Green spaces and mortality due to cardiovascular diseases in the city of Rio de Janeiro

Silveira, Ismael Henrique da; Junger, Washington Leite

doi:10.11606/S1518-8787.2018052000290

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Sumário

Original Article • Rev. Saúde Pública 52 • 2018 • https://doi.org/10.11606/S1518-8787.2018052000290 copy

Green spaces and mortality due to cardiovascular diseases in the city of Rio de Janeiro

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

Investigate the association between exposure to green spaces and mortality from ischemic heart and cerebrovascular diseases, and the role of socioeconomic status in this relationship, in the city of Rio de Janeiro, Brazil.

METHODS

Ecological study, with the census tracts as unit of analysis. This study used data from deaths due to ischemic heart and cerebrovascular diseases among residents aged over 30 years, from 2010 to 2012. Exposure to green was estimated using the Normalized Difference Vegetation Index based on satellite images. The associations between exposure to green spaces and mortality rates due to ischemic heart and cerebrovascular diseases, standardized by gender and age, were analyzed using conditional autoregressive models, adjusted for the density of light and heavy traffic routes, pollution proxy, and by the socioeconomic situation, measured by the Social Development Index. Analyzes stratified by socioeconomic levels were also carried out, given by the tertiles of the Social Development Index.

RESULTS

Among the greener sectors, with a Normalized Difference Vegetation Index above the third quartile, the reduction in mortality due to ischemic heart disease was 6.7% (95%CI 3.5–9.8) and cerebrovascular was 4.7% (95%CI 1.2–8.0). In the stratified analysis, the protective effect of green spaces on ischemic heart disease mortality was observed among the greenest sectors of all strata, and it was higher for those with a lower socioeconomic level (8.6%, 95%CI 1.8–15.0). In the case of mortality due to cerebrovascular diseases, the protective effect was verified only for the greenest sectors of the lowest socioeconomic level (9.6%, 95%CI 2.3–16.5).

CONCLUSIONS

Mortality rates for ischemic heart and cerebrovascular diseases are inversely associated with exposure to green spaces when controlling socioeconomic status and air pollution. The protective effect of green spaces is greater among the tracts of lower socioeconomic level.

DESCRIPTORS
Cardiovascular Diseases, mortality; Green Areas; Urban Health; Ecological Studies

Variable		Minimum	1st quartile	Medium	Average	3rd quartile	Maximum
SMR for ischemic heart disease		0.000	0.000	0.707	0.963	1.400	23.030
SMR for cerebrovascular diseases		0.000	0.000	0.648	0.978	1.393	29.950
Social Development Index (SDI)		0.265	0.575	0.608	0.623	0.675	0.900
Density of light roads (m^-1)		0.0000	0.0100	0.0136	0.0139	0.0174	0.0472
Density of heavy roads (m^-1)		0.0000	0.0000	0.0000	0.0023	0.0038	0.0276
Normalized Difference Vegetation Index Average
	All normal tracts	-0.097	0.045	0.086	0.111	0.153	0.593
	Tracts with low SDI	-0.044	0.061	0.061	0.140	0.192	0.576
	Tracts with increased SDI	-0.061	0.039	0.070	0.087	0.120	0.580
	Tracts with high SDI	-0.097	0.041	0.085	0.105	0.154	0.593

Variable		IHD		CBVD
Variable		β	95%CI	β	95%CI
Social Development Index		-0.705	-0.812– -0.599	-1.413	-1.569– -1.257
Indicator of coastal tracts		0.014	-0.135–0.164	0.017	-0.084–0.119
Density of light roads		1.958	1.861–2.056	3.328	0.993–5.663
Density of heavy roads		4.606	2.369–6.843	4.798	0.753–8.843
Average NDVI quarters
	Q2	0.023	-0.008–0.054	0.010	-0.022–0.043
	Q3	-0.043	-0.075– -0.012	-0.011	-0.044–0.022
	Q4	-0.069	-0.101– -0.038	-0.048	-0.083– -0.012

Average NDVI quarters		1st stratum of SDI^a a Adjusted by the density of light and heavy traffic roads.	2nd stratum of SDI^b b Adjusted by the indicator of coastal tracts, by the density of light and heavy traffic roads.	3rd stratum of SDI^c
Average NDVI quarters		β (95%CI)	β (95%CI)	β (95%CI)
IHD	Q2	-0.043 (-0.103–0.017)	0.026 (-0.025–0.077)	0.045 (-0.003–0.093)
	Q3	-0.044 (-0.105–0.018)	-0.034 (-0.085–0.018)	-0.040 (-0.089–0.009)
	Q4	-0.090 (-0.163– -0.018)	-0.065 (-0.119– -0.011)	-0.069 (-0.119– -0.020)
CBVD	Q2	0.003 (-0.062–0.068)	0.010 (-0.045–0.065)	-0.001 (-0.046–0.045)
	Q3	-0.011 (-0.078–0.055)	0.005 (-0.050–0.060)	-0.031 (-0.078–0.015)
	Q4	-0.101 (-0.180– -0.023)	-0.020 (-0.077–0.038)	-0.036 (-0.083–0.012)

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E-mail: revsp@usp.br

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[1] Correspondence: Ismael Henrique da Silveira, Rua São Francisco Xavier, 524 Sala, 7013-D Maracanã, 20550-013 Rio de Janeiro, RJ, Brasil, E-mail: ismaelhsilveira@gmail.com