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spelling Effect modification of greenness on the association between heat and mortality: A multi-city multi-country studyEffect ModificationGreenspaceHeatMortalityClimate ChangeEnvironmental HealthDeterminantes da Saúde e da DoençaAvaliação do Impacte em SaúdeErratum EBioMedicine. 2023 Jan;87:104396. doi: 10.1016/j.ebiom.2022.104396. Epub 2022 Dec 1.Background: 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.Research 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.This 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.ElsevierRepositório Científico do Instituto Nacional de SaúdeChoi, Hayon MichelleLee, WhanheeRoye, DominicHeo, SeulkeeUrban, AlešEntezari, AlirezaVicedo-Cabrera, Ana MariaZanobetti, AntonellaGasparrini, AntonioAnalitis, AntonisTobias, AurelioArmstrong, BenForsberg, BertilÍñiguez, CarmenÅström, ChristoferIndermitte, EneLavigne, EricMayvaneh, FatemehAcquaotta, FiorellaSera, FrancescoOrru, HansKim, HoKyselý, JanMadueira, JoanaSchwartz, JoelJaakkola, Jouni J.K.Katsouyanni, KleaDiaz, Magali HurtadoRagettli, Martina S.Pascal, MathildeRyti, NiiloScovronick, NoahOsorio, SamuelTong, ShiluSeposo, XerxesGuo, Yue LeonGuo, YumingBell, Michelle L.2022-11-07T15:47:36Z2022-102022-10-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfapplication/pdfhttp://hdl.handle.net/10400.18/8308engEBioMedicine. 2022 Oct;84:104251. doi: 10.1016/j.ebiom.2022.104251. Epub 2022 Sep 8.2352-396410.1016/j.ebiom.2022.104251info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-07-20T15:42:30Zoai:repositorio.insa.pt:10400.18/8308Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T18:42:57.615352Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv Effect modification of greenness on the association between heat and mortality: A multi-city multi-country study
title Effect modification of greenness on the association between heat and mortality: A multi-city multi-country study
spellingShingle Effect modification of greenness on the association between heat and mortality: A multi-city multi-country study
Choi, Hayon Michelle
Effect Modification
Greenspace
Heat
Mortality
Climate Change
Environmental Health
Determinantes da Saúde e da Doença
Avaliação do Impacte em Saúde
title_short Effect modification of greenness on the association between heat and mortality: A multi-city multi-country study
title_full Effect modification of greenness on the association between heat and mortality: A multi-city multi-country study
title_fullStr Effect modification of greenness on the association between heat and mortality: A multi-city multi-country study
title_full_unstemmed Effect modification of greenness on the association between heat and mortality: A multi-city multi-country study
title_sort Effect modification of greenness on the association between heat and mortality: A multi-city multi-country study
author Choi, Hayon Michelle
author_facet Choi, Hayon Michelle
Lee, Whanhee
Roye, Dominic
Heo, Seulkee
Urban, Aleš
Entezari, Alireza
Vicedo-Cabrera, Ana Maria
Zanobetti, Antonella
Gasparrini, Antonio
Analitis, Antonis
Tobias, Aurelio
Armstrong, Ben
Forsberg, Bertil
Íñiguez, Carmen
Åström, Christofer
Indermitte, Ene
Lavigne, Eric
Mayvaneh, Fatemeh
Acquaotta, Fiorella
Sera, Francesco
Orru, Hans
Kim, Ho
Kyselý, Jan
Madueira, Joana
Schwartz, Joel
Jaakkola, Jouni J.K.
Katsouyanni, Klea
Diaz, Magali Hurtado
Ragettli, Martina S.
Pascal, Mathilde
Ryti, Niilo
Scovronick, Noah
Osorio, Samuel
Tong, Shilu
Seposo, Xerxes
Guo, Yue Leon
Guo, Yuming
Bell, Michelle L.
author_role author
author2 Lee, Whanhee
Roye, Dominic
Heo, Seulkee
Urban, Aleš
Entezari, Alireza
Vicedo-Cabrera, Ana Maria
Zanobetti, Antonella
Gasparrini, Antonio
Analitis, Antonis
Tobias, Aurelio
Armstrong, Ben
Forsberg, Bertil
Íñiguez, Carmen
Åström, Christofer
Indermitte, Ene
Lavigne, Eric
Mayvaneh, Fatemeh
Acquaotta, Fiorella
Sera, Francesco
Orru, Hans
Kim, Ho
Kyselý, Jan
Madueira, Joana
Schwartz, Joel
Jaakkola, Jouni J.K.
Katsouyanni, Klea
Diaz, Magali Hurtado
Ragettli, Martina S.
Pascal, Mathilde
Ryti, Niilo
Scovronick, Noah
Osorio, Samuel
Tong, Shilu
Seposo, Xerxes
Guo, Yue Leon
Guo, Yuming
Bell, Michelle L.
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
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author
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author
author
dc.contributor.none.fl_str_mv Repositório Científico do Instituto Nacional de Saúde
dc.contributor.author.fl_str_mv Choi, Hayon Michelle
Lee, Whanhee
Roye, Dominic
Heo, Seulkee
Urban, Aleš
Entezari, Alireza
Vicedo-Cabrera, Ana Maria
Zanobetti, Antonella
Gasparrini, Antonio
Analitis, Antonis
Tobias, Aurelio
Armstrong, Ben
Forsberg, Bertil
Íñiguez, Carmen
Åström, Christofer
Indermitte, Ene
Lavigne, Eric
Mayvaneh, Fatemeh
Acquaotta, Fiorella
Sera, Francesco
Orru, Hans
Kim, Ho
Kyselý, Jan
Madueira, Joana
Schwartz, Joel
Jaakkola, Jouni J.K.
Katsouyanni, Klea
Diaz, Magali Hurtado
Ragettli, Martina S.
Pascal, Mathilde
Ryti, Niilo
Scovronick, Noah
Osorio, Samuel
Tong, Shilu
Seposo, Xerxes
Guo, Yue Leon
Guo, Yuming
Bell, Michelle L.
dc.subject.por.fl_str_mv Effect Modification
Greenspace
Heat
Mortality
Climate Change
Environmental Health
Determinantes da Saúde e da Doença
Avaliação do Impacte em Saúde
topic Effect Modification
Greenspace
Heat
Mortality
Climate Change
Environmental Health
Determinantes da Saúde e da Doença
Avaliação do Impacte em Saúde
description Erratum EBioMedicine. 2023 Jan;87:104396. doi: 10.1016/j.ebiom.2022.104396. Epub 2022 Dec 1.
publishDate 2022
dc.date.none.fl_str_mv 2022-11-07T15:47:36Z
2022-10
2022-10-01T00:00:00Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
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format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://hdl.handle.net/10400.18/8308
url http://hdl.handle.net/10400.18/8308
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv EBioMedicine. 2022 Oct;84:104251. doi: 10.1016/j.ebiom.2022.104251. Epub 2022 Sep 8.
2352-3964
10.1016/j.ebiom.2022.104251
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dc.publisher.none.fl_str_mv Elsevier
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