Open access
Research Article
14 April 2016

Exposure to Greenness and Mortality in a Nationwide Prospective Cohort Study of Women

Publication: Environmental Health Perspectives
Volume 124, Issue 9
Pages 1344 - 1352



Green, natural environments may ameliorate adverse environmental exposures (e.g., air pollution, noise, and extreme heat), increase physical activity and social engagement, and lower stress.


We aimed to examine the prospective association between residential greenness and mortality.


Using data from the U.S.-based Nurses’ Health Study prospective cohort, we defined cumulative average time-varying seasonal greenness surrounding each participant’s address using satellite imagery [Normalized Difference Vegetation Index (NDVI)]. We followed 108,630 women and observed 8,604 deaths between 2000 and 2008.


In models adjusted for mortality risk factors (age, race/ethnicity, smoking, and individual- and area-level socioeconomic status), women living in the highest quintile of cumulative average greenness (accounting for changes in residence during follow-up) in the 250-m area around their home had a 12% lower rate of all-cause nonaccidental mortality [95% confidence interval (CI); 0.82, 0.94] than those in the lowest quintile. The results were consistent for the 1,250-m area, although the relationship was slightly attenuated. These associations were strongest for respiratory and cancer mortality. The findings from a mediation analysis suggested that the association between greenness and mortality may be at least partly mediated by physical activity, particulate matter < 2.5 μm, social engagement, and depression.


Higher levels of green vegetation were associated with decreased mortality. Policies to increase vegetation may provide opportunities for physical activity, reduce harmful exposures, increase social engagement, and improve mental health. Planting vegetation may mitigate the effects of climate change; in addition, evidence of an association between vegetation and lower mortality rates suggests it also might be used to improve health.


James P, Hart JE, Banay RF, Laden F. 2016. Exposure to greenness and mortality in a nationwide prospective cohort study of women. Environ Health Perspect 124:1344–1352;

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Information & Authors


Published In

Environmental Health Perspectives
Volume 124Issue 9September 2016
Pages: 1344 - 1352
PubMed: 27074702


Received: 19 June 2015
Revision received: 27 October 2015
Accepted: 17 March 2016
Published online: 14 April 2016



Department of Epidemiology, and
Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
Jaime E. Hart
Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
Rachel F. Banay
Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
Francine Laden
Department of Epidemiology, and
Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA


Address correspondence to P. James, Department of Epidemiology and Environmental Health, Harvard T.H. Chan School of Public Health, 401 Park Dr., 3rd Floor West, Boston, MA 02215 USA. Telephone: (617) 525-2567. E-mail: [email protected]

Competing Interests

The authors declare they have no actual or potential competing financial interests.

Funding Information

The research conducted for this manuscript was supported by the Harvard NHLBI (National Heart, Lung, and Blood Insitute, National Institutes of Health [NIH]) Cardiovascular Epidemiology training grant T32 HL 098048 and NIH grants UM1 CA186107 and R01 ES017017.

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