Urban green space and the risks of dementia and stroke

Paul, Lauren A.; Hystad, Perry; Burnett, Richard T.; Kwong, Jeffrey C.; Crouse, Dan; Donkelaar, Aaron van; Tu, Karen; Lavigne, Éric; Copes, Ray; Martin, Randall V.; Chen, Hong

doi:10.1016/j.envres.2020.109520

Cited by 80 publications

(46 citation statements)

References 46 publications

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“…Results from this study appear to be generally consistent with other findings showing modest associations between greenspace and dementia outcomes [ 54 – 56 ]. Without more detailed information it is difficult to parse out whether mediation by physical exercise, air pollution mitigation, cognitive restoration, or increased socialization are the main route by which greenspace may be lowering risk or if it is a combination of many routes.…”

Section: Discussionsupporting

confidence: 91%

Neighborhood greenspace exposure as a protective factor in dementia risk among U.S. adults 75 years or older: a cohort study

et al. 2022

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Background Research suggests that greenspace may confer neurocognitive benefits. This study examines whether residential greenspace is associated with risk of dementia among older adults. Methods Greenspace exposure was computed for 3047 participants aged 75 years and older enrolled in the Gingko Evaluation of Memory Study (GEMS) across four U.S. sites that prospectively evaluated dementia and its subtypes, Alzheimer’s disease (AD), vascular dementia (VaD), and mixed pathologies, using neuropsychiatric evaluations between 2000 and 2008. After geocoding participant residences at baseline, three greenspace metrics—Normalized Difference Vegetative Index, percent park overlap within a 2-km radius, and linear distance to nearest park—were combined to create a composite residential greenspace measure categorized into tertiles. Cox proportional hazards models estimated the associations between baseline greenspace and risk of incident all-cause dementia, AD, and Mixed/VaD. Results Compared to low residential greenspace, high residential greenspace was associated with a reduced risk of dementia (HR = 0.76 95% CI: 0.59,0.98) in models adjusted for multiple covariates. After additional adjustment for behavioral characteristics, Apolipoprotein E ɛ4 status, and other covariates, the association was slightly attenuated (HR = 0.82; 95% CI:0.63,1.06). Those exposed to medium levels of greenspace also had 28% lower risk (HR = 0.72; CI: 0.55, 0.95) of dementia compared to those with low greenspace in adjusted models. Subtype associations between high residential greenspace and AD were not statistically significant. Greenspace was not found to be significantly associated with mixed/vascular pathologies. Conclusions This study showed evidence for an association between residential greenspace and all-cause dementia among older adults. Future research with larger sample size, precise characterization of different dementia subtypes, and assessment of residential greenspace earlier in life may help clarify the role between exposure to greenspace and dementia risk.

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Section: Discussionsupporting

confidence: 91%

Neighborhood greenspace exposure as a protective factor in dementia risk among U.S. adults 75 years or older: a cohort study

et al. 2022

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“…Future studies might consider examining associations between green space and cardiometabolic and cerebrovascular diseases. Additionally, given China’s rapidly ageing population [ 15 ], research on green space and neurodegenerative diseases would also align with emerging studies in high-income countries [ 133 , 134 , 135 ].…”

Section: Discussionmentioning

confidence: 99%

Green Space and Health in Mainland China: A Systematic Review

Rahimi-Ardabili

Astell-Burt

Nguyen

et al. 2021

IJERPH

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Non-communicable diseases (NCDs) have become a major cause of premature mortality and disabilities in China due to factors concomitant with rapid economic growth and urbanisation over three decades. Promoting green space might be a valuable strategy to help improve population health in China, as well as a range of co-benefits (e.g., increasing resilience to climate change). No systematic review has so far determined the degree of association between green space and health outcomes in China. This review was conducted to address this gap. Five electronic databases were searched using search terms on green space, health, and China. The review of 83 publications that met eligibility criteria reports associations indicative of various health benefits from more green space, including mental health, general health, healthier weight status and anthropometry, and more favorable cardiometabolic and cerebrovascular outcomes. There was insufficient evidence to draw firm conclusions on mortality, birth outcomes, and cognitive function, and findings on respiratory and infectious outcomes were inconsistent and limited. Future work needs to examine the health benefits of particular types and qualities of green spaces, as well as to take advantage of (quasi-)experimental designs to test greening interventions within the context of China’s rapid urbanization and economic growth.

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“…First, urban greenness has been documented to be a protective factor against dementia and related mental health diseases (Motealleh et al, 2019). For example, Paul et al (2020) found that greenness could be negatively associated with dementia. Our study further implies the necessity of applying greenness as a natural-based preventive medicine against dementia mortality and related causes of death (e.g.…”

Section: Discussionmentioning

confidence: 99%

The associations between social, built and geophysical environment and age-specific dementia mortality among older adults in a high-density Asian city

Fong

Chan

et al. 2020

Preprint

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Background: Although socio-environmental factors which may affect dementia have widely been studied, the mortality of dementia and socio-environmental relationships among older adults have seldom been discussed.Method: A retrospective, observational study based on territory-wide register-based data was conducted to evaluate the relationships of four individual-level social measures, two community-level social measures, six short-term (temporally varying) environmental measures, and four long-term (spatially varying) environmental measures with dementia mortality among older adults in a high-density Asian city (Hong Kong), for the following decedents: 1) all deaths: age >=65, 2) “old-old”: age >= 85, 3) “mid-old”: aged 75 - 84, and 4) “young-old”: aged 65 – 74.Results: This study identified 5438 deaths (3771 old-old; 1439 mid-old; 228 young-old) from dementia out of 228,600 all-cause deaths among older adults in Hong Kong between 2007 and 2014. Generally, regional air pollution, being unmarried or female, older age, and daily O3 were associated with higher dementia mortality, while more urban compactness and greenness were linked to lower dementia mortality among older adults. Specifically, being unmarried and the age effect were associated with higher dementia mortality among the “old-old”, “mid-old” and “young-old”. Regional air pollution was linked to increased dementia mortality, while urban compactness and greenness were associated with lower dementia mortality among the “old-old” and “mid-old”. Higher daily O3 had higher dementia mortality, while districts with a greater percentage of residents whose native language is not Cantonese were linked to lower dementia mortality among the “old-old”. Economic inactivity was associated with increased dementia mortality among the “young-old”. Gender effect varied by age.Conclusion: The difference in strengths of association of various factors with dementia mortality among different age groups implies the need for a comprehensive framework for community health planning. In particular, strategies for air quality control, usage of greenspace and social space, and activity engagement to reduce vulnerability at all ages are warranted.

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Urban green space and the risks of dementia and stroke

Cited by 80 publications

References 46 publications

Neighborhood greenspace exposure as a protective factor in dementia risk among U.S. adults 75 years or older: a cohort study

Neighborhood greenspace exposure as a protective factor in dementia risk among U.S. adults 75 years or older: a cohort study

Green Space and Health in Mainland China: A Systematic Review

The associations between social, built and geophysical environment and age-specific dementia mortality among older adults in a high-density Asian city

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