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Urban green space and the risks of dementia and stroke

Paul LA, Hystad P, Burnett RT, Kwong JC, Crouse DL, van Donkelaar A, Tu K, Lavigne E, Copes R, Martin RV, Hong C. Environ Res J. 2020; 186:109520. Epub 2020 Apr 17. DOI:

Introduction — It is unknown whether urban green space is associated with reduced risk of major neurological conditions, especially dementia and stroke.

Methods — Retrospective, population-based cohorts were created for each study outcome, including 1.7 and 4.3 million adults in Ontario, Canada for dementia and stroke, respectively. Residential green space was quantified using the satellite-derived Normalized Difference Vegetation Index. Incidence was ascertained using health administrative data with validated algorithms. Mixed-effects Cox models were used to estimate hazard ratios per interquartile range increase in green space exposure.

Results — Between 2001 and 2013, 219,013 individuals were diagnosed with dementia and 89,958 had a stroke. The hazard ratio per interquartile range increase in green space was 0.97 (95% CI: 0.96–0.98) for dementia and 0.96 (0.95–0.98) for stroke. Estimates remained generally consistent in sensitivity analyses.

Discussion — Increased exposure to urban green space was associated with reduced incidence of dementia and stroke. To our knowledge, this is the first population-based cohort study to assess these relationships.