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Climate 2017, 5(3), 55; doi:10.3390/cli5030055

An Ecological Study of the Association between Area-Level Green Space and Adult Mortality in Hong Kong

Merkle Shanghai, Pudong New Area, Shanghai 200136, China
School of Architecture, The Chinese University of Hong Kong, Hong Kong
Department of Architecture, National University of Singapore, Singapore
Department of Land Surveying and Geo-informatics, The Hong Kong Polytechnic University, Hong Kong
School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
Author to whom correspondence should be addressed.
Academic Editors: Sotiris Vardoulakis, Jennifer Salmond and Clive Sabel
Received: 25 April 2017 / Revised: 7 July 2017 / Accepted: 14 July 2017 / Published: 18 July 2017
(This article belongs to the Special Issue Urban Climate, Air Pollution, and Public Health)
View Full-Text   |   Download PDF [392 KB, uploaded 18 July 2017]   |  


There is evidence that access to green spaces have positive effects on health, possibly through beneficial effects on exercise, air quality, urban heat islands, and stress. Few previous studies have examined the associations between green space and mortality, and they have given inconsistent results. This ecological study relates green space to mortality in Hong Kong from 2006 to 2011. The Normalized Difference Vegetation Index (NDVI), a measure of green space coverage, was measured for 199 small geographic areas in Hong Kong. Negative Binomial Regression Models were fit for mortality outcomes with NDVI, age, gender, population density, and area-level socio-economic variables as predictors, with Generalized Estimating Equations used to control for within-cluster correlation. An interquartile range (0.44 units) higher NDVI was significantly associated with lower cardiovascular (relative risk (RR) = 0.88, 95% confidence interval (CI) = 0.80, 0.98) and diabetes (RR = 0.72, 95% CI = 0.60, 0.92) mortality, and non-significantly associated with lower chronic respiratory mortality (RR = 0.90, 95% CI = 0.79, 1.02). Associations were stronger for males and low-income area residents. Lung cancer mortality had no significant association with green space. Better provision of urban green space, particularly in low-income areas, appears to have potential to reduce mortality in densely-populated Asian cities. View Full-Text
Keywords: cardiovascular disease; environmental epidemiology; diabetes; mortality; urbanization; green space cardiovascular disease; environmental epidemiology; diabetes; mortality; urbanization; green space

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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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Xu, L.; Ren, C.; Yuan, C.; Nichol, J.E.; Goggins, W.B. An Ecological Study of the Association between Area-Level Green Space and Adult Mortality in Hong Kong. Climate 2017, 5, 55.

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