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Morbidity is related to a green living environment
  1. Jolanda Maas1,*,
  2. Robert A Verheij2,
  3. Sjerp de Vries3,
  4. Peter Spreeuwenberg2,
  5. Francois G Schellevis4,
  6. Peter P Groenewegen5
  1. 1 EMGO Institute VU University Medical Centre, Netherlands;
  2. 2 Netherlands Institute for Health Services Research, Netherlands;
  3. 3 Alterra, Green World Research, Netherlands;
  4. 4 Netherlands Institute for Health Services Research/ EMGO Insitute VU University Medical Centre, Netherlands;
  5. 5 Netherlands Institute for Health Services Research/ Utrecht University, Netherlands
  1. Correspondence to: Jolanda Maas, VTV-Preventie, RIVM, Netherlands Institute for Public Health and the Environment, P.O. Box 1, Bilthoven, 3720 BA, Netherlands; jolanda.maas{at}


Background: Due to increasing urbanisation people face the prospect of living in environments with few green spaces. There is increasing evidence for a positive relation between green space in people's living environment and self-reported indicators of physical and mental health. This study investigates whether physician assessed morbidity is also related to green space in people's living environment.

Methods: Morbidity data were derived from electronic medical records of 195 general practitioners in 96 Dutch practices, serving a population of 345,143 people. Morbidity was classified by the general practitioners according to the International Classification of Primary Care (ICPC). The percentage of green space within a one kilometre and three kilometre radius around the postal code coordinates was derived from an existing database and was calculated for each household. Multilevel logistic regression analyses were performed controlling for demographic and socio-economic characteristics.

Results: The annual prevalence rate of 15 of the 24 disease clusters was lower in living environments with more green space in a 1 km radius. The relation was strongest for anxiety disorder and depression. The relation was stronger for children and people with a lower socio-economic status. Furthermore, the relation was strongest in slightly urban areas and not apparent in very strongly urban areas.

Conclusion: This study indicates that the previously established relation between green space and a number of self-reported general indicators of physical and mental health can also be found for clusters of specific physician assessed morbidity. The study stresses the importance of green space close to home for children and lower socio-economic groups.

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