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

Abstract

BackgroundThe 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).MethodsWe 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.ResultsWe 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).ConclusionOur analysis suggests public health policies aimed at promoting healthy lifestyles in urban settings could produce cardiovascular benefits.

Natural outdoor environments and mental and physical health: Relationships and mechanisms

“…When stratified by gender and degree of urbanization, there was a tendency for slightly stronger associations between green spaces and health for women and those living in non-densely populated areas, but this was not statistical significant. The small differences we found by gender are consistent with previous findings that have suggested that women use green spaces more because they are more likely to take care of older people and children than men (Tamosiunas et al, 2014). However, some other studies have found that green spaces are more used and more beneficial for males (Richardson and Mitchell, 2010).…”

“…There is some evidence suggesting that the associations between natural outdoor environments and health might be stronger for low socioeconomic statuses (SES) (Mitchell and Popham, 2007;De Vries et al, 2003;Mitchell and Popham, 2008;Dadvand et al, 2014), and might vary by gender (Tamosiunas et al, 2014;Reklaitiene et al, 2014;Astell-Burt et al, 2014;Richardson and Mitchell, 2010) and degree of urbanization (Mitchell and Popham, 2007;De Vries et al, 2003). But these differences are still not well-established.…”

“…Natural outdoor environments, especially green spaces, have been associated with better objective and subjective physical health including: self-perceived health (Maas et al, 2006;Mitchell and Popham, 2007;De Vries et al, 2013Wheeler et al, 2012;Maas et al, 2009;Mitchell et al, 2011), well-being (White et al, 2013a), longevity (Mitchell et al, 2011;Mitchell and Popham, 2008), cardiovascular diseases (Pereira et al, 2013;Tamosiunas et al, 2014), recovery from illness (Ulrich, 1984), symptoms experienced (De Vries et al, 2003), and birth outcomes (Donovan et al, 2011;Dadvand et al, 2014) among others.…”

Car free cities: Pathway to healthy urban living

“…However, green space has been associated a number of beneficial health effects (Lee and Maheswaran, 2010;Hartig et al, 2014) including decreased mortality and longevity (Mitchell and Popham, 2008;Gascon et al, 2016), decreased cardiovascular disease (Pereira et al, 2012;Tamosiunas et al, 2014), improved people's self-reported general health (Maas et al, 2006;de Vries et al, 2013) and mental health (Gascon et al, 2015), reduced behavioral problems (Amoly et al, 2014) and increased cognitive function in children, better sleep patterns (Astell-Burt et al, 2013), recovery from illness (Ulrich, 1984), social contacts (Maas et al, 2009;de Vries et al, 2013), the microbiome (Hanski et al, 2012) and improved birth outcomes (Dzhambov et al, 2014). Increased physical activity and social contacts, psychological restoration/stress reduction, and a reduction in environmental exposure such as noise and air pollution and temperature have been proposed as possible mechanisms for the health benefits of green space (Lee and Maheswaran, 2010;Hartig et al, 2014;de Vries et al, 2013).…”

Urban Green Spaces and the Potential for Health Improvement and Environmental Justice in a Changing Climate

“…Recent epidemiological studies seem to confirm the beneficial health impact of natural spaces. Demonstrated health effects in a general population are, for example, reduced mortality (Gascon et al 2016), reduced cardiovascular morbidity (Tamosiunas et al 2014;Donovan et al 2015), lower blood pressure ) and decreased depressive symptoms (Reklaitiene et al 2014). At the same time, improved conditions are found for pregnancy outcomes (Dadvand et al 2012), and general physical and mental health (Annerstedt et al 2012;TrigueroMas et al 2015).…”