Abstract
BACKGROUND AND AIM: Frailty is a predictor of well-being, representing a person’s vulnerability due to degenerative changes. There is evidence on the health benefits of greenspace measured with normalized difference vegetation index (NDVI) on frailty, but little is known about different health effects of various landscape types. We aim to study the association between greenness structures and frailty in an elderly Chinese cohort. METHODS: We included older adults from the 2008-2014 waves of the China Longitudinal Healthy Longevity Survey (CLHLS). We calculated landscape indices to quantify greenspace structure characteristics: area-edge, shape, and proximity, and calculated frailty index (FI) as the outcome. We did the cross-sectional analysis using the linear regression and logistical regression, and did the longitudinal analysis using the generalized estimating equations (GEE). Additionally, participants were categorized into groups with no change, decreased, or increased FI in 2014. All models were adjusted for covariates. RESULTS:Among 8,776 participants at baseline, the mean LPI, SHAPE, COHESION, and FI were 7.93, 8.11, 97.6, and 0.17. We found a consistent dose-response relationship for greenspace structures and frailty in the cross-sectional analysis. Each 0.1-unit increase in LPI, SHAPE, and COHESION was associated with a 0.026-point (95% CI -0.019 to -0.005), 0.028-point (-0.035 to -0.021), and 0.025-point (-0.032 to -0.018) lower FI score in the fourth quartile. Compared to participants living in the lowest quartile of greenness structures, those in the highest quartile had an average 23% lower odds of frailty. The association was stronger among females, city residents, people without a spouse, and deteriorated frailty. However, we did not find a significant association in the longitudinal analysis. CONCLUSIONS:The larger value of area-edge, shape, and proximity are related to a lower likelihood of frailty. We proposed several greenness planning strategies, including maximizing the largest green patch proportion, building greenspaces with complex shapes, and connecting fragmentary greenspaces. KEYWORDS: Green space, Built environment, Incidence, Long-term exposure, Policy
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