Urban greenspace and cardiovascular disease comorbidity at breast cancer diagnosis in the US: regional, racial/ethnic, and socioeconomic variations among older women
Objective To investigate the association between urban greenspace and cardiovascular disease (CVD) comorbidity at breast cancer (BC) diagnosis among older women, and explore regional, racial/ethnic, and socioeconomic differences.Study design A cross-sectional analysis of population-based registry da...
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| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Taylor & Francis Group
2025-12-01
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| Series: | Cancer Survivorship Research & Care |
| Subjects: | |
| Online Access: | https://www.tandfonline.com/doi/10.1080/28352610.2025.2494564 |
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| Summary: | Objective To investigate the association between urban greenspace and cardiovascular disease (CVD) comorbidity at breast cancer (BC) diagnosis among older women, and explore regional, racial/ethnic, and socioeconomic differences.Study design A cross-sectional analysis of population-based registry data.Methods Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database, data on women aged 66-90 diagnosed with BC (2010-2017) were analyzed. A tract-level measure of tree canopy cover was derived from the National Landcover Database (2011) and linked to SEER-Medicare records. Logistic regression models assessed the probability of CVD comorbidity based on state-specific percent tree canopy quartiles, adjusting for covariates.Results Out of 116,660 women, 74.7% (n = 87,152) had CVD comorbidity at BC diagnosis. Overall, women residing in areas with higher percent tree canopy cover had a lower likelihood of CVD comorbidity compared to those in the lowest canopy areas, with Adjusted Odds Ratio (AOR) and 95% confidence interval (CI) of 0.89 (0.84-0.94). Racial/ethnic, socioeconomic status (SES), and regional variations were noted. Adjusted effects of greenspace were significant only for NHW women; AOR (95%CI) = 0.78 (0.71-0.86). Women in the highest tree canopy quartile in California, New Jersey, and New Mexico had lower odds of comorbid CVD, with AORs (95% CI) of 0.80 (0.72-0.88), 0.77 (0.71-0.84), and 0.46 (0.34-0.63) respectively. Adjusted results for New York, Massachusetts, and Kentucky showed adverse harmful effects, while adjusted results for all other SEER states were not statistically significant. Both dual enrollment eligible and non-eligible women had benefits from greenspace, but greater benefits were observed in dual enrollment eligible women; AOR (95% CI) = 0.64 (0.48-0.86) versus 0.76 (0.69-0.84) for non-eligible women.Conclusions Overall, urban greenspace is associated with a lower risk of CVD comorbidity among older women with BC, and variations exist by region, race/ethnicity, and SES. Our findings underscore the role of greenspace in mitigating Cardio-Oncology disparities. Further research is needed to better understand factors contributing to observed differences across SEER regions and racial/ethnic subgroups. A better understanding of interactions among greenspace, other environmental factors, and individual lifestyle factors will help improve CVD outcomes among women with BC. |
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| ISSN: | 2835-2610 |