Abstract
BACKGROUND AND AIM: Greenness is beneficial to health and is associated with lower mortality. Many studies used the normalized difference vegetation index (NDVI) to measure greenness. However, these measures cannot reflect the type of landscape. We aim to study the association between greenness structures and all-cause mortality in an elderly Chinese cohort. METHODS: We used the 2008-2014 waves of the China Longitudinal Healthy Longevity Survey (CLHLS), a prospective cohort representative of China’s older population in a wide range of geographic and climatic regions. We calculated landscape indices to quantify three greenspace structure characteristics: area-edge, shape, and proximity. The health outcome was all-cause mortality. We used the Cox-proportional hazards model, adjusted for the study entrant year, age, sex, activities of daily living (ADL), marital status, geographic region, urban or rural residential location, literacy, annual household income, smoking status, alcohol consumption, exercise status, biodiversity index, numbers of hosts for zoonosis, contemporaneous NDVI, annual average temperature, and three-year average PM2.5. RESULTS:Among 12,999 individuals (average age at baseline 87.2 years, 5,502 males), we observed 7,589 deaths between 2008 and 2014. We did not find a consistent dose-response relationship for greenspace structures and all-cause mortality, however, there were some signals of associations. Compared with individuals living in the lowest quartile of the number of patches, the adjusted-HR (95%CI) of individuals living in the highest quartile was 0.85 (0.80-0.92). In stratified analyses, the largest patch index and perimeter-area ratio had protective effects on males, individuals aged 90, with sufficient capacity to perform activities of daily living independently, and with higher income. The protective influence of greenspace structures was not as evident as NDVI. CONCLUSIONS:Specific types of greenspace structures (larger area-edge, higher complexity, more concentrated greenspace) have influences on mortality, but without an evidence dose-response curve. KEYWORDS: Green space, Built environment, Incidence, Long-term exposure, Policy
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