Type and Proximity of Green Spaces Are Important for Preventing Cardiovascular Morbidity and Diabetes-A Cross-Sectional Study for Quebec, Canada

This study aimed at determining the role of proximity to specific types of green spaces (GSes) as well as their spatial location in the relationship with the most morbid cardiovascular diseases (CVD) and diabetes. We measured the accessibility to various types of GS and used a cross-sectional approach at census Dissemination Area (DA) levels in the Montreal and Quebec City metropolitan zones for the period 2006-2011. Poisson and negative binomial regression models were fitted to quantify the relationship between distances to specific types of GS and CVD morbidity as well as some risk factors (diabetes and hypertension) while controlling for several social and environmental confounders. GSes that have sports facilities showed a significant relationship to cerebrovascular diseases: the most distant population had an 11% higher prevalence rate ratio (PRR) compared to the nearest, as well as higher diabetes risk (PRR 9%) than the nearest. However, the overall model performance and the understanding of the role of GSes with sport facilities may be substantially achieved with lifestyle factors. Significantly higher prevalence of diabetes and cerebrovascular diseases as well as lower access to GSes equipped with sports facilities were found in suburban areas. GSes can advantageously be used to prevent some CVDs and their risk factors, but there may be a need to reconsider their types and location.