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Article

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

1
Department of Population Health Sciences, Geisinger, Danville, PA 17822, USA
2
Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
3
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
5
Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2021, 18(2), 614; https://doi.org/10.3390/ijerph18020614
Received: 12 November 2020 / Revised: 5 January 2021 / Accepted: 8 January 2021 / Published: 13 January 2021
(This article belongs to the Section Environmental Health)
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. View Full-Text
Keywords: community context; diabetes mellitus; greenspace; hypertension; percent forest; rural health community context; diabetes mellitus; greenspace; hypertension; percent forest; rural health
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MDPI and ACS Style

Poulsen, M.N.; Schwartz, B.S.; Nordberg, C.; DeWalle, J.; Pollak, J.; Imperatore, G.; Mercado, C.I.; Siegel, K.R.; Hirsch, A.G. Association of Greenness with Blood Pressure among Individuals with Type 2 Diabetes across Rural to Urban Community Types in Pennsylvania, USA. Int. J. Environ. Res. Public Health 2021, 18, 614. https://doi.org/10.3390/ijerph18020614

AMA Style

Poulsen MN, Schwartz BS, Nordberg C, DeWalle J, Pollak J, Imperatore G, Mercado CI, Siegel KR, Hirsch AG. Association of Greenness with Blood Pressure among Individuals with Type 2 Diabetes across Rural to Urban Community Types in Pennsylvania, USA. International Journal of Environmental Research and Public Health. 2021; 18(2):614. https://doi.org/10.3390/ijerph18020614

Chicago/Turabian Style

Poulsen, Melissa N., Brian S. Schwartz, Cara Nordberg, Joseph DeWalle, Jonathan Pollak, Giuseppina Imperatore, Carla I. Mercado, Karen R. Siegel, and Annemarie G. Hirsch. 2021. "Association of Greenness with Blood Pressure among Individuals with Type 2 Diabetes across Rural to Urban Community Types in Pennsylvania, USA" International Journal of Environmental Research and Public Health 18, no. 2: 614. https://doi.org/10.3390/ijerph18020614

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