Abstract P248: Green Space and Mortality Following Ischemic Stroke
Background: Residential proximity to green space has been associated with physical and mental health benefits, but whether green space is associated with post-stroke survival is not well understood.
Methods: We identified patients ≥21 years of age admitted to the Beth Israel Deaconess Medical Center (BIDMC) between April 1, 1999 and October 31, 2008 with neurologist-confirmed acute ischemic stroke. Demographics, presenting symptoms, medical history and imaging results were abstracted from medical records at the time of hospitalization for stroke onset. The time of stroke symptom onset or time last seen normal was documented by the attending stroke neurologist at the time of hospital presentation. Participant addresses were geocoded and linked to average Normalized Difference Vegetation Index (NDVI) derived from satellite-based estimates within a 250x250m grid (July 2000-2012), distance to roadways with more than 10,000 cars/day, and 2000 US census block group. We identified deaths through June 2012 using the Social Security Death Index (SSDI).
Results: We observed 929 deaths among 1,645 patients with complete data (median follow up: 5 years). In multivariable Cox models adjusted for indicators of medical history and demographic and socioeconomic factors, patients living in locations in the lowest quartile of green space had 28% higher rate of post-stroke mortality (95% Confidence Interval (CI): 4% to 59%) than those living in the highest quartile of green space (p-trend=0.009). This association remained significant after adjustment for residential proximity to a high traffic road.
Conclusions: Residential proximity to green space is associated with higher rates of survival after ischemic stroke in multivariable adjusted models. Further work is necessary to elucidate the underlying mechanisms for this association and to better understand susceptibility factors that may contribute to greater mortality in low green space areas.
Author Disclosures: E. Wilker: None. C. Wu: None. E. McNeely: None. E. Mostofsky: None. J. Spengler: None. G. Wellenius: None. M. Mittleman: None.
- © 2014 by American Heart Association, Inc.