TY - JOUR
T1 - Associations of parks, greenness, and blue space with cardiovascular and respiratory disease hospitalization in the US Medicare cohort
AU - Klompmaker, Jochem O.
AU - Laden, Francine
AU - Browning, Matthew H. E. M.
AU - Domonici, Francesca
AU - Ogletree, S. Scott
AU - Rigolon, Alessandro
AU - Hart, Jamie E.
AU - James, Peter
N1 - Funding Information:
R software (R Project for Statistical Computing) version 3.6.1 were used for our analyses. The analyses were conducted on the Harvard Research Computing Environment, which is supported by the Institute for Quantitative Social Science at Harvard University.
Funding Information:
This study was supported by the National Institute of Environmental Health Sciences ( R01 ES028033 , R01 ES028033-S1 , R01 ES026217 , 1R01 ES030616 , 1R01 ES029950 , P30 ES000002 ), the National Heart, Lung and Blood Institute ( R01 HL150119 ), the National Institute on Aging ( 5R01 AG060232-03 , 1R01 AG066793 , 3R01 AG066793-02S1 , 1RF1 AG071024 , 1RF1 AG074372-01A1 ), and the National Institute on minority Health and Health Disparities ( R01 MD012769 ).
Publisher Copyright:
© 2022 The Authors
PY - 2022/11/1
Y1 - 2022/11/1
N2 - Natural environments have been linked to decreased risk of cardiovascular disease (CVD) and respiratory disease (RSD) mortality. However, few cohort studies have looked at associations of natural environments with CVD or RSD hospitalization. The aim of this study was to evaluate these associations in a cohort of U.S. Medicare beneficiaries (∼63 million individuals). Our open cohort included all fee-for-service Medicare beneficiaries (2000–2016), aged ≥65, living in the contiguous U.S. We assessed zip code-level park cover based on the United States Geological Survey Protected Areas Database, average greenness (Normalized Difference Vegetation Index, NDVI), and percent blue space cover based on Landsat satellite images. Cox-equivalent Poisson models were used to estimate associations of the exposures with first CVD and RSD hospitalization in the full cohort and among those living in urban zip codes (≥1000 persons/mile2). NDVI was weakly negatively correlated with percent park cover (Spearman ρ = −0.23) and not correlated with percent blue space (Spearman ρ = 0.00). After adjustment for potential confounders, percent park cover was not associated with CVD or RSD hospitalization in the full or urban population. An IQR (0.27) increase in NDVI was negatively associated with CVD (HR: 0.97, 95%CI: 0.96, 0.97), but not with RSD hospitalization (HR: 0.99, 95%CI: 0.98, 1.00). In urban zip codes, an IQR increase in NDVI was positively associated with RSD hospitalization (HR: 1.02, 95%CI: 1.00, 1.03). In stratified analyses, percent park cover was negatively associated with CVD and RSD hospitalization for Medicaid eligible individuals and individuals living in low socioeconomic status neighborhoods in the urban population. We observed no associations of percent blue space cover with CVD or RSD hospitalization. This study suggests that natural environments may benefit cardiorespiratory health; however, benefits may be limited to certain contexts and certain health outcomes.
AB - Natural environments have been linked to decreased risk of cardiovascular disease (CVD) and respiratory disease (RSD) mortality. However, few cohort studies have looked at associations of natural environments with CVD or RSD hospitalization. The aim of this study was to evaluate these associations in a cohort of U.S. Medicare beneficiaries (∼63 million individuals). Our open cohort included all fee-for-service Medicare beneficiaries (2000–2016), aged ≥65, living in the contiguous U.S. We assessed zip code-level park cover based on the United States Geological Survey Protected Areas Database, average greenness (Normalized Difference Vegetation Index, NDVI), and percent blue space cover based on Landsat satellite images. Cox-equivalent Poisson models were used to estimate associations of the exposures with first CVD and RSD hospitalization in the full cohort and among those living in urban zip codes (≥1000 persons/mile2). NDVI was weakly negatively correlated with percent park cover (Spearman ρ = −0.23) and not correlated with percent blue space (Spearman ρ = 0.00). After adjustment for potential confounders, percent park cover was not associated with CVD or RSD hospitalization in the full or urban population. An IQR (0.27) increase in NDVI was negatively associated with CVD (HR: 0.97, 95%CI: 0.96, 0.97), but not with RSD hospitalization (HR: 0.99, 95%CI: 0.98, 1.00). In urban zip codes, an IQR increase in NDVI was positively associated with RSD hospitalization (HR: 1.02, 95%CI: 1.00, 1.03). In stratified analyses, percent park cover was negatively associated with CVD and RSD hospitalization for Medicaid eligible individuals and individuals living in low socioeconomic status neighborhoods in the urban population. We observed no associations of percent blue space cover with CVD or RSD hospitalization. This study suggests that natural environments may benefit cardiorespiratory health; however, benefits may be limited to certain contexts and certain health outcomes.
KW - built environment
KW - cardiorespiratory health
KW - nature
U2 - 10.1016/j.envpol.2022.120046
DO - 10.1016/j.envpol.2022.120046
M3 - Article
SN - 0269-7491
VL - 312
JO - Environmental Pollution
JF - Environmental Pollution
M1 - 120046
ER -