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Green space exposure on mortality and cardiovascular outcomes in older adults: a systematic review and meta-analysis of observational studies

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Abstract

Background

With the launch of the “Global Age-Friendly Cities project”, increasing emphasis has been placed on the effects of green spaces on health in the elderly. The previous literature has shown that green spaces are beneficial to a range of health-related outcomes in adults. However, associations of greenness with mortality and cardiovascular outcomes are less certain, which may differ depending on the age class. This review aimed to synthesize current evidence from observational studies to assess relationships of green space exposure with mortality and cardiovascular outcomes in older individuals.

Methods

Five databases were searched. Qualitative evaluation and meta-analyses of included studies were conducted. This review is registered with PROSPERO, CRD42020160366.

Results

Of the 8,143 records identified, we finally included 22 studies. In a narrative systematic review, we observed that the majority of studies showed reductions in the risk of all-cause mortality and total cardiovascular disease. Further meta-analyses which included eight cohort studies, indicated that greater greenness exposure (per 0.1 unit increase of normalized difference vegetation index (NDVI)) was associated with a reduced risk of all-cause mortality (pooled hazard ratios (HR) (95% confidence interval (CI) = 0.99 (0.97, 1.00)) and stroke mortality (pooled HR (95% CI) = 0.77 (0.59, 1.00)) in older individuals.

Conclusions

This review supports increasing green space exposure in terms of the prevention of death and cardiovascular outcomes in older individuals. Effective measures to increase or preserve greenspaces should therefore be considered as important public health interventions.

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Funding

This review was supported by the Fujian Major Projects on Science and Technology for Social Development (2016YZ0001) and Fujian Science and Technology Innovation Joint Major Project (2019Y9027).

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Author notes

  1. Yin Yuan and Feng Huang contributed equally to this work.

Authors and Affiliations

  1. The Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China

    Yin Yuan, Feng Huang, Fan Lin & Pengli Zhu

  2. Department of Geriatric Medicine, Fujian Provincial Hospital, Fuzhou, China

    Yin Yuan, Feng Huang, Fan Lin & Pengli Zhu

  3. Fujian Provincial Institute of Clinical Geriatrics, Fuzhou, China

    Yin Yuan, Feng Huang, Fan Lin & Pengli Zhu

  4. Fujian Provincial Key Laboratory of Geriatrics, Fuzhou, China

    Yin Yuan, Feng Huang, Fan Lin & Pengli Zhu

  5. School of Economics, Fujian Normal University, Fuzhou, China

    Pengyi Zhu

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  1. Yin Yuan
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Contributions

All authors contributed to the initial planning of the review. YY, HF and LF developed the search strategy. YY and HF screened articles and extracted data, which was then cross-checked by LF and ZPL. ZPY mediated the discrepancies in article screening. YY and HF assessed study quality and performed meta-analyses. YY drafted the manuscript. All authors contributed to reviewing and revising the manuscript, read and approved the final manuscript.

Corresponding authors

Correspondence to Pengyi Zhu or Pengli Zhu.

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Conflict of interest

The authors declare no competing interests.

Ethical approval

All reported studies with human subjects performed by the authors have been previously published and complied with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Statement of human and animal rights

This review does not contain any experiments involving human participants or animals.

Informed consent

We confirm that the present study is based on the analysis of other studies which had obtained informed consent for all included individuals.

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Yuan, Y., Huang, F., Lin, F. et al. Green space exposure on mortality and cardiovascular outcomes in older adults: a systematic review and meta-analysis of observational studies. Aging Clin Exp Res 33, 1783–1797 (2021). https://doi.org/10.1007/s40520-020-01710-0

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