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Residential neighbourhood greenspace is associated with reduced risk of cardiovascular disease: a prospective cohort study

Published version
Peer-reviewed

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Authors

Dalton, AM 
Jones, Andy 

Abstract

Abstract Background Living in a greener neighbourhood may reduce the risk of developing incident cardiovascular disease, but evidence is limited by reliance on cross-sectional comparisons. We use data from a longitudinal study with a time-independent measure of risk to explore the association between exposure to greenspace and cardiovascular disease. Methods Data was from the European Prospective Investigation of Cancer Norfolk UK cohort, baseline 1993-1997 (n=24,420). Neighbourhoods were defined as 800m radius zones around participants’ home, according to their home postcode (zip code) in the year 2000. Greenspace exposure was identified using classified satellite imagery. Adjusted Cox proportional hazards regression examined associations between greenspace and incident cardiovascular disease. Mediation analysis assessed if physical activity mediated associations, whilst modification by rurality, socio-economic status and age was explored. Results The mean age of participants was 59.2 years at baseline, 54.7% were female, and mean follow-up time was 14.5 years. Individuals living in the greenest neighbourhood quartile had a 7% lower relative hazard of developing cardiovascular disease than other neighbourhoods (HR 0.93; 95% CI 0.88, 0.97; p=0.003) after adjusting for age, sex, BMI, prevalent diabetes and socio-economic status (SES). Physical activity did not mediate the relationship (greenest compared to the least green quartile HR 0.99; 95% CI 0.97, 1.01; p=0.416). Models predicted incidence of cardiovascular disease in the least green neighbourhoods (19.4% greenspace on average) would fall by 4.8% (95% CI 1.6%, 8.2% p=0.003) if they were as green as the average neighbourhood (59.0% greenspace). Occupation moderated the relationship, whereby exposure to greenspace was not associated with incident CVD for participants engaged in manual occupations. Conclusions Greener home neighbourhoods may protect against risk of cardiovascular disease even after accounting for SES, whilst the mechanism does not appear to be strongly associated with physical activity. Putative causal mechanisms require investigation.

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Keywords

Cardiovascular Diseases, Environment Design, Exercise, Female, Humans, Incidence, Longitudinal Studies, Male, Middle Aged, Prospective Studies, Residence Characteristics, Risk Reduction Behavior, United Kingdom

Journal Title

PLoS One

Conference Name

Journal ISSN

1932-6203
1932-6203

Volume Title

Publisher

Public Library of Science (PLoS)
Sponsorship
Medical Research Council (MR/K023187/1)
Medical Research Council (MR/K025147/1)
This work was supported by the Centre for Diet and Activity Research (CEDAR), a UKCRC Public Health Research Centre of Excellence. Funding from Cancer Research UK, the British Heart Foundation, the Economic and Social Research Council, the Medical Research Council, the National Institute for Health Research, and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged. The corresponding and lead authors were supported by MR/K025147/1. The views and opinions expressed herein are those of the authors. The funders had no role in study design, data analysis, the decision to publish, or the preparation of the manuscript.