{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T20:32:26Z","timestamp":1784752346336,"version":"3.55.0"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,1,3]],"date-time":"2025-01-03T00:00:00Z","timestamp":1735862400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background and aims<\/jats:title><jats:p>The relationship between green space and new-onset stroke is inconclusive. This study aimed to investigate the association between green space and stroke risk among Chinese middle-aged and older adults.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data were taken from participants aged \u226545\u202fyears in the China Health and Retirement Longitudinal Study (CHARLS). Baseline data were collected in 2011 and new-onset stroke data were gathered during follow-up in 2013, 2015, 2018, and 2020. Multivariate Cox regression models were constructed to investigate the association between green space and stroke risk. Subgroup analysis was also performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 13,696 participants with a mean age of 59.3\u202f\u00b1\u202f9.3\u202fyears were included. After a mean follow-up duration of 6.32\u202fyears, there were 728 stroke events during a total of 86,530 person-years of follow-up. The study found a L-shaped relationship between green space and the risk of new-onset stroke in participants. By using a two-piecewise linear regression model, we calculated that the inflection point for the <jats:italic>per capita<\/jats:italic> park green area was 10.61 square meters per person (log-likelihood ratio test <jats:italic>p<\/jats:italic>\u202f=\u202f0.041). On the left of the inflection point, we observed a negative relationship between green space and the incidence of stroke (HR: 0.89, 95% CI: 0.84\u20130.94, <jats:italic>p<\/jats:italic>\u202f=\u202f0.0001). On the right side of the inflection point, however, the relationship tended to be saturated (HR: 0.97, 95% CI: 0.94\u20131.01, <jats:italic>p<\/jats:italic>\u202f=\u202f0.2111).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our study found that the relationship between green space and the risk of new-onset stroke follows a L-shaped curve. A lower amount of green space is associated with an increased risk of new-onset stroke. These findings require confirmation in future studies.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2024.1424510","type":"journal-article","created":{"date-parts":[[2025,1,3]],"date-time":"2025-01-03T05:10:53Z","timestamp":1735881053000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Green space is associated with new-onset stroke among Chinese middle-aged and older adults: data from China Health and Retirement Longitudinal Study (CHARLS)"],"prefix":"10.3389","volume":"12","author":[{"given":"Qiong","family":"Lu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng","family":"Lian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinglin","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,1,3]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"100655","DOI":"10.1016\/j.lanepe.2023.100655","article-title":"Concomitant exposure to air pollution, green space, and noise and risk of stroke: a cohort study from Denmark","volume":"31","author":"Poulsen","year":"2023","journal-title":"Lancet Reg Health Eur"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1016\/j.landurbplan.2011.12.015","article-title":"More green space is linked to less stress in deprived communities: evidence from salivary cortisol patterns","volume":"105","author":"Thompson","year":"2012","journal-title":"Landsc Urban Plan"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1016\/j.envres.2014.05.005","article-title":"Green space and mortality following ischemic stroke","volume":"133","author":"Wilker","year":"2014","journal-title":"Environ Res"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"2076","DOI":"10.3390\/ijerph16122076","article-title":"Association between the first occurrence of asthma and residential greenness in children and teenagers in Taiwan","volume":"16","author":"Hsieh","year":"2019","journal-title":"Int J Environ Res Public Health"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1016\/j.envint.2015.10.013","article-title":"Residential green spaces and mortality: a systematic review","volume":"86","author":"Gasc\u00f3n","year":"2016","journal-title":"Environ Int"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"568","DOI":"10.1016\/j.socscimed.2010.04.015","article-title":"Gender differences in relationships between urban green space and health in the United Kingdom","volume":"71","author":"Richardson","year":"2010","journal-title":"Soc Sci Med"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"513","DOI":"10.3390\/ijerph17020513","article-title":"Exploring the relationship between green space in a neighbourhood and cardiovascular health in the winter city of China: a study using a health survey for Harbin","volume":"17","author":"Li","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1244477","DOI":"10.3389\/fpubh.2023.1244477","article-title":"The impact of urban green space on the health of middle-aged and older adults","volume":"11","author":"Li","year":"2023","journal-title":"Front Public Health"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"11700","DOI":"10.3390\/ijerph191811700","article-title":"Long-term exposure to greenspace and cognitive function during the lifespan: a systematic review","volume":"19","author":"Ricciardi","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1093\/pubmed\/fdq068","article-title":"The health benefits of urban green spaces: a review of the evidence","volume":"33","author":"Lee","year":"2011","journal-title":"J Public Health (Oxf)"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"578","DOI":"10.1136\/jech-2013-203767","article-title":"The association between green space and mental health varies across the lifecourse. 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