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 $\sim 10\%$ 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 $\sim 53\%$ 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. https://doi.org/10.1289/EHP6161

中文翻译：

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居住区绿色与心血管疾病的发病率，再入院率和死亡率。

摘要

背景：

居住在城市绿色区域与提高体育锻炼水平，改善心理健康以及降低有害环境暴露有关，所有这些都可能影响人类健康。但是，目前尚不清楚居住在绿色区域是否可能降低心血管疾病的发生，发展和过早死亡的风险。

目标：

我们进行了一项队列研究，研究了居民绿色空间与急性心肌梗塞（AMI）和心力衰竭（HF）的发生率，AMI后和HF住院再入院率和死亡率之间的关系。

方法：

我们同时跟踪了加拿大安大略省的四个大型人群队列研究，包括整个成年人口，无AMI和HF的成年人以及AMI或HF的幸存者。从2000年到2014年。我们使用卫星观测资料估算了居民在绿色空间中的暴露程度并使用经过验证的疾病登记表确定健康结果。我们使用空间随机效应Cox比例风险模型估算了相关性。我们进行了各种敏感性分析，包括进一步调整属性值和进行探索性调解分析。

结果：

居住区绿色度每四分位数范围的增加都会使AMI发生率降低7％[95％置信区间（CI）：4％，9％]，事件发生率降低6％（95％CI：4％，7％）高频 住宅的绿色与$〜10％$降低无AMI和HF的成年人以及整个成年人的心血管死亡率。这些关联在敏感性分析中保持一致，并且在年轻成年人中更加突出。此外，我们估计与住宅绿色相关的AMI和HF发病率下降说明了$〜53％$住宅绿色与心血管疾病死亡率之间的保护性联系。相反，AMI和HF患者的居室绿色与再入院或死亡没有任何延迟。

结论：

在没有AMI和HF的人群中，生活在拥有更多绿色空间的城市地区与改善心血管健康有关，但在已经出现这些状况的人群中却没有。https://doi.org/10.1289/EHP6161