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      Urban green space, tree canopy and prevention of cardiometabolic diseases: a multilevel longitudinal study of 46 786 Australians

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          Abstract

          Background

          Cross-sectional studies suggest that more green space may lower the odds of prevalent diabetes, hypertension and cardiovascular diseases (CVD) in cities. We assess if these results are replicable for tree canopy exposure and then extend the study longitudinally to examine incident cardiometabolic outcomes.

          Methods

          The study was set in the Australian cities of Sydney, Wollongong and Newcastle. Total green space and tree canopy as percentages of landcover within 1.6 km (1 mile) from home were linked to a residentially stable sample of 46 786 participants in the Sax Institute’s 45 and Up Study (baseline 2006–09; follow-up 2012–15). Separate multilevel models were used to investigate whether the odds of prevalent and incident doctor-diagnosed diabetes, hypertension and CVD were associated with total green space and tree canopy provision, adjusting for age, sex, income, education, employment and couple status.

          Results

          Lower odds of prevalent diabetes were observed with 1% increases in total green space [odds ratio (OR) 0.993, 95% confidence interval (CI) 0.988 to 0.998] and tree canopy (0.984, 0.978 to 0.989). Lower odds of prevalent CVD were found with a 1% increase in tree canopy only (0.996, 0.993 to 0.999). Lower odds of incident diabetes (0.988, 0.981 to 0.994), hypertension (0.993, 0.989 to 0.997) and CVD (0.993, 0.988 to 0.998) were associated with a 1% increase in tree canopy, but not total green space. At ≥30% compared with 0–9% tree canopy, there were lower odds of incident diabetes (0.687, 0.547 to 0.855), hypertension (0.828, 0.719 to 0.952) and CVD (0.782, 0.652 to 0.935). However, ≥30% compared with 0–4% total green space was associated with lower odds of prevalent diabetes only (0.695, 0.512 to 0.962).

          Conclusions

          Restoring local tree canopy in neighbourhoods may help to prevent the incidence of cardiometabolic diseases.

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          Most cited references 20

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          Accessibility and use of urban green spaces, and cardiovascular health: findings from a Kaunas cohort study

          Background The aims of this study were to explore associations of the distance and use of urban green spaces with the prevalence of cardiovascular diseases (CVD) and its risk factors, and to evaluate the impact of the accessibility and use of green spaces on the incidence of CVD among the population of Kaunas city (Lithuania). Methods We present the results from a Kaunas cohort study on the access to and use of green spaces, the association with cardiovascular risk factors and other health-related variables, and the risk of cardiovascular mortality and morbidity. A random sample of 5,112 individuals aged 45-72 years was screened in 2006-2008. During the mean 4.41 years follow-up, there were 83 deaths from CVD and 364 non-fatal cases of CVD among persons free from CHD and stroke at the baseline survey. Multivariate Cox proportional hazards regression models were used for data analysis. Results We found that the distance from people’s residence to green spaces was not related to the prevalence of health-related variables. However, the prevalence of cardiovascular risk factors and the prevalence of diabetes mellitus were significantly lower among park users than among non-users. During the follow up, an increased risk of non-fatal and fatal CVD combined was observed for those who lived ≥629.61 m from green spaces (3rd tertile of distance to green space) (hazard ratio (HR) = 1.36), and the risk for non-fatal CVD–for those who lived ≥347.81 m (2nd and 3rd tertile) and were not park users (HR = 1.66) as compared to men and women who lived 347.8 m or less (1st tertile) from green space. Men living further away from parks (3rd tertile) had a higher risk of non-fatal and fatal CVD combined, compared to those living nearby (1st tertile) (HR = 1.51). Compared to park users living nearby (1st tertile), a statistically significantly increased risk of non-fatal CVD was observed for women who were not park users and living farther away from parks (2nd and 3rd tertile) (HR = 2.78). Conclusion Our analysis suggests public health policies aimed at promoting healthy lifestyles in urban settings could produce cardiovascular benefits.
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            A study on the cooling effects of greening in a high-density city: An experience from Hong Kong

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              Is neighborhood green space associated with a lower risk of type 2 diabetes? Evidence from 267,072 Australians.

              OBJECTIVE Lifestyle interventions for type 2 diabetes mellitus (T2DM) are best positioned for success if participants live in supportive neighborhood environments. Deprived neighborhoods increase T2DM risk. Parks and other "green spaces" promote active lifestyles and therefore may reduce T2DM risk. We investigated association between neighborhood green space and the risk of T2DM in a large group of adult Australians. RESEARCH DESIGN AND METHODS Multilevel logit regression was used to fit associations between medically diagnosed T2DM and green space exposure among 267,072 participants in the 45 and Up Study. Green space data were obtained from the Australian Bureau of Statistics, and exposure was calculated using a 1-km buffer from a participant's place of residence. Odds ratios (ORs) were controlled for measures of demographic, cultural, health, diet, active lifestyles, socioeconomic status, and neighborhood circumstances. RESULTS The rate of T2DM was 9.1% among participants in neighborhoods with 0-20% green space, but this rate dropped to approximately 8% for participants with over 40% green space within their residential neighborhoods. The risk of T2DM was significantly lower in greener neighborhoods, controlling for demographic and cultural factors, especially among participants residing in neighborhoods with 41-60% green space land use (OR 0.87; 95% CI 0.83-0.92). This association was consistent after controlling for other explanatory variables and did not vary according to neighborhood circumstances. CONCLUSIONS People in greener surroundings have a lower risk of T2DM. Planning, promoting, and maintaining local green spaces is important in multisector initiatives for addressing the T2DM epidemic.
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                Author and article information

                Journal
                Int J Epidemiol
                Int J Epidemiol
                ije
                International Journal of Epidemiology
                Oxford University Press
                0300-5771
                1464-3685
                June 2020
                13 November 2019
                13 November 2019
                : 49
                : 3
                : 926-933
                Affiliations
                [1 ] Population Wellbeing and Environment Research Lab (PowerLab) , School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales, Australia
                [2 ] School of Public Health and Community Medicine , University of New South Wales, Sydney, New South Wales, Australia
                Author notes
                Corresponding author. Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, NSW 2522, Australia. E-mail: thomasab@ 123456uow.edu.au
                Article
                dyz239
                10.1093/ije/dyz239
                7394941
                31722373
                © The Author(s) 2019. Published by Oxford University Press on behalf of the International Epidemiological Association.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                Page count
                Pages: 8
                Product
                Funding
                Funded by: Hort Frontiers Green Cities Fund;
                Funded by: University of Wollongong, DOI 10.13039/501100001777;
                Award ID: #GC15005
                Funded by: National Health and Medical Research Council Boosting Dementia Research Leader Fellowship;
                Award ID: #1140317
                Funded by: National Health and Medical Research Council Career Development Fellowship;
                Award ID: #1148792
                Funded by: National Health and Medical Research Council, DOI 10.13039/501100000925;
                Award ID: #1101065
                Categories
                Green Space and Built Environment
                AcademicSubjects/MED00860

                Public health

                diabetes, hypertension, cardiovascular diseases, green space, tree canopy

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