ArticleEnvironmental health perspectives2016
Modification of Heat-Related Mortality in an Elderly Urban Population by Vegetation (Urban Green) and Proximity to Water (Urban Blue): Evidence from Lisbon, Portugal.
Article in Environmental health perspectives, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 53 papers, 10 of them syntheses that pooled it.
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Who cites it
53 citing papers in PubMed, 10 syntheses or guidelines pooled it, 187 citations in OpenAlex.
- The Role of Greenness in Heat-Related Mortality: A Systematic Review and Meta-Analysis.Annals of global health · 2026Pooled it
- Climate, Health, and Urban Green Infrastructure: The Evidence Base and Implications for Urban Policy and Spatial Planning.International journal of environmental research and public health · 2025Pooled it
- Thermal indices for assessing the impact of outdoor thermal environments on human health: a systematic review of epidemiological studies.International journal of biometeorology · 2025Pooled it
- Health impact of urban green spaces: a systematic review of heat-related morbidity and mortality.BMJ open · 2024Pooled it
- Urban heat island impacts on heat-related cardiovascular morbidity: A time series analysis of older adults in US metropolitan areas.Environment international · 2023Pooled it
- Is altitude a determinant of the health benefits of nature exposure? A systematic review and meta-analysis.Frontiers in public health · 2022Pooled it
- Temporal changes in associations between high temperature and hospitalizations by greenspace: Analysis in the Medicare population in 40 U.S. northeast counties.Environment international · 2021Pooled it
- Mechanisms of Impact of Blue Spaces on Human Health: A Systematic Literature Review and Meta-Analysis.International journal of environmental research and public health · 2021Pooled it
- Green spaces and mortality: a systematic review and meta-analysis of cohort studies.The Lancet. Planetary health · 2019Pooled it
- The health benefits of the great outdoors: A systematic review and meta-analysis of greenspace exposure and health outcomes.Environmental research · 2018Pooled it
- Separate and combined associations of heatwaves, air pollution, green spaces, and blue spaces with depressive symptoms: a national cohort study.Archives of public health = Archives belges de sante publique · 2026Article
- Greening mitigates heat-related mortality in Paris.npj urban sustainability · 2026Article
- Association between dry eye disease and temperature is modified by residential greenness: case-crossover study in Beijing, China.BMC public health · 2025Article
- Estimating Heat-Related Mortality Burden Changes under Type-Specific Green and Blue Space Scenarios in China.Environmental health perspectives · 2025Article
- The impact of exposure to green or bluespace on dietary intake and food choices among adults-A systematic literature review.Food science & nutrition · 2024Review
- The heat-mortality association in Jordan: Effect modification by greenness, population density and urbanization level.The Science of the total environment · 2024Article
- Modifying temperature-related cardiovascular mortality through green-blue space exposure.Environmental science and ecotechnology · 2024Article
- Unequal distributions of crowdsourced weather data in England and Wales.Nature communications · 2024Article
- Climate crisis risks to elderly health: strategies for effective promotion and response.Health promotion international · 2024Review
- Augmented human thermal discomfort in urban centers of the Arabian Peninsula.Scientific reports · 2024Article
Corrections and comments
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Authors and funding
8 authors at 4 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundUrban populations are highly vulnerable to the adverse effects of heat, with heat-related mortality showing intra-urban variations that are likely due to differences in urban characteristics and socioeconomic status.
objectivesWe investigated the influence of urban green and urban blue, that is, urban vegetation and water bodies, on heat-related excess mortality in the elderly > 65 years old in Lisbon, Portugal, between 1998 and 2008.
methodsWe used remotely sensed data and geographic information to determine the amount of urban vegetation and the distance to bodies of water (the Atlantic Ocean and the Tagus Estuary). Poisson generalized additive models were fitted, allowing for the interaction between equivalent temperature [universal thermal climate index (UTCI)] and quartiles of urban greenness [classified using the Normalized Difference Vegetation Index (NDVI)] and proximity to water (≤ 4 km vs. > 4 km), while adjusting for potential confounders.
resultsThe association between mortality and a 1°C increase in UTCI above the 99th percentile (24.8°C) was stronger for areas in the lowest NDVI quartile (14.7% higher; 95% CI: 1.9, 17.5%) than for areas in the highest quartile (3.0%; 95% CI: 2.0, 4.0%). In areas > 4 km from water, a 1°C increase in UTCI above the 99th percentile was associated with a 7.1% increase in mortality (95% CI: 6.2, 8.1%), whereas in areas ≤ 4 km from water, the estimated increase in mortality was only 2.1% (95% CI: 1.2, 3.0%).
conclusionsUrban green and blue appeared to have a mitigating effect on heat-related mortality in the elderly population in Lisbon. Increasing the amount of vegetation may be a good strategy to counteract the adverse effects of heat in urban areas. Our findings also suggest potential benefits of urban blue that may be present several kilometers from a body of water. CITATION: Burkart K, Meier F, Schneider A, Breitner S, Canário P, Alcoforado MJ, Scherer D, Endlicher W. 2016. Modification of heat-related mortality in an elderly urban population by vegetation (urban green) and proximity to water (urban blue): evidence from Lisbon, Portugal. Environ Health Perspect 124:927-934; http://dx.doi.org/10.1289/ehp.1409529.
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