paraphrase with correct Harvard in-text citation
Significant gender differences were observed in the association between coverage of green space and cause-spe- cific mortality (figure 2). Coverage of green space was significantly associated with a reduced risk of all-cause mortality in women (HR 0.93, 95%CI 0.88 to 0.99), but not in men (HR 0.97, 95%CI 0.93 to 1.01). The associ- ation between coverage of green space and circulatory system-caused mortality was stronger in women (HR 0.85, 95% CI 0.74 to 0.97) than in men (HR 0.89, 95% CI 0.81 to 0.99). However, the association between coverage of green space and stroke-caused mortality was stronger in men (HR 0.59, 95%CI 0.41 to 0.84) than in women (HR 0.71, 95% CI 0.52 to 0.96)
Our results show that older people who live in a greener neighbourhood may have a lower risk of all-cause mortality, particularly for mortality caused by circulatory diseases, including stroke, independent of age, sex, marital status, years lived in Hong Kong, education level, socioeconomic ladder, smoking, alcohol intake, diet quality, self-rated health and housing type. The inverse association between green space and mortality persisted after further adjust- ments for physical activity and cognitive function, which have been suggested as important factors linking green space to improved health and well-being.53–57
The findings of this study are consistent with the find- ings reported in other studies which also used NDVI to assess the neighbouring coverage of green space for adults.14 15 In particular, a cohort study conducted in Japan found a similar positive association betwee walkable green space and longevity for senior citizens.13 However, while the comparison with other studies confirms the beneficial effect of green space on mortality, most previous studies collected the reported residential address only once at baseline, assuming stable exposure to green space, which may not be true, especially in cities, with a high rate of residence change or if the individually reported address is not the predominant living place of the subject. Unlike other studies, we established certain recruiting criteria to ensure that all of the subjects had an exposure to their neighbouring green space for a period longer than 3 years.
Although coverage of green space was associated with a reduced risk of all-cause mortality and mortality caused by stroke in the present study, it was not associated with respiratory system disease-caused or AMI/IHD-caused mortality. The lack of an association between green space and respiratory system-caused mortality may be due to the lack of variation in exposure to green space in subjects who had died of respiratory diseases. In addition, the vulnerability of the respiratory system of those subjects may have limited their daily activities or changed their health behaviours such that the connection with the neighbouring green space may have been of less benefit.58 In terms of AMI/IHD-caused mortality, the lack of an association may be due to the relatively small number of deaths caused by AMI/IHD in the study.
Our findings also showed that the effect of green space on all-cause mortality tended to be stronger in females than in males. The observed stronger associa- tion for females may be related to the relatively greater exposure to the neighbouring green space (eg, visit the residential market, participate in community activities), as observed from other studies.59–61 Nevertheless, the number of deaths caused by AMI/IHD and stroke in the study were small. A longer follow-up period with a larger number of deaths from AMI/IHD and stroke might be able to provide a more definitive answer. Further studies exploring the health effect of neighbouring environ- ment should also take gender difference into account. to provide applicable evidence for urban planners in addressing various needs from different population
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