Thinking beyond general greenness: The nuanced associations between a variety of greenspaces and cardiovascular diseases across urbanicity

Abstract

<p>Cardiovascular diseases (CVDs) are the leading causes of death globally. Exposure to greenspaces has been proposed to be beneficial for CVDs. However, past studies have often overlooked how varying levels of urbanicity may differently impact the relationships between greenspaces and cardiovascular health. Moreover, different types of greenspaces uniquely affect people's behaviors and psychological wellbeing, potentially yielding distinct effects on CVDs. This study investigates the associations between population-weighted exposure to various types of greenspaces and prevalence of coronary heart disease (CHD) and stroke in the US at tract level, and whether these associations are modified by urbanicity. We identified a contrasting difference in health effects between greenspaces inside and outside park. Neighbourhoods with more forest (CHD β = −2.99, 95 % CI: −4.25, −1.73; stroke β = −1.85, 95 % CI: −2.56, −1.13) and open space (CHD β = −4.31, 95 % CI: −5.49, −3.14; stroke β = −2.33, 95 % CI: −3.00, −1.66) inside park were associated with a lower prevalence of CVDs, whereas more forest (CHD β = 7.67, 95 % CI: 5.81, 9.54; stroke β = 3.01, 95 % CI: 1.95, 4.07) and open space (CHD β = 11.52, 95 % CI: 9.99, 13.05; stroke β = 5.77, 95 % CI:4.90, 6.64) outside park were associated with a higher prevalence of CVDs. We observed a reversal pattern across urbanicity: the significant beneficial associations only held in highly urbanized tracts but attenuated or reversed in the three less urbanized tracts. These findings highlight a need to prioritize investment in parks within walking distance to urban residents and improve the accessibility and design of rural greenspaces. We propose the Landscape Compensation Effect, which may serve as a new theoretical framework to guide future research and design practices of greenspaces to promote the cardiovascular health of both urban and rural residents.</p>