Download This Paper
Preprints with The Lancet is part of SSRN´s First Look, a place where journals identify content of interest prior to publication. Authors have opted in at submission to The Lancet family of journals to post their preprints on Preprints with The Lancet. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These preprints are early stage research papers that have not been peer-reviewed. The findings should not be used for clinical or public health decision making and should not be presented to a lay audience without highlighting that they are preliminary and have not been peer-reviewed. For more information on this collaboration, see the comments published in The Lancet about the trial period, and our decision to make this a permanent offering, or visit The Lancet´s FAQ page, and for any feedback please contact preprints@lancet.com.
Green Space and Cardiovascular Disease: A Systematic Review with Meta-Analysis
36 Pages Posted: 31 Aug 2021
More...Abstract
Background: Exposure to greenspace has been proposed to be beneficially associated with cardiovascular morbidity and mortality. Many studies have explored this topic, but the results remain conflicting. We aimed to evaluate the epidemiological evidence on this topic by performing a systematic review with meta-analysis.
Methods: We searched PubMed, Web of Science and Embase for studies on the green space-cardiovascular disease (CVD) relationship that were published till May 12th, 2021. Two authors independently performed study selection, data extraction, quality assessment, and risk of bias assessment. For studies providing detailed numeric data, we conducted quantitative meta-analyses and calculated the pooled odd ratios (ORs) for associations between the most commonly used greenspace exposure (normalized difference vegetative index [NDVI]) and six CVD events: CVD mortality, ischemic heart disease (IHD) mortality, stroke incidence/prevalence, and coronary heart disease (CHD) incidence/prevalence. Sensitivity analyses and publication bias tests were also conducted.
Findings: Of the 6229 records identified, 48 studies were eligible for inclusion. These studies covered 18 countries and included data from more than 100 million persons. Meta-analyses showed that a 0∙1 increase in NDVI was associated with 2-13% lower odds of CVD mortality (OR 0∙97, 95% CI 0∙96-0∙99, I2 95∙8%), IHD mortality (OR 0∙98, 95% CI 0∙96-1∙00, I2 90∙7%), stroke incidence/prevalence (OR 0∙97, 95% CI 0∙96-0∙99, I2 29∙6%), and CHD incidence/prevalence (OR 0∙87, 95% CI 0∙83-0∙91, I2 0∙0%). The pooled estimates were not substantially different in sensitive analyses. No evidence of publication bias was detected.
Interpretation: We provide strong and robust evidence for beneficial effects of greenspace exposure on cardiovascular health. More prospective studies and mechanistic studies are needed.
Funding: The Natural Science Foundation of the Xinjiang Uyghur Autonomous Region, China; the National Natural Science Foundation of China.
Declaration of Interests: We declare no competing interests.
Suggested Citation: Suggested Citation