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Effect modification of greenness on the association between heat and mortality: A multi-city multi-country study

2022-10Journal article Open access
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dc.contributor.authorChoi, Hayon Michelle
dc.contributor.authorLee, Whanhee
dc.contributor.authorRoye, Dominic
dc.contributor.authorHeo, Seulkee
dc.contributor.authorUrban, Aleš
dc.contributor.authorEntezari, Alireza
dc.contributor.authorVicedo-Cabrera, Ana Maria
dc.contributor.authorZanobetti, Antonella
dc.contributor.authorGasparrini, Antonio
dc.contributor.authorAnalitis, Antonis
dc.contributor.authorTobias, Aurelio
dc.contributor.authorArmstrong, Ben
dc.contributor.authorForsberg, Bertil
dc.contributor.authorÍñiguez, Carmen
dc.contributor.authorÅström, Christofer
dc.contributor.authorIndermitte, Ene
dc.contributor.authorLavigne, Eric
dc.contributor.authorMayvaneh, Fatemeh
dc.contributor.authorAcquaotta, Fiorella
dc.contributor.authorSera, Francesco
dc.contributor.authorOrru, Hans
dc.contributor.authorKim, Ho
dc.contributor.authorKyselý, Jan
dc.contributor.authorMadueira, Joana
dc.contributor.authorSchwartz, Joel
dc.contributor.authorJaakkola, Jouni J.K.
dc.contributor.authorKatsouyanni, Klea
dc.contributor.authorDiaz, Magali Hurtado
dc.contributor.authorRagettli, Martina S.
dc.contributor.authorPascal, Mathilde
dc.contributor.authorRyti, Niilo
dc.contributor.authorScovronick, Noah
dc.contributor.authorOsorio, Samuel
dc.contributor.authorTong, Shilu
dc.contributor.authorSeposo, Xerxes
dc.contributor.authorGuo, Yue Leon
dc.contributor.authorGuo, Yuming
dc.contributor.authorBell, Michelle L.
dc.date.accessioned2022-11-07T15:47:36Z
dc.date.available2022-11-07T15:47:36Z
dc.date.issued2022-10
dc.descriptionErratum EBioMedicine. 2023 Jan;87:104396. doi: 10.1016/j.ebiom.2022.104396. Epub 2022 Dec 1.
dc.description.abstractBackground: Identifying how greenspace impacts the temperature-mortality relationship in urban environments is crucial, especially given climate change and rapid urbanization. However, the effect modification of greenspace on heat-related mortality has been typically focused on a localized area or single country. This study examined the heat-mortality relationship among different greenspace levels in a global setting. Methods: We collected daily ambient temperature and mortality data for 452 locations in 24 countries and used Enhanced Vegetation Index (EVI) as the greenspace measurement. We used distributed lag non-linear model to estimate the heat-mortality relationship in each city and the estimates were pooled adjusting for city-specific average temperature, city-specific temperature range, city-specific population density, and gross domestic product (GDP). The effect modification of greenspace was evaluated by comparing the heat-related mortality risk for different greenspace groups (low, medium, and high), which were divided into terciles among 452 locations. Findings: Cities with high greenspace value had the lowest heat-mortality relative risk of 1·19 (95% CI: 1·13, 1·25), while the heat-related relative risk was 1·46 (95% CI: 1·31, 1·62) for cities with low greenspace when comparing the 99th temperature and the minimum mortality temperature. A 20% increase of greenspace is associated with a 9·02% (95% CI: 8·88, 9·16) decrease in the heat-related attributable fraction, and if this association is causal (which is not within the scope of this study to assess), such a reduction could save approximately 933 excess deaths per year in 24 countries. Interpretation: Our findings can inform communities on the potential health benefits of greenspaces in the urban environment and mitigation measures regarding the impacts of climate change.pt_PT
dc.description.abstractResearch in context - I-Evidence before this study: Urbanization and climate change have resulted in changes to the urban environment, including the urban heat island effect and contributions to other extreme weather events. Recently, as metropolitan areas have become denser due to rapid urbanization, environmental problems such as high temperatures are also worsening. Many studies showed that high temperatures increase health risks, including mortality. Therefore, identifying factors that could mitigate the high-temperature conditions in urban environments are a crucial part of climate change mitigation strategies. Many studies found that urban green spaces may play an important role in mitigating heat. Specifically, large green spaces have shown a significant and positive cooling effect. Vegetation can promote air convection through shading and evapotranspiration, which indicates that dense vegetation can lower air temperature. Therefore, more greenspace could result in lower temperatures during the warm season, which would lower exposure to high temperatures that impact human health. Importantly, while greenspace can lower exposure to heat, this study examined how greenspace modifies the heat-health relationship. Some studies have investigated this issue. For example, studies found that heat-related mortality and ambulance calls are negatively correlated with the amount of greenspace coverage. However, most previous work on how greenspace modifies the heat-health relationship was based on one country or region. Research is needed on a global scale to understand how greenspace in urban areas among different countries, with different populations, levels of urbanization, and types of greenspace, can modify the relationship between extreme temperatures and health. As climate change is anticipated to increase temperatures and the associated health consequences worldwide, greenspace may be a plausible mitigation strategy for cities in order to address heat-related health impacts at present and in the future. II-Added value of this study: In this study, we explored the effect modification of greenspace on the heat-mortality relationship on a global scale. With a dataset of 452 locations from 24 countries located in various climate zones and continents, this study incorporated variability in greenspace, temperature, and population characteristics. We found that, based on 452 locations, the heat-mortality risks differed with greenspace category and the cities with higher greenspace values had lower heat-mortality risk than those with lower greenspace values. III-Implications of all the available evidence: Our findings provide evidence that higher greenspace reduces the heat-related mortality, which is similar to other previous smaller studies, and our study results were consistent in different countries around various climate zones. These findings indicate that disparate greenspace levels, temperature, and environment settings should be considered when developing policies and strategies in climate change mitigation and public health adaptation. This study adds to the existing literature that greenspace can reduce the urban heat island effect, by providing evidence for the theory that greenspace can also lower the heat-mortality association, and documents such impacts on a global scale.pt_PT
dc.description.sponsorshipThis publication was developed under Assistance Agreement No. RD83587101 awarded by the U.S. Environmental Protection Agency to Yale University. Research reported in this publication was also supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health under Award Number R01MD012769. Also, this work has been supported by the National Research Foundation of Korea (2021R1A6A3A03038675), Medical Research Council-UK (MR/V034162/1 and MR/R013349/1), Natural Environment Research Council UK (Grant ID: NE/R009384/1), Academy of Finland (Grant ID: 310372), European Union's Horizon 2020 Project Exhaustion (Grant ID: 820655 and 874990), Czech Science Foundation (22-24920S), Emory University's NIEHS-funded HERCULES Center (Grant ID: P30ES019776), and Grant CEX2018-000794-S funded by MCIN/AEI/ 10.13039/501100011033.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationEBioMedicine. 2022 Oct;84:104251. doi: 10.1016/j.ebiom.2022.104251. Epub 2022 Sep 8.pt_PT
dc.identifier.doi10.1016/j.ebiom.2022.104251pt_PT
dc.identifier.issn2352-3964
dc.identifier.urihttp://hdl.handle.net/10400.18/8308
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherElsevierpt_PT
dc.relation.publisherversionhttps://www.sciencedirect.com/science/article/pii/S2352396422004339?via%3Dihubpt_PT
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/pt_PT
dc.subjectEffect Modificationpt_PT
dc.subjectGreenspacept_PT
dc.subjectHeatpt_PT
dc.subjectMortalitypt_PT
dc.subjectClimate Changept_PT
dc.subjectEnvironmental Healthpt_PT
dc.subjectDeterminantes da Saúde e da Doençapt_PT
dc.subjectAvaliação do Impacte em Saúdept_PT
dc.titleEffect modification of greenness on the association between heat and mortality: A multi-city multi-country studypt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.startPage104251pt_PT
oaire.citation.titleeBioMedicinept_PT
oaire.citation.volume84pt_PT
rcaap.embargofctAcesso de acordo com política editorial da revista.pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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