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A high level of greenness is emerging as a strategy to mitigate the effects of extreme heat.\nObjective: To assess whether higher levels of greenness are associated with reduced mortality compared with lower greenness during periods of extreme heat.\nMethods: In this systematic review and meta\u2011analysis, we searched MEDLINE, SCOPUS, WEB OF SCIENCE, CINHAL, Environment Complete, and GreenFILE. Observational studies were included. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated via a random\u2011effects model.\nResults: The systematic review and meta\u2011analysis included 11 articles. These cover data from China, France, Germany, Jordan, Switzerland, and the USA, as well as a global analysis covering 24 countries. The meta\u2011analysis suggested that heat waves significantly increased mortality in areas with the lowest greenness (RR = 1.33; 95% CI: 1.15\u20131.55; I2 = 99.4%) and in areas with the highest greenness (RR = 1.18; 95% CI: 1.03\u20131.36; I2 = 97.9%). The pooled ratio of RR (RoR) indicated that the association was significantly stronger in low\u2011greenness areas than in high\u2011greenness areas (RoR = 1.11; 95% CI: 1.06\u20131.15; I2 = 90.5%), indicating that the heat\u2013mortality association was 11% stronger in low\u2011greenness areas. The pooled associations varied descriptively across subgroup analyses, although no statistically significant differences were observed between geographical regions or study settings.\nConclusion: Higher temperatures were associated with increased mortality in both low\u2011 and high\u2011greenness areas; however, the heat\u2013mortality association was 11% stronger in low\u2011greenness areas. These findings suggest that greater greenness may attenuate vulnerability to extreme heat, although the limited evidence base and considerable between\u2011study heterogeneity warrant cautious interpretation.<\/jats:p>","DOI":"10.5334\/aogh.5216","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T12:06:08Z","timestamp":1790337968000},"page":"99","source":"Crossref","is-referenced-by-count":0,"title":["The Role of Greenness in Heat\u2011Related Mortality: A Systematic Review and Meta\u2011Analysis"],"prefix":"10.5334","volume":"92","author":[{"given":"Maria","family":"Martinez\u2011Andres","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blanca","family":"Notario\u2011Pacheco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Marcilla\u2011Toribio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shkelzen","family":"Cekrezi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lidia","family":"Lucas\u2011de la Cruz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio Miguel","family":"Caraballo\u2011Betancort","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Bizzozero\u2011Peroni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Perez\u2011Moreno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3285","published-online":{"date-parts":[[2026,9,25]]},"reference":[{"key":"1","unstructured":"Intergovernmental Panel on Climate Change. 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