Effects of urban greenspace on time to major adverse cardiovascular events among women with breast cancer in the US: Insights from the Greater Milwaukee, WI Area. Health Place 2025 May;93:103460
Date
04/06/2025Pubmed ID
40187121DOI
10.1016/j.healthplace.2025.103460Scopus ID
2-s2.0-105001825932 (requires institutional sign-in at Scopus site) 1 CitationAbstract
BACKGROUND: Cardiovascular (CV) disease (CVD) remains a significant concern among breast cancer (BC) survivors, particularly following potentially cardiotoxic treatments, such as anthracyclines and anti-HER2 drugs, which increase the risk of major adverse CV events (MACE). Social determinants of health (SDOH) and environmental factors influence health outcomes, including those related to CVD. Urban greenspace has been associated with CV and cancer-related health benefits, yet its specific impact on MACE among BC survivors remains unknown.
OBJECTIVE: This study aims to investigate the association between urban greenspace and time to first MACE incidence among individuals with BC after being treated with cardiotoxic therapies in the greater Milwaukee, WI area.
METHODS: A retrospective cohort study was conducted using electronic medical records from the Froedtert Health System, linked to the National Death Index. Cox proportional hazards regression models were used to assess the association between percent tree canopy cover and MACE-specific hazards, adjusting for sociodemographic, clinical, and neighborhood-level factors.
RESULTS: Among the 849 women included, 44.6 % experienced a MACE. Adjusted models indicated an 18 % reduction in MACE-specific hazard (HR: 0.82, 95 % CI: 0.70, 0.96) and a 20 % reduction in MACE-specific hazard (HR: 0.80, 95 % CI: 0.67, 0.97) for women in the second and third quartiles of percent tree canopy cover, respectively, compared to the women in the first (lowest) quartile. However, we did not observe a risk difference for women living in the fourth quartile of tree canopy. Racial/ethnic disparities in greenspace exposure and MACE incidence were evident, with Non-Hispanic Black (NHB) women having a lower proportion living in areas with the highest tree canopy cover and a higher MACE incidence (61.9 %) compared to Non-Hispanic White (NHW) women (41.6 %), who had the highest proportion residing in areas within the 4th quartile of tree canopy cover.
DISCUSSION: Our findings suggest that urban tree canopy is associated with time to incident MACE among BC survivors receiving cardiotoxic treatments. These results underscore the importance of considering socioenvironmental factors in CardioOncology care and highlight the benefits of greenspace in mitigating CV complications among individuals with BC. Future research should delve into individual lifestyle and behavioral factors, environmental factors, and biological mechanisms that may underlie these associations. Additionally, longitudinal studies should be conducted to evaluate greenspace-based interventions for BC survivors, aiming to advance precision CardioOncology interventions. Observed racial/ethnic disparities in MACE incidence underscore the urgent need for equity-focused interventions addressing greenspace access and MACE-related disparities.
Author List
Bikomeye JC, Tarima S, Zhou Y, Kwarteng JL, Beyer AM, Yen TWF, Winn AN, Beyer KMMAuthors
Andreas M. Beyer PhD Professor in the Medicine department at Medical College of WisconsinKirsten M. Beyer PhD, MS, MPH Professor in the Institute for Health and Humanity department at Medical College of Wisconsin
Jean Bikomeye Postdoctoral Researcher 1 in the Cancer Center department at Medical College of Wisconsin
Jamila L. Kwarteng PhD Assistant Professor in the Institute for Health and Humanity department at Medical College of Wisconsin
Tina W F Yen BA, MS, MD Professor in the Surgery department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdultAged
Breast Neoplasms
Cancer Survivors
Cardiovascular Diseases
Female
Humans
Incidence
Middle Aged
Proportional Hazards Models
Retrospective Studies
Urban Population
Wisconsin
