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

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Abstract

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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Most cited references 59

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Green space, urbanity, and health: how strong is the relation?

Jolanda Maas, Robert A. Verheij, Peter Groenewegen … (2006)

To investigate the strength of the relation between the amount of green space in people's living environment and their perceived general health. This relation is analysed for different age and socioeconomic groups. Furthermore, it is analysed separately for urban and more rural areas, because the strength of the relation was expected to vary with urbanity. The study includes 250 782 people registered with 104 general practices who filled in a self administered form on sociodemographic background and perceived general health. The percentage of green space (urban green space, agricultural space, natural green space) within a one kilometre and three kilometre radius around the postal code coordinates was calculated for each household. Multilevel logistic regression analyses were performed at three levels-that is, individual level, family level, and practice level-controlled for sociodemographic characteristics. The percentage of green space inside a one kilometre and a three kilometre radius had a significant relation to perceived general health. The relation was generally present at all degrees of urbanity. The overall relation is somewhat stronger for lower socioeconomic groups. Elderly, youth, and secondary educated people in large cities seem to benefit more from presence of green areas in their living environment than other groups in large cities. This research shows that the percentage of green space in people's living environment has a positive association with the perceived general health of residents. Green space seems to be more than just a luxury and consequently the development of green space should be allocated a more central position in spatial planning policy.

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Increasing walking: how important is distance to, attractiveness, and size of public open space?

Billie Giles-Corti, Melissa H. Broomhall, Matthew Knuiman … (2005)

Well-designed public open space (POS) that encourages physical activity is a community asset that could potentially contribute to the health of local residents. In 1995-1996, two studies were conducted-an environmental audit of POS over 2 acres (n =516) within a 408-km2 area of metropolitan Perth, Western Australia; and personal interviews with 1803 adults (aged 18 to 59 years) (52.9% response rate). The association between access to POS and physical activity was examined using three accessibility models that progressively adjusted for distance to POS, and its attractiveness and size. In 2002, an observational study examined the influence of attractiveness on the use of POS by observing users of three pairs of high- and low-quality (based on attractiveness) POS matched for size and location. Overall, 28.8% of respondents reported using POS for physical activity. The likelihood of using POS increased with increasing levels of access, but the effect was greater in the model that adjusted for distance, attractiveness, and size. After adjustment, those with very good access to large, attractive POS were 50% more likely to achieve high levels of walking (odds ratio, 1.50; 95% confidence level, 1.06-2.13). The observational study showed that after matching POS for size and location, 70% of POS users observed visited attractive POS. Access to attractive, large POS is associated with higher levels of walking. To increase walking, thoughtful design (and redesign) of POS is required that creates large, attractive POS with facilities that encourage active use by multiple users (e.g., walkers, sports participants, picnickers).

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Effect of exposure to natural environment on health inequalities: an observational population study.

Frank Popham, Richard Mitchell (2008)

Studies have shown that exposure to the natural environment, or so-called green space, has an independent effect on health and health-related behaviours. We postulated that income-related inequality in health would be less pronounced in populations with greater exposure to green space, since access to such areas can modify pathways through which low socioeconomic position can lead to disease. We classified the population of England at younger than retirement age (n=40 813 236) into groups on the basis of income deprivation and exposure to green space. We obtained individual mortality records (n=366 348) to establish whether the association between income deprivation, all-cause mortality, and cause-specific mortality (circulatory disease, lung cancer, and intentional self-harm) in 2001-05, varied by exposure to green space measured in 2001, with control for potential confounding factors. We used stratified models to identify the nature of this variation. The association between income deprivation and mortality differed significantly across the groups of exposure to green space for mortality from all causes (p<0.0001) and circulatory disease (p=0.0212), but not from lung cancer or intentional self-harm. Health inequalities related to income deprivation in all-cause mortality and mortality from circulatory diseases were lower in populations living in the greenest areas. The incidence rate ratio (IRR) for all-cause mortality for the most income deprived quartile compared with the least deprived was 1.93 (95% CI 1.86-2.01) in the least green areas, whereas it was 1.43 (1.34-1.53) in the most green. For circulatory diseases, the IRR was 2.19 (2.04-2.34) in the least green areas and 1.54 (1.38-1.73) in the most green. There was no effect for causes of death unlikely to be affected by green space, such as lung cancer and intentional self-harm. Populations that are exposed to the greenest environments also have lowest levels of health inequality related to income deprivation. Physical environments that promote good health might be important to reduce socioeconomic health inequalities.

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Author and article information

Contributors

Abdonas Tamosiunas

Regina Grazuleviciene

Dalia Luksiene

Audrius Dedele

Regina Reklaitiene

Migle Baceviciene

Jone Vencloviene

Gailute Bernotiene

Ricardas Radisauskas

Vilija Malinauskiene

Egle Milinaviciene

Martin Bobak

Anne Peasey

Mark J Nieuwenhuijsen

Journal

Journal ID (nlm-ta): Environ Health

Journal ID (iso-abbrev): Environ Health

Title: Environmental Health

Publisher: BioMed Central

ISSN (Electronic): 1476-069X

Publication date Collection: 2014

Publication date (Electronic): 19 March 2014

Volume: 13

Page: 20

Affiliations

[1 ]Lithuanian University of Health Sciences, Academy of Medicine, Institute of Cardiology, Kaunas, Lithuania

[2 ]Department of Environmental Sciences, Vytautas Magnus University, Kaunas, Lithuania

[3 ]Department of Epidemiology and Public Health, University College London, London, UK

[4 ]Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain

[5 ]Municipal Institute of Medical Research (IMIM-Hospital del Mar), Barcelona, Spain

[6 ]CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain

Article

Publisher ID: 1476-069X-13-20

DOI: 10.1186/1476-069X-13-20

PMC ID: 4000006

PubMed ID: 24645935

SO-VID: f5336f58-4de2-4121-b5fd-6a341ca85250

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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

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Abstract

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UCL: UN SDG 11 Sustainable Cities and Communities

Most cited references 59

Green space, urbanity, and health: how strong is the relation?

Increasing walking: how important is distance to, attractiveness, and size of public open space?

Effect of exposure to natural environment on health inequalities: an observational population study.

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