Urban greenspace and cardiovascular disease comorbidity at breast cancer diagnosis in the US: Regional, racial/ethnic, and socioeconomic variations among older women. Cancer Surviv Res Care 2025;3(1)
Date
09/01/2025Pubmed ID
40881314Pubmed Central ID
PMC12382361DOI
10.1080/28352610.2025.2494564Abstract
OBJECTIVE: To investigate the association between urban residential greenspace and cardiovascular disease (CVD) comorbidity at breast cancer (BC) diagnosis among older women, and explore regional, racial/ethnic, and socioeconomic differences.
STUDY DESIGN: This is a cross-sectional analysis of a 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 census tract clustering and 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 an Adjusted Odds Ratio (AOR) and 95% confidence interval (CI) of 0.78 (0.71-0.85). 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.
Author List
Bikomeye JC, McGinley EL, Zhou Y, Tarima S, 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
Emily L. McGinley MS, MPH Biostatistician III in the Center for Advancing Population Science department at Medical College of Wisconsin
Tina W F Yen BA, MS, MD Professor in the Surgery department at Medical College of Wisconsin
