ArticleEnvironmental research2021
Effect modification of greenness on temperature-mortality relationship among older adults: A case-crossover study in China.
Article in Environmental research, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
17 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- 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
- Urban Sprawl, Natural Environments, and Mortality Inequality: Socioeconomic Pathways and Spatial Heterogeneity Across U.S. Counties.Applied geography (Sevenoaks, England) · 2026Article
- Association between dry eye disease and temperature is modified by residential greenness: case-crossover study in Beijing, China.BMC public health · 2025Article
- Long-term exposure to extreme heat and cold and cognitive decline in older adults: Results from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort.Environmental research · 2025Article
- Association between temperature rise from climate normal and sleep quality.Scientific reports · 2025Article
- The heat-mortality association in Jordan: Effect modification by greenness, population density and urbanization level.The Science of the total environment · 2024Article
- Longitudinal Impacts of High Versus Low Greenness on Cardiovascular Disease Conditions.Journal of the American Heart Association · 2024Article
- Pollen effects in a changing climate: Ragweed pollen exposure and sleepiness in immunotherapy patients of a Southeastern Michigan allergy clinic.International journal of biometeorology · 2024Article
- Climate change and healthy ageing: An assessment of the impact of climate hazards on older people.Journal of global health · 2024Review
- Greenspaces And Cardiovascular Health.Circulation research · 2024Review
- How do urban green spaces influence heat-related mortality in elderly? A realist synthesis.BMC public health · 2024Article
- Trade-offs between cold protection and air pollution-induced mortality of China's heating policy.PNAS nexus · 2023Article
- A Long Way from Steubenville: Environmental Epidemiology in a Rapidly Changing World.American journal of epidemiology · 2023Article
- Effect Modifications of Overhead-View and Eye-Level Urban Greenery on Heat-Mortality Associations: Small-Area Analyses Using Case Time Series Design and Different Greenery Measurements.Environmental health perspectives · 2023Article
- Disentangling associations between multiple environmental exposures and all-cause mortality: an analysis of European administrative and traditional cohorts.Frontiers in epidemiology · 2023Article
- Long-Term PMInternational journal of environmental research and public health · 2022Article
Corrections and comments
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Authors and funding
3 authors.
Funding
Abstract
backgroundClimate change exacerbates temperature-related mortality, but effects may vary by geographic characteristics. We hypothesize that higher greenness may mitigate temperature-related mortality, and that the effect may vary in different areas.
objectiveWe examined how mortality among older adults in China was associated with temperature for 2000-2014, and how geolocation and residential greenness may modulate this association.
methodsWe used health data from the China Longitudinal Healthy Longevity Survey (CLHLS), and meteorological data from the Global Surface Summary of Day (GSOD) product by National Climate Data Center. We used a case-crossover study design with distributed nonlinear modeling to estimate mortality risks in relation to temperature, and stratified analysis by quartile of greenness. Greenness was estimated by Normalized Difference Vegetation Index (NDVI) from remote-sensed imagery. In addition to the national analysis, we also assessed three provinces (Jiangsu, Guangdong, and Liaoning) to examine differences by climatic regions.
resultsExtreme temperatures had a significant association with higher mortality, with regional differences. Findings from the national analysis suggest that individuals in the lowest quartile of greenness exposure had a ratio of relative risks (RRR) of 1.38 (0.79, 2.42) for mortality risk on extreme hot days at the 95th percentile compared to those at the 50th percentile, compared to those in the highest quartile, which means those residing in the lowest quartile of greenness had a 38% higher RR than those residing in the highest quartile of greenness, where RR refers to the risk of mortality on days at the 95th percentile of temperature compared to days at the 50th percentile. The RRR for the highest to lowest quartiles of greenness for mortality risk on extreme cold days at the 5th percentile compared to the 50th percentile was 2.08 (0.12, 36.2). In Jiangsu and Guangdong provinces, both the heat effects and cold effects were the lowest in the highest greenness quartile, and the results in Liaoning province were not statistically significant, indicating different regional effects of greenness on modulating the temperature-mortality relationship. DISCUSSION: We elucidated one pathway through which greenness benefits health by decreasing impact from extreme high temperatures. The effects of greenness differed by climatic regions. Policymakers should consider vegetation in the context of climate change and health.
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