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

Anne Peasey,Egle Milinaviciene,Ricardas Radisauskas,Gailute Bernotiene,Jone Vencloviene,Migle Baceviciene,Audrius Dedele,Regina Grazuleviciene,Vilija Malinauskiene,Regina Reklaitiene,Dalia Luksiene,Martin Bobak,Mark J Nieuwenhuijsen,Abdonas Tamosiunas

doi:10.1186/1476-069x-13-20

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.

Highlights

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)
The results from the baseline data of our study suggest that objectively measured access to green space in people’s environment has little or no influence on people’s levels of known cardiovascular risk factors or the prevalence of most common chronic non-communicable diseases, such as coronary heart disease (CHD), stroke, and diabetes mellitus
Our results are in accordance with other studies in which no significant association was observed between exposure to green spaces and levels of physical activity, and the prevalence of obesity or overweight [28,6,29]

Summary

Introduction

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). The decline in the incidence and mortality from CVD and other noncommunicable diseases lasting already several decades in most high-income countries is mainly attributable to lifestyle and other modifiable factors, including the reduction in smoking, control of high blood pressure and cholesterol levels, increasing physical activity, healthy nutrition habits, and other positive changes in cardiovascular risk factors [2,4]. Green space has been related to lower CVD mortality, reduced stress, and better self-rated health, mental health, and cognitive functions [12,13,14,15]

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