Greenspace exposure and poststroke disability: A nationwide longitudinal study

Introduction: Exposure to greenspace has been reported to reduce stroke mortality, but there is a lack of evidence regarding poststroke disability. This study aimed to investigate the association between long-term greenspace exposure and the risk of poststroke disability. Methods: Based on the China National Stroke Screening Survey from 2013 to 2019, a total of 65,892 visits from 28,085 stroke survivors with >= 2 visits were included in this longitudinal study. Long-term greenspace exposure was assessed by a 3-year average of the Normalized Difference Vegetation Index (NDVI) and the proportion of green land cover according to participants' residential communities. Poststroke functional status was assessed with the modified Ranking Score (mRS) at each visit; a cutoff score > 2 indicated disability. Fixed effects re-gressions were used to examine the association of greenspace exposure with continuous mRS scores or binary indicators for disability.Results: The annual mean NDVI value was 0.369 (standard deviation = 0.120) for all visits among stroke sur-vivors. With full adjustments, each 0.05 increase in NDVI was associated with a 0.056-unit (95 % confidence interval (CI): 0.034, 0.079) decrease in the mRS score and a 46.6 % (95 % CI: 10.0 %, 68.3 %) lower risk of poststroke disability. An L-shaped curve was observed for the nonlinear associations between NDVI and mRS score or disability. Additionally, each 1 % increase in grasslands, savannas, forest, and croplands was associated with 0.008-(95 % CI: 0.002, 0.014), 0.003-(95 % CI: 0.001, 0.005), 0.001-(95 % CI:-0.015, 0.018), and 0.002 -unit (95 % CI:-0.003, 0.007) decreases in the mRS score, respectively.Conclusions: Increasing greenspace was inversely associated with mRS score. Greenspace planning can be a po-tential intervention to prevent poststroke disability.