Elsevier

Environment International

Volume 86, January 2016, Pages 60-67
Environment International

Review article
Residential green spaces and mortality: A systematic review

https://doi.org/10.1016/j.envint.2015.10.013Get rights and content

Highlights

  • We reviewed the evidence on the association between residential green spaces and mortality.

  • Studies are heterogeneous in design, study population and green space assessment.

  • Most of the studies show a reduction of the risk of cardiovascular disease mortality.

  • Evidence of a reduction of all-cause mortality is more limited.

  • No benefits of residential greenness on lung cancer mortality are observed.

Abstract

Background

A number of studies have associated natural outdoor environments with reduced mortality but there is no systematic review synthesizing the evidence.

Objectives

We aimed to systematically review the available evidence on the association between long-term exposure to residential green and blue spaces and mortality in adults, and make recommendations for further research. As a secondary aim, we also conducted meta-analyses to explore the magnitude of and heterogeneity in the risk estimates.

Methods

Following the PRISMA statement guidelines for reporting systematic reviews and meta-analysis, two independent reviewers searched studies using keywords related to natural outdoor environments and mortality.

Discussion

Our review identified twelve eligible studies conducted in North America, Europe, and Oceania with study populations ranging from 1645 up to more than 43 million individuals. These studies are heterogeneous in design, study population, green space assessment and covariate data. We found that the majority of studies show a reduction of the risk of cardiovascular disease (CVD) mortality in areas with higher residential greenness. Evidence of a reduction of all-cause mortality is more limited, and no benefits of residential greenness on lung cancer mortality are observed. There were no studies on blue spaces.

Conclusions

This review supports the hypothesis that living in areas with higher amounts of green spaces reduces mortality, mainly CVD. Further studies such as cohort studies with more and better covariate data, improved green space assessment and accounting well for socioeconomic status are needed to provide further and more complete evidence, as well as studies evaluating the benefits of blue spaces.

Introduction

About half of the world population is currently living in cities and it is projected that by 2030 three of every five persons will live in urban areas (Martine and Marshall, 2007). As the world continues to urbanize, sustainable development and liveability challenges in cities will increase (United Nations Department of Economic and Social Affairs, 2014). Certain environmental factors in urban settings, such as air pollution, noise and extremely high temperatures have been associated with increased mortality (Selander et al., 2009, Basagaña et al., 2011, Hoek et al., 2013). Some studies have suggested that natural outdoor environments might help reduce the levels of air pollution and noise, as well as extreme temperatures in cities, and therefore reduce the impact of these environmental factors on our health and life-expectancy (Shanahan et al., 2015, Wolf and Robbins, 2015). Moreover, studies have observed that people living near or having access to natural outdoor environments are more likely to be physically active and have better mental health and therefore to be healthier (Shanahan et al., 2015, Wolf and Robbins, 2015).

Previously a number of studies have associated natural outdoor environments with reduced mortality (Shanahan et al., 2015, Wolf and Robbins, 2015) but there is no systematic review synthesizing the evidence, nor a precise and global estimate of the reduction of the risk of mortality in adults in relation to these types of environments. These synthesis and estimates are of importance for healthcare professionals and policymakers while translating available evidence into salutogenic interventions and policies to improve public health in urban areas. We aimed to systematically review the evidence of an association between residential natural outdoor environments, particularly green and blue spaces (e.g. lakes, rivers, beaches, etc.), and mortality in adults. As a secondary aim we also conducted meta-analyses to explore the magnitude of and heterogeneity in the risk.

Section snippets

Search strategy and selection criteria

We followed the PRISMA statement guidelines for reporting systematic reviews and meta-analysis (Moher et al., 2010). The bibliographic search was carried out by two independent reviewers (MG and MTM) using MEDLINE (National Library of Medicine) and SCOPUS search engines using keywords related to natural outdoor environments (greenspace, green space, natural environment, urban design, built environment, blue space, park, forest) combined with keywords related to mortality (mortality, survival,

Results

A total of 706 articles were identified in MEDLINE and 99 in SCOPUS. Through other sources one article was also identified. After screening the title and the abstracts and checking for duplicates, 17 articles were chosen for full-text evaluation of which 12 were finally included in the systematic review (Fig. 1).

Most of the studies (seven) had ecological design (Hu et al., 2008, Richardson and Mitchell, 2010, Richardson et al., 2010, Richardson et al., 2012, Uejio et al., 2011, Harlan et al.,

Discussion

The present systematic review shows that there are only a limited number of studies evaluating the relationship between green space and mortality and that these studies are heterogeneous in design, study population, green space assessment and covariate data. We found evidence of a reduction of the risk of CVD mortality in areas with higher residential greenness. The results of the meta-analyses conducted support this conclusion. The current review also observes some evidence of the benefits of

Conclusion

Despite the limitations described so far, this review showed evidence of an association between residential greenness and CVD mortality. This is important if we take into account that CVDs are the leading cause of mortality and years of life lost in high-income countries and that its incidence is increasing in low- and middle-income countries (Global, 2014). Future studies should evaluate effects in these countries, for which no information is currently available. Additionally, future studies

Conflict of interest

The authors declare they have no actual or potential competing financial interests.

Acknowledgments

This project was funded by the CERCA Institutes Integration Program (SUMA 2013) [promoted and managed by the Secretariat for Universities and Research of the Ministry Economy and Knowledge of the Government of Catalonia (SUR), the Agency for Management of University and Research Grants (AGAUR) and the CERCA Institute]. Payam Dadvand is funded by a Ramón y Cajal fellowship (RYC-2012-10,995) awarded by the Spanish Ministry of Economy and Competitiveness. Margarita Triguero-Mas is funded by a

References (42)

  • E.H. Wilker et al.

    Green space and mortality following ischemic stroke

    Environ. Res.

    (2014)
  • M. Annerstedt et al.

    Green qualities in the neighbourhood and mental health — results from a longitudinal cohort study in southern Sweden

    BMC Public Health

    (2012)
  • X. Basagaña et al.

    Heat waves and cause-specific mortality at all ages

    Epidemiology

    (2011)
  • M. Borenstein et al.

    Introduction to Meta-Analysis

    (2009)
  • D.E. Bowler et al.

    A systematic review of evidence for the added benefits to health of exposure to natural environments

    BMC Public Health

    (2010)
  • P. Dadvand et al.

    Surrounding greenness and exposure to air pollution during pregnancy: an analysis of personal monitoring data

    Environ. Health Perspect.

    (2012)
  • P. Dolan

    Developing methods that really do value the “Q” in the QALY

    Health Econ. Policy Law

    (2008)
  • A.M. Dzhambov et al.

    Urban green spaces' effectiveness as a psychological buffer for the negative health impact of noise pollution: a systematic review

    Noise Health

    (2014)
  • Expert group on the urban environment

    Towards a Local Sustainability Profile: European Common Indicators [Internet]

    (2001)
  • S.L. Harlan et al.

    Neighborhood effects on heat deaths: social and environmental predictors of vulnerability in Maricopa County, Arizona

    Environ. Health Perspect.

    (2013)
  • J.P.T. Higgins et al.

    Quantifying heterogeneity in a meta-analysis

    Stat. Med.

    (2002)
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