title: Accessibility and use of urban green spaces, and cardiovascular health: findings from a Kaunas cohort study.
abstract: BACKGROUND
  The aims of this study were to explore associations of the distance and use of urban green spaces with the prevalence of cardiovascular diseases (CVD) and its risk factors, and to evaluate the impact of the accessibility and use of green spaces on the incidence of CVD among the population of Kaunas city (Lithuania).
  
  
  METHODS
  We present the results from a Kaunas cohort study on the access to and use of green spaces, the association with cardiovascular risk factors and other health-related variables, and the risk of cardiovascular mortality and morbidity. A random sample of 5,112 individuals aged 45-72 years was screened in 2006-2008. During the mean 4.41 years follow-up, there were 83 deaths from CVD and 364 non-fatal cases of CVD among persons free from CHD and stroke at the baseline survey. Multivariate Cox proportional hazards regression models were used for data analysis.
  
  
  RESULTS
  We found that the distance from people's residence to green spaces was not related to the prevalence of health-related variables. However, the prevalence of cardiovascular risk factors and the prevalence of diabetes mellitus were significantly lower among park users than among non-users. During the follow up, an increased risk of non-fatal and fatal CVD combined was observed for those who lived ≥629.61 m from green spaces (3rd tertile of distance to green space) (hazard ratio (HR) = 1.36), and the risk for non-fatal CVD-for those who lived ≥347.81 m (2nd and 3rd tertile) and were not park users (HR = 1.66) as compared to men and women who lived 347.8 m or less (1st tertile) from green space. Men living further away from parks (3rd tertile) had a higher risk of non-fatal and fatal CVD combined, compared to those living nearby (1st tertile) (HR = 1.51). Compared to park users living nearby (1st tertile), a statistically significantly increased risk of non-fatal CVD was observed for women who were not park users and living farther away from parks (2nd and 3rd tertile) (HR = 2.78).
  
  
  CONCLUSIONS
  Our analysis suggests public health policies aimed at promoting healthy lifestyles in urban settings could produce cardiovascular benefits.
authors.forename: Abdonas
authors.initials: A
authors.lastname: Tamosiunas
authors.affiliation: Department of Environmental Sciences, Vytautas Magnus University, Kaunas, Lithuania. r.grazuleviciene@gmf.vdu.lt.
authors.forename: Regina
authors.initials: R
authors.lastname: Grazuleviciene
authors.forename: Dalia
authors.initials: D
authors.lastname: Luksiene
authors.forename: Audrius
authors.initials: A
authors.lastname: Dedele
authors.forename: Regina
authors.initials: R
authors.lastname: Reklaitiene
authors.forename: Migle
authors.initials: M
authors.lastname: Baceviciene
authors.forename: Jone
authors.initials: J
authors.lastname: Vencloviene
authors.forename: Gailute
authors.initials: G
authors.lastname: Bernotiene
authors.forename: Ricardas
authors.initials: R
authors.lastname: Radisauskas
authors.forename: Vilija
authors.initials: V
authors.lastname: Malinauskiene
authors.forename: Egle
authors.initials: E
authors.lastname: Milinaviciene
authors.forename: Martin
authors.initials: M
authors.lastname: Bobak
authors.forename: Anne
authors.initials: A
authors.lastname: Peasey
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Nieuwenhuijsen
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002947:Cities; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000453:epidemiology; D004777:Environment; D006801:Humans; D008097:Lithuania / Q000453:epidemiology; D008875:Middle Aged; D011998:Recreation; D012111:Residence Characteristics; D014504:Urban Health