Association of Greenness with Blood Pressure among Individuals with Type 2 Diabetes across Rural to Urban Community Types in Pennsylvania, USA

Melissa N. Poulsen, Brian S. Schwartz, Cara Nordberg, Joseph DeWalle, Jonathan Pollak, Giuseppina Imperatore, Carla I. Mercado, Karen R. Siegel and Annemarie G. Hirsch
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Melissa N. Poulsen: Department of Population Health Sciences, Geisinger, Danville, PA 17822, USA
Brian S. Schwartz: Department of Population Health Sciences, Geisinger, Danville, PA 17822, USA
Cara Nordberg: Department of Population Health Sciences, Geisinger, Danville, PA 17822, USA
Joseph DeWalle: Department of Population Health Sciences, Geisinger, Danville, PA 17822, USA
Jonathan Pollak: Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
Giuseppina Imperatore: Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
Carla I. Mercado: Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
Karen R. Siegel: Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
Annemarie G. Hirsch: Department of Population Health Sciences, Geisinger, Danville, PA 17822, USA

IJERPH, 2021, vol. 18, issue 2, 1-14

Abstract: Greenness may impact blood pressure (BP), though evidence is limited among individuals with type 2 diabetes (T2D), for whom BP management is critical. We evaluated associations of residential greenness with BP among individuals with T2D in geographically diverse communities in Pennsylvania. To address variation in greenness type, we evaluated modification of associations by percent forest. We obtained systolic (SBP) and diastolic (DBP) BP measurements from medical records of 9593 individuals following diabetes diagnosis. Proximate greenness was estimated within 1250-m buffers surrounding individuals’ residences using the normalized difference vegetation index (NDVI) prior to blood pressure measurement. Percent forest was calculated using the U.S. National Land Cover Database. Linear mixed models with robust standard errors accounted for spatial clustering; models were stratified by community type (townships/boroughs/cities). In townships, the greenest communities, an interquartile range increase in NDVI was associated with reductions in SBP of 0.87 mmHg (95% CI: −1.43, −0.30) and in DBP of 0.41 mmHg (95% CI: −0.78, −0.05). No significant associations were observed in boroughs or cities. Evidence for modification by percent forest was weak. Findings suggest a threshold effect whereby high greenness may be necessary to influence BP in this population and support a slight beneficial impact of greenness on cardiovascular disease risk.

Keywords: community context; diabetes mellitus; greenspace; hypertension; percent forest; rural health (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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