The influence of residential greenness on mortality in the Asia-Pacific region: a systematic review and meta-analysis

Abstract

Aims: To critically appraise the evidence of the impact of exposure to salutogenic green environment on mortality, which is an important endpoint in epidemiological and clinical studies. Methods: We searched for studies published and indexed in three databases (PubMed, AMED, and CINAHL Plus) from inception until 31 March 2020, complemented with a search of cited literature for articles describing the effects of greenness on mortality in Asia-Pacific region. Eligible articles were screened and data were extracted independently by two reviewers. A random-effects model was utilised to obtain pool hazard ratio (HR) and risk ratio of all-cause mortality outcome. Results: The search identified 3239 studies, of which 20 studies reporting 133,363 participants from longitudinal cohort studies and 202 million people from population-based prevalence studies were included in the review. The majority of the studies (60%) were conducted in high-income countries in Asia-Pacific. All participants of the longitudinal cohort studies were aged 60 years or older, whereas the prevalence studies involved people of all age groups. A significant protective association of green environment exposure with all-cause mortality was reported in 18 studies. Pooled results from five studies showed increased level of greenness exposure was associated with a significant decrease in all-cause mortality (pooled HR = 0.97; 95% confidence interval (CI) = 0.93 to 1.02; p < 0.01; I²= 87.8%). Meta-analysis of total number of deaths in different quartiles of green spaces noted decreased risks of mortality with all causes of death with increased surrounding greenness. Conclusions: Some limited evidence suggests that populations exposed to the greener environment have a lower risk of mortality, implying the potential role of greenness in increasing longevity. Further studies with standardised design and outcome reporting should be conducted in low- and middle-income countries and in populations of low socioeconomic status to glean more generalisable and complete evidence for public health policy implications.

Associations and pathways between residential greenness and metabolic syndromes in Fujian Province

“…We defined residential greenness as the annual mean NDVI/EVI during 2016–2018 (the 3 years before the survey) within the 250, 500, and 1,000 m buffer zones around the residential address of each participant, for easier comparison with similar studies ( 27 , 28 ). The 500 m radius of the buffer zone has been widely used in many similar studies to measure residential greenness ( 29 ), so the results from the 500 m buffer zone were presented as the main results.…”

Reported evidence of greenness co-benefits on health, climate change mitigation, and adaptation: a systematic review of the literature

“…Experts are suggesting greenness as a solution that can help curb climate change [43] by providing the co-benefits of improving resiliency and recovery from the impacts of climate change [44,45]. While some pioneering studies focused on specific climate change impacts (extreme heat, heat island impact [46][47][48] and air quality interactions [49]), others focused on health interactions in specific regions (Asia, Europe) [50][51][52]. We review research on the challenges exacerbated by climate change and show how greenness can help accomplish climate change adaptation and mitigation goals while also enhancing human health.…”

Residential surrounding greenness is associated with improved lung function in adults: a cross-sectional study in eastern China

“…In recent years, greenness has been a research hotspot in the environmental epidemiology. Greenness has been generally associated with health benefits in humans, such as reduced all-cause mortality [ 4 , 5 ], reduced incidence of adverse pregnancy outcomes [ 6 , 7 ], and reduced risk of overweight and obesity [ 8 , 9 ]. Therefore, one study suggested that greenness was considered to act on health through various ways, and these were divided into three fields – reducing harmful exposure, resilience, and building capacity [ 10 ].…”