Journal Article

Residential Greenness and Cardiovascular Disease Incidence, Readmission, and Mortality

Ilango, Sindana D., Burnett, Richard T., Kwong, Jeffrey C., Chen, Hong, Bai, Li, Lavigne, Eric, Benmarhnia, Tarik, Hystad, Perry, Crouse, Dan L., Copes, Ray, Goldberg, Mark S., van Donkelaar, Aaron, Martin, Randall V.

2020

Overview

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. 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. 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. 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 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 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. 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. https://doi.org/10.1289/EHP6161.

• Publisher: National Institute of Environmental Health Sciences,Environmental Health Perspectives
• Subject: Adult / Adults / Analysis / Built Environment / Cardiovascular disease / Cardiovascular diseases / Cardiovascular Diseases - epidemiology / Cardiovascular health / Cities / Cohort Studies / Confidence intervals / Congestive heart failure / Development and progression / Environmental Exposure - statistics & numerical data / Exercise / Female / Green infrastructure / Health risks / Heart attack / Hospitals / Humans / Incidence / Male / Mediation / Medical research / Medicine, Experimental / Middle Aged / Mortality / Myocardial infarction / Ontario - epidemiology / Outdoor air quality / Patient Readmission / Personal health / Physical activity / Physical fitness / Population / Population-based studies / Property values / Proportional Hazards Models / Public health / Real estate / Residence Characteristics / Satellite observation / Sensitivity analysis / Statistical models / Urban areas / Well being