title: Neighborhood Greenness and Chronic Health Conditions in Medicare Beneficiaries.
abstract: Prior studies suggest that exposure to the natural environment may impact health. The present study examines the association between objective measures of block-level greenness (vegetative presence) and chronic medical conditions, including cardiometabolic conditions, in a large population-based sample of Medicare beneficiaries in Miami-Dade County, Florida.
  
  
  
  The sample included 249,405 Medicare beneficiaries aged ≥65 years whose location (ZIP+4) within Miami-Dade County, Florida, did not change, from 2010 to 2011. Data were obtained in 2013 and multilevel analyses conducted in 2014 to examine relationships between greenness, measured by mean Normalized Difference Vegetation Index from satellite imagery at the Census block level, and chronic health conditions in 2011, adjusting for neighborhood median household income, individual age, gender, race, and ethnicity.
  
  
  
  Higher greenness was significantly associated with better health, adjusting for covariates: An increase in mean block-level Normalized Difference Vegetation Index from 1 SD less to 1 SD more than the mean was associated with 49 fewer chronic conditions per 1,000 individuals, which is approximately similar to a reduction in age of the overall study population by 3 years. This same level of increase in mean Normalized Difference Vegetation Index was associated with a reduced risk of diabetes by 14%, hypertension by 13%, and hyperlipidemia by 10%. Planned post-hoc analyses revealed stronger and more consistently positive relationships between greenness and health in lower- than higher-income neighborhoods.
  
  
  
  Greenness or vegetative presence may be effective in promoting health in older populations, particularly in poor neighborhoods, possibly due to increased time outdoors, physical activity, or stress mitigation.
authors.affiliation: Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida; University of Miami School of Architecture, Coral Gables, Florida. Electronic address: sbrown@med.miami.edu.
authors.forename: Scott C
authors.initials: SC
authors.lastname: Brown
authors.affiliation: Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida; University of Miami School of Architecture, Coral Gables, Florida.
authors.forename: Joanna
authors.initials: J
authors.lastname: Lombard
authors.affiliation: Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Kefeng
authors.initials: K
authors.lastname: Wang
authors.affiliation: Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Byrne
authors.affiliation: Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Matthew
authors.initials: M
authors.lastname: Toro
authors.affiliation: Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida; University of Miami School of Architecture, Coral Gables, Florida.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Plater-Zyberk
authors.affiliation: Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Feaster
authors.affiliation: Miami-Dade County Department of Parks, Recreation and Open Spaces, Miami, Florida.
authors.forename: Jack
authors.initials: J
authors.lastname: Kardys
authors.affiliation: Miami-Dade County Department of Parks, Recreation and Open Spaces, Miami, Florida.
authors.forename: Maria I
authors.initials: MI
authors.lastname: Nardi
authors.affiliation: Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Gianna
authors.initials: G
authors.lastname: Perez-Gomez
authors.affiliation: Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Hilda M
authors.initials: HM
authors.lastname: Pantin
authors.affiliation: Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida; University of Miami School of Architecture, Coral Gables, Florida.
authors.forename: José
authors.initials: J
authors.lastname: Szapocznik
mesh_terms: D000368:Aged; D002908:Chronic Disease / Q000453:epidemiology*; D004777:Environment; D005260:Female; D005431:Florida / Q000453:epidemiology; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D058998:Remote Sensing Technology; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014481:United States