old: A 10-Year Prospective Cohort Study

“…More importantly, the results of our study exhibited a greater protective effect of greenness exposure on hypertension incidence than prior published literature included older adults [9,11,14,16], which indicated that the advantages of greenness for these oldest people were greater than expected. Our results provide new insights that the bene t of greenness exposure to hypertension prevention possible increases with age, especially for the oldest old people.…”

“…Third, published studies reported there was a modi cation effect of the relationship between greenness and blood pressure varied by elderly's age. Some studies proposed this protective effects were stronger in younger age elderly but others were not, due to the rare sample for oldest-old people, this modi cation effect of age was not fully understand [9,10,14]. In addition, previous cross-sectional study designs have dominated the literature [7,15,16].…”

Breaking Down and Building Up: Gentrification, Its drivers, and Urban Health Inequality

“…The improvement or construction of new environmental amenities such as parks, entwined with political and economic agendas, may ultimately socially and physically exclude or even displace long-term underprivileged residents, a process that has been called green or environmental gentrification [ 42 ]. Greenspace availability has been associated with a wide range of health outcomes [ 43 – 45 ]. Exposure to greenspaces alone has also been linked to decreased health inequalities [ 43 , 46 – 48 ].…”

Green space and mortality in European cities: a health impact assessment study

“…2 Many studies have associated green space with beneficial health effects, including enhanced restoration, improved perceived wellbeing and mental health, [3][4][5][6] and reduction in cardiovascular disease. 7,8 Additionally, green spaces are associated with decreased natural-cause mortality. 5,9 75% of the European population lives in urban environments.…”