Abstract 15304: Nature Exposure and Cardiovascular Outcomes in a Large Metropolitan Area: The Role of Access to Nature

Background: Previous studies have found conflicting results regarding the association between greenspaces and cardiovascular health. We aimed to investigate the relationship between cardiovascular risk factors (CVRF) and diseases (CVD), and NatureScore, as well as access to nature using the Walk Score.

Methods: Cross-sectional study including one million adult patients in Houston Methodist Outpatient Registry (2016-2022) living in the greater Houston metroplex. NatureScore is a composite score of natural environment exposure and quality of greenspace calculated for each patient. NatureScore was categorized as follows: nature-deficient/light (0-39), nature-adequate (40-59), nature-rich (60-79), and nature-utopia (80-100). Walk Score was divided into 4 categories: car-dependent (all errands) (0-19), car-dependent (most errands) (20-39), somewhat walkable (40-59), and very walkable/ walker’s paradise (60-100).

Results: A total of 1.07 million patients (mean age 52, female 59%, Hispanic 16%, NHB 14%) were included with median NatureScore of 69 and 99% living in urban areas. The prevalence of CVRF and CVD (CAD, PAD, and stroke) was significantly higher in patients living in neighborhoods with high NatureScore without taking access to nature into account (Figure). On adjusting for access to nature (Walk Score), patients living in the highest NatureScore areas had 9% lower odds of any CVRF and 4% of any CVD, than those living in the lowest NatureScore areas. On stratification by Walk Score, those living in high NatureScore high walkability areas had lower odds of CVRF than those in high NatureScore low walkability areas (Figure).

Conclusion: Our findings suggest that greenspace can positively impact cardiovascular health, yet its accessibility plays a crucial role in determining its actual effect. Our results can guide stakeholders in allocating resources for population health improvement and urban design that consider both exposure and access to nature.