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Published on: March 27, 2018
Residential Greenness and Long-term Mortality Among Patients Who Underwent Coronary Artery Bypass Graft Surgery
Maya Sadeh1, Nir Fulman2, Nirit Agay3
1From the Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Insights
Living near green spaces was linked to a lower risk of death for patients after coronary artery bypass graft (CABG) surgery. This study highlights the importance of residential greenness for cardiac patient recovery and survival.
Area of Science:
- Environmental Health
- Cardiovascular Health
- Public Health
Background:
- Previous studies suggest a link between residential greenness and reduced mortality, but often with small sample sizes.
- Greenness exposure has also been associated with improved surgical recovery.
- This study addresses limitations by investigating residential greenness and mortality in a large cohort of cardiac surgery patients.
Purpose of the Study:
- To examine the association between residential greenness and all-cause mortality in patients who underwent coronary artery bypass graft (CABG) surgery.
- To determine if higher exposure to greenness correlates with a reduced risk of death in this specific patient population.
Main Methods:
- A cohort of 3,128 CABG patients from Israel (2004-2009) was followed until May 2021.
- Normalized Difference Vegetation Index (NDVI) was used to quantify residential greenness within a 300m buffer of patient home addresses.
- Cox proportional hazards regression models adjusted for covariates including age, sex, socioeconomic status, and air pollution.
Main Results:
- During an average follow-up of 12.1 years, 1,442 (46%) patients died.
- A 7% lower risk of mortality was associated with each interquartile range increase in NDVI (HR: 0.93, 95% CI [0.85, 1.00]).
- Findings remained robust across different buffer sizes and NDVI exposure periods.
Conclusions:
- Residential greenness is associated with a reduced risk of all-cause mortality in patients following CABG surgery.
- These findings support the role of environmental factors, specifically green space exposure, in long-term outcomes for cardiac patients.
Background:
Studies have reported inverse associations between exposure to residential greenness and mortality. Greenness has also been associated with better surgical recovery. However, studies have had small sample sizes and have been restricted to clinical settings. We investigated the association between exposure to residential greenness and all-cause mortality among a cohort of cardiac patients who underwent coronary artery bypass graft (CABG) surgery.
Methods:
We studied this cohort of 3,128 CABG patients between 2004 and 2009 at seven cardiothoracic departments in Israel and followed patients until death or 1st May 2021. We collected covariate information at the time of surgery and calculated the patient-level average normalized difference vegetation index (NDVI) over the entire follow-up in a 300 m buffer from the home address. We used Cox proportional hazards regression models to estimate associations between greenness and death, adjusting for age, sex, origin, socioeconomic status, type of hospital admission, peripherality, air pollution, and distance from the sea.
Results:
Mean age at surgery was 63.8 ± 10.6 for men and 69.5 ± 10.0 for women. During an average of 12.1 years of follow-up (37,912 person-years), 1,442 (46%) patients died. A fully adjusted Cox proportional hazards model estimated a 7% lower risk of mortality (HR: 0.93, 95% CI = [0.85, 1.00]) per 1 interquartile range width increase (0.04) in NDVI. Results were robust to the use of different buffer sizes (100 m-1,250 m from the home) and to the use of average NDVI exposure during the first versus the last 2 years of follow-up.
Conclusions:
Residential greenness was associated with lower risk of mortality in CABG patients.
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