BACKGROUND The potential health benefits of exposure to vegetation, or greenness, are well documented, but there are few nationwide studies in Brazil, a country facing challenges related to land-use planning, deforestation, and environmental health risks. OBJECTIVES In this study, we investigated the association between greenness and hospitalizations for cardiorespiratory diseases in Brazil. METHODS We accessed hospital admissions data from 967,771 postal codes (a total of 26,724,624 admissions) covering Brazil for the period between 2008 and 2018. We used Normalized Difference Vegetation Index (NDVI) data from the Moderate Resolution Imaging Spectroradiometer (MODIS) to measure greenness at the postal-code level. First, we applied a quasi-Poisson regression model to estimate the association between greenness and hospitalizations for circulatory and respiratory diseases, adjusted for air pollution, weather variables, and area-level socioeconomic status. We stratified the analyzes by sex, age group, health outcome, and Brazilian regions. In the second stage, we performed a meta-analysis to estimate pooled effects across the Brazilian regions. RESULTS The national meta-analysis for the whole population, incorporating both urban and nonurban areas, showed that higher levels of greenness were associated with a lower risk of hospitalizations for circulatory diseases. An interquartile range (IQR=0.18) increase in average NDVI was associated with a 17% (95% confidence interval: 8%, 27%) lower risk of cardiovascular admissions. In contrast, there was no association found between greenness and respiratory admissions. When specifically examining urban areas, the results remained consistent with the overall findings. However, the analyses of nonurban areas revealed divergent results, suggesting that higher levels of greenness in rural regions are associated with a lower risk of hospital admissions for both circulatory and respiratory diseases. DISCUSSION The findings emphasize the importance of prioritizing the preservation and creation of green spaces in urban areas as a means of promoting cardiovascular health in Brazil. https://doi.org/10.1289/EHP13442.

中文翻译：

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巴西的绿色环保和心肺疾病住院治疗。


背景 暴露于植被或绿色环境中的潜在健康益处已得到充分证明，但在巴西，全国范围内的研究很少，该国面临着与土地使用规划、森林砍伐和环境健康风险相关的挑战。目的 在这项研究中，我们调查了巴西绿色环境与心肺疾病住院之间的关联。方法 我们获取了巴西 2008 年至 2018 年间 967,771 个邮政编码的入院数据（总共 26,724,624 名入院患者）。我们使用中分辨率成像光谱仪 (MODIS) 的归一化植被指数 (NDVI) 数据来测量邮政编码级别。首先，我们应用准泊松回归模型来估计绿色度与循环系统和呼吸系统疾病住院率之间的关联，并根据空气污染、天气变量和地区社会经济状况进行调整。我们按性别、年龄组、健康结果和巴西地区进行分层分析。在第二阶段，我们进行了荟萃分析，以估计整个巴西地区的汇总效应。结果对全国人口（包括城市和非城市地区）的荟萃分析表明，较高的绿化水平与较低的循环系统疾病住院风险相关。平均 NDVI 四分位数范围 (IQR=0.18) 的增加与心血管入院风险降低 17%（95% 置信区间：8%、27%）相关。相比之下，绿色和呼吸道入院之间没有发现关联。当具体考察城市地区时，结果与总体调查结果保持一致。 然而，对非城市地区的分析显示出不同的结果，表明农村地区较高的绿化水平与较低的循环系统和呼吸系统疾病住院风险相关。讨论 研究结果强调了优先考虑城市地区绿色空间的保护和创建作为促进巴西心血管健康的一种手段的重要性。 https://doi.org/10.1289/EHP13442。