Residential greenspace and multiple chronic health conditions in China: a cross-sectional study

Background: Multiple chronic conditions are imposing an increasing health and economic burden on the Chinese health system. While exposure to residential greenness has been shown to provide various health benefits, its relationship with multiple chronic conditions remains largely unexplored. This study aims to investigate this relationship using high-resolution satellite imagery and data from the 6th Health Services Survey (HSS) cohort in Shandong province. Methods: We linked health data from the HSS with 12-month average Normalised Difference Vegetation Index (NDVI) measurements based on reported residential geocodes. Multiple chronic condition status was defined as having two or more chronic conditions concurrently, according to the HSS's predefined disease classification. Generalised mixed regression models were utilised to assess both the likelihood and count of multiple chronic conditions in relation to greenspace exposure. Additionally, using the pre-defined disease classes, we also explored how greenspace influences multiple chronic conditions across various physiological systems and disease categories. Results: A total of 28 489 individuals were included in this cross-sectional analysis. After adjusting for potential confounding factors, we found that exposure to greenspace was significantly associated with a reduced prevalence and count of chronic conditions. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for were: Q2 (aOR = 0.74; 95% CI = 0.62, 0.88), Q3 (aOR = 0.69; 95% CI = 0.55, 0.86), and Q4 (aOR = 0.70; 95% CI = 0.56, 0.88), respectively, compared against the baseline Q1 quartile. Subgroup analyses revealed that higher residential greenspace exposure reduced risks of blood, endocrine, nutritional and metabolic chronic diseases. No clear associations were found for other chronic disease classes. Additionally, consistent results were observed across spatial and temporal sensitivity analyses. Conclusions: Our findings underscore the potential beneficial effects of residential greenness on multiple chronic conditions, with implications for urban planning, environmental policy, and community development.