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Effect Modification of Greenness on the Association Between Heat and Mortality: A Multi-City Multi-Country Study

16 Pages Posted: 25 Mar 2022

See all articles by Hayon Michelle Choi

Hayon Michelle Choi

affiliation not provided to SSRN

Whanhee Lee

affiliation not provided to SSRN

Seulkee Heo

Yale University

Aleš Urban

Czech University of Life Sciences Prague (CULS)

Alireza Entezari

Hakim Sabzevari University

Ana Vicedo-Cabrera

University of Bern - Institute of Social and Preventive Medicine

Antonella Zanobetti

Harvard University - Department of Environmental Health

Antonio Analitis

affiliation not provided to SSRN

Antonio Gasparrini

London School of Hygiene & Tropical Medicine

Aurelio Tobias

Nagasaki University - Department of Global Health

Ben Armstrong

London School of Hygiene & Tropical Medicine

Bertil Forsberg

affiliation not provided to SSRN

Carmen Íñiguez

University of Valencia

Christofer Åström

affiliation not provided to SSRN

Dominic Roye

affiliation not provided to SSRN

Ene Indermitte

affiliation not provided to SSRN

Eric Lavigne

University of Ottawa

Fatemeh Mayvaneh

Hakim Sabzevari University

Fiorella Acquaotta

affiliation not provided to SSRN

Francesco Sera

University of Florence

Hans Orru

affiliation not provided to SSRN

Ho Kim

Seoul National University - Institute of Health and Environment

Jan Kyselý

affiliation not provided to SSRN

Joana Madureira

Universidade do Porto

Joel Schwartz

Harvard University - Department of Epidemiology

Jouni JK Jaakkola

University of Oulu - Center for Environmental and Respiratory Health Research (CERH)

Klea Katsouyanni

National and Kapodistrian University of Athens - Department of Hygiene, Epidemiology and Medical Statistics

Magali Hurtado Diaz

National Institute of Public Health

Martina S. Ragettli

University of Basel

Mathilde Pascal

affiliation not provided to SSRN

Niilo Ryti

affiliation not provided to SSRN

Noah Scovronick

Emory University

Samuel Osorio

affiliation not provided to SSRN

Shilu Tong

Queensland University of Technology

Xerxes Seposo

affiliation not provided to SSRN

Yue-Liang Leon Guo

National Taiwan University

Yuming Guo

Monash University - Department of Epidemiology and Preventive Medicine

Michelle L. Bell

Yale University - School of the Environment

More...

Abstract

Background: Identifying how greenspace impacts the temperature-mortality relationship in urban environments is crucial, especially given climate change and rapid urbanization. To date, studies on this topic have indicated conflicting findings and typically focus on a localized area or single country. We evaluated the effect modification of greenspace on heat-related mortality in a global setting.

Methods: We collected daily ambient temperature and mortality data for 452 locations in 24 countries and used Enhanced Vegetation Index (EVI) as the greenspace measurement. We used distributed lag non-linear model to estimate the heat-mortality relationship in each city and evaluated the effect modification of greenspace.

Findings: Cities with high greenspace value had the lowest heat-mortality relative risk of 1·19 (95% CI: 1·13, 1·25), while the heat-related relative risk was 1·46 (95% CI: 1·31, 1·62) for cities with low greenspace. A 1% increase of greenspace in all cities was predicted to reduce all-cause heat-related mortality by 0·48 (95% CI: 0·24, 0·63), decreasing approximately 50 excess deaths per year. 20% increase of greenspace would reduce 9·02% (95%CI: 8·88, 9·16) heat-related attributable fraction, and this would result in saving approximately 933 excess deaths per year in 24 countries.

Interpretation: Our findings can inform communities on the potential health benefits of greenspaces in the urban environment and mitigation measures regarding the impacts of climate change.

Funding Information: Funding was provided by the U.S. Environmental Protection Agency (RD83587101), the National Research Foundation of Korea (2021R1A6A3A03038675), National Institutes of Health (R01MD012769), Medical Research Council-UK (MR/R013349/1), Natural Environment Research Council UK (Grant ID: NE/R009384/1), and European Union’s Horizon 2020 Project Exhaustion (Grant ID: 820655).

Declaration of Interests: None.

Keywords: greenspace, temperature, mortality, effect modification

Suggested Citation

Choi, Hayon Michelle and Lee, Whanhee and Heo, Seulkee and Urban, Aleš and Entezari, Alireza and Vicedo-Cabrera, Ana and Zanobetti, Antonella and Analitis, Antonio and Gasparrini, Antonio and Tobias, Aurelio and Armstrong, Ben and Forsberg, Bertil and Íñiguez, Carmen and Åström, Christofer and Roye, Dominic and Indermitte, Ene and Lavigne, Eric and Mayvaneh, Fatemeh and Acquaotta, Fiorella and Sera, Francesco and Orru, Hans and Kim, Ho and Kyselý, Jan and Madureira, Joana and Schwartz, Joel and Jaakkola, Jouni JK and Katsouyanni, Klea and Diaz, Magali Hurtado and Ragettli, Martina S. and Pascal, Mathilde and Ryti, Niilo and Scovronick, Noah and Osorio, Samuel and Tong, Shilu and Seposo, Xerxes and Guo, Yue-Liang Leon and Guo, Yuming and Bell, Michelle L., Effect Modification of Greenness on the Association Between Heat and Mortality: A Multi-City Multi-Country Study. Available at SSRN: https://ssrn.com/abstract=4064658 or http://dx.doi.org/10.2139/ssrn.4064658

Hayon Michelle Choi

affiliation not provided to SSRN ( email )

No Address Available

Whanhee Lee

affiliation not provided to SSRN ( email )

No Address Available

Seulkee Heo

Yale University ( email )

Aleš Urban

Czech University of Life Sciences Prague (CULS) ( email )

Alireza Entezari

Hakim Sabzevari University ( email )

Sabzevar, 9617976487
Iran

Ana Vicedo-Cabrera

University of Bern - Institute of Social and Preventive Medicine ( email )

Bern
Switzerland

Antonella Zanobetti

Harvard University - Department of Environmental Health ( email )

Antonio Analitis

affiliation not provided to SSRN ( email )

No Address Available

Antonio Gasparrini

London School of Hygiene & Tropical Medicine ( email )

Keppel Street
London, WC1E 7HT
United Kingdom

Aurelio Tobias

Nagasaki University - Department of Global Health

Ben Armstrong

London School of Hygiene & Tropical Medicine ( email )

Keppel Street
London, WC1E 7HT
United Kingdom

Bertil Forsberg

affiliation not provided to SSRN ( email )

No Address Available

Carmen Íñiguez

University of Valencia ( email )

Christofer Åström

affiliation not provided to SSRN ( email )

No Address Available

Dominic Roye

affiliation not provided to SSRN ( email )

No Address Available

Ene Indermitte

affiliation not provided to SSRN ( email )

No Address Available

Eric Lavigne

University of Ottawa ( email )

2292 Edwin Crescent
Ottawa, K2C 1H7
Canada

Fatemeh Mayvaneh

Hakim Sabzevari University ( email )

Sabzevar, 9617976487
Iran

Fiorella Acquaotta

affiliation not provided to SSRN ( email )

No Address Available

Francesco Sera

University of Florence ( email )

Hans Orru

affiliation not provided to SSRN ( email )

No Address Available

Ho Kim

Seoul National University - Institute of Health and Environment ( email )

Seoul
Korea, Republic of (South Korea)

Jan Kyselý

affiliation not provided to SSRN ( email )

No Address Available

Joana Madureira

Universidade do Porto

Lisbon
Portugal

Joel Schwartz

Harvard University - Department of Epidemiology ( email )

655 Huntington Ave.
Boston, MA 02115
United States
(617) 384-8752 (Phone)
(617) 384-8745 (Fax)

HOME PAGE: http://www.hsph.harvard.edu/facres/schwrtz.html

Jouni JK Jaakkola

University of Oulu - Center for Environmental and Respiratory Health Research (CERH) ( email )

Klea Katsouyanni

National and Kapodistrian University of Athens - Department of Hygiene, Epidemiology and Medical Statistics ( email )

Magali Hurtado Diaz

National Institute of Public Health ( email )

Universidad 655
100 42 Praha 10, 62508
Czech Republic

Martina S. Ragettli

University of Basel ( email )

Mathilde Pascal

affiliation not provided to SSRN ( email )

No Address Available

Niilo Ryti

affiliation not provided to SSRN ( email )

No Address Available

Noah Scovronick

Emory University ( email )

201 Dowman Drive
Atlanta, GA 30322
United States

Samuel Osorio

affiliation not provided to SSRN ( email )

No Address Available

Shilu Tong

Queensland University of Technology ( email )

Xerxes Seposo

affiliation not provided to SSRN ( email )

No Address Available

Yue-Liang Leon Guo

National Taiwan University ( email )

1 Sec. 4, Roosevelt Road
Taipei 106, 106
Taiwan

Yuming Guo

Monash University - Department of Epidemiology and Preventive Medicine ( email )

Melbourne, Victoria
Australia

Michelle L. Bell (Contact Author)

Yale University - School of the Environment ( email )

New Haven, CT
United States

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