{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:42:28Z","timestamp":1791420148482,"version":"4.3.3"},"reference-count":42,"publisher":"American Medical Association (AMA)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Exposure to natural environments has been associated with health outcomes related to neurological diseases. However, the few studies that have examined associations of natural environments with neurological diseases report mixed findings.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate associations of natural environments with hospital admissions for Alzheimer disease and related dementias (ADRD) and Parkinson disease (PD) among older adults in the US.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This open cohort study included fee-for-service Medicare beneficiaries aged 65 years or older who lived in the contiguous US from January 1, 2000, to December 31, 2016. Beneficiaries entered the cohort on January 1, 2000, or January 1 of the year after enrollment. Data from US Medicare enrollment and Medicare Provider Analysis and Review files, which contain information about individual-level covariates and all hospital admissions for Medicare fee-for-service beneficiaries, were analyzed between January 2021 and September 2022.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Differences in IQRs for zip code\u2013level greenness (normalized difference vegetation index [NDVI]), percentage park cover, and percentage blue space cover (surface water; \u22651.0% vs &amp;lt;1.0%).<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The main outcome was first hospitalizations with a primary or secondary discharge diagnosis of ADRD or PD. To examine associations of exposures to natural environments with ADRD and PD hospitalization, we used Cox-equivalent Poisson models.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n We included 61 662 472 and 61 673 367 Medicare beneficiaries in the ADRD and PD cohorts, respectively. For both cohorts, 55.2% of beneficiaries were women. Most beneficiaries in both cohorts were White (84.4%), were not eligible for Medicaid (87.6%), and were aged 65 to 74 years (76.6%) at study entry. We observed 7\u202f737\u202f609 and 1\u202f168\u202f940 first ADRD and PD hospitalizations, respectively. After adjustment for potential individual- and area-level confounders (eg, Medicaid eligibility and zip code\u2013level median household income), NDVI was negatively associated with ADRD hospitalization (hazard ratio [HR],\u20090.95 [95% CI, 0.94-0.96], per IQR increase). We found no evidence of an association of percentage park and blue space cover with ADRD hospitalization. In contrast, NDVI (HR,\u20090.94 [95% CI, 0.93-0.95], per IQR increase), percentage park cover (HR,\u20090.97 [95% CI, 0.97-0.98], per IQR increase), and blue space cover (HR,\u20090.97 [95% CI, 0.96-0.98], \u22651.0% vs &amp;lt;1.0%) were associated with a decrease in PD hospitalizations. Patterns of effect modification by demographics differed between exposures.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n The findings of this cohort study suggest that some natural environments are associated with a decreased risk of ADRD and PD hospitalization.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2022.47664","type":"journal-article","created":{"date-parts":[[2022,12,20]],"date-time":"2022-12-20T11:01:13Z","timestamp":1671534073000},"page":"e2247664","source":"Crossref","is-referenced-by-count":52,"title":["Associations of Greenness, Parks, and Blue Space With Neurodegenerative Disease Hospitalizations Among Older US Adults"],"prefix":"10.1001","volume":"5","author":[{"given":"Jochem O.","family":"Klompmaker","sequence":"first","affiliation":[{"name":"Department of Environmental Health, Harvard T. H. 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M.","family":"Browning","sequence":"additional","affiliation":[{"name":"Department of Parks, Recreation and Tourism Management, Clemson University, Clemson, South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Dominici","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcia P.","family":"Jimenez","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. Scott","family":"Ogletree","sequence":"additional","affiliation":[{"name":"OPENspace Research Centre, School of Architecture and Landscape Architecture, University of Edinburgh, Edinburgh, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Rigolon","sequence":"additional","affiliation":[{"name":"Department of City and Metropolitan Planning, University of Utah, Salt Lake City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonella","family":"Zanobetti","sequence":"additional","affiliation":[{"name":"Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaime E.","family":"Hart","sequence":"additional","affiliation":[{"name":"Department of Environmental Health, Harvard T. H. 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