Abstract Body (Do not enter title and authors here): Background: Access to and use of green spaces are increasingly recognized as vital for cardiovascular health, yet few studies have quantified green space exposure behaviorally or explored how climate might modify its effects.
Methods: Using population mobility data, we estimated annual green space visits per person at the census tract level to examine the association between green space use and coronary heart disease (CHD) prevalence. We focused on three U.S. metropolitan areas with distinct climates: Houston (hot), Minneapolis (cold), and San Diego (mild), to assess whether the relationship between green space use and CHD varies by climate. Annual green space visit counts in 2021 were calculated per person using Advan Patterns mobility dataset (formerly SafeGraph Patterns) and linked to 2021 CHD prevalence estimates from CDC PLACES at the census tract level. We conducted Pearson correlation analyses separately by metro area and further applied geographically weighted regression (GWR) models adjusting for socioeconomic vulnerability (CDC Social Vulnerability Index) to assess spatial heterogeneity in the association within each metro.
Results: Houston had the lowest green space visitation rates, while Minneapolis had the highest (Figure 1). Across all three cities, higher green space visits were associated with lower CHD prevalence (Houston: r = –0.32; San Diego: r = –0.25; Minneapolis: r = –0.22; all p < 0.001). Notably, the association was strongest in Houston despite its lowest visit rate, suggesting that barriers like low availability of green space or extreme heat may limit usage, but for those who do access green spaces, the cardiovascular benefit is substantial. GWR revealed spatial variation in effect strength, with suburban areas consistently showing stronger protective associations than urban cores (Figure 2). This rural-urban gradient was most pronounced in Houston, highlighting potential inequities in green space access and its health benefits under extreme climatic conditions.
Conclusion: Behavioral exposure to green space is inversely associated with CHD prevalence across diverse climates. The stronger protective association observed in Houston underscores the potential amplified benefits of green space in environments where access may be constrained. These findings suggest targeted urban planning and climate adaptation strategies could enhance cardiovascular outcomes, particularly in heat-prone, under-visited areas.