Green and blue spaces residential exposure over childhood and multimorbidity in adolescence

Abstract

Abstract Background Previous studies have explored associations of exposure to natural spaces with specific adverse health outcomes over childhood. However, knowledge is lacking on its effects on multimorbidity, defined as the co-occurrence of two or more diseases in the same individual. We aimed to assess the associations between exposure to green and blue spaces, at multiple time points and through trajectories over childhood, with multimorbidity in early adolescence. Methods In 2388 children from the Generation XXI birth cohort, we assessed, at birth, 4, 7 and 10 years, the residential greenness through the Normalized Difference Vegetation Index (NDVI), the distance from the child’s residence to the closest green and blue space, and the presence of green and blue space (>5,000m²) within 300m distance from the child’s residence. We identified, from birth to 10 years, longitudinal trajectories of exposure to green and blue spaces, using latent class mixed models. At 13 years, participants were classified as having 0, 1 or ≥ 2 cardiometabolic, respiratory and/or neurodevelopmental adverse health outcomes. Adjusted multinomial logistic regression models were used. Results The prevalence of multimorbidity at 13 years was 43%, with overweight/obesity (35%), allergies and asthma (30%), and dyslipidemia (26%) as the most common adverse health outcomes. We observed that the presence of green spaces > 5,000m² within a distance of 300m at birth, 4, 7, and 10 years was associated with lower odds of developing multimorbidity (Odds Ratio (OR) [95% CI] 0.55 [0.32-0.95]; 0.52 [0.32-0.84]; 0.51 [0.32-0.82]; 0.51 [0.32-0.80], respectively). No other significant associations were observed. Conclusions Green spaces around the child’s residence seem to have a protective effect on the development of multimorbidity at 13 years. These findings reinforce the importance of urban design, and the creation of green spaces close to residential areas to optimize health across childhood and adolescence. Key messages • The prevalence of multimorbidity at 13 years is high and worrying. • Increasing accessibility to green spaces might decrease the risk of multimorbidity in adolescence.