Greenspace and Survival Among Older Women With Breast Cancer: Regional Variations Within the U.S. SEER-Medicare-Linked Database
Authors' conclusion
This study highlights the importance of investigating the relationship between greenspace and cardiooncology-related outcomes across regions, underscoring the need for more place-specific research to guide targeted interventions to improve survival outcomes.
Study context
- Population
- Women aged 66+ with invasive BC, enrolled in Medicare (Parts A and B) for 12 months prediagnosis and with known tract-level greenspace data, United Stateswomen included
- Participants
- 86,300 women
- Exposure
- Greater percent tree canopy and survival
- Outcome
- Deaths during follow-up
Methodological details2010 to 2017, censoring by December 31, 2018
- 2010 to 2017
- Censoring by December 31, 2018
Main finding
As reported in the abstract
Died during the follow-up
22,541
26.1%
Died from BC, of those who died
9,012
40.6%
Died from cardiovascular disease (CVD), of those who died
4,195
18.9%
Observational data: associations, not effects.
Further findings
All-cause mortality (ACM)
| HR (95% CI) | ||
|---|---|---|
| Greater percent tree canopyLower ACM with greater percent tree canopy | 0.90 (0.86–0.95) | |
| 0.512Hazard ratio (log scale) |
BC-specific mortality (BCSM)
| Cause-specific HR (95% CI) | ||
|---|---|---|
| Greater percent tree canopyLower BCSM with greater percent tree canopy | 0.90 (0.82–0.98) | |
| 0.512Cause-specific hazard ratio (log scale) |
Regional variations
- Greenspace linked to lower ACM in California, New Jersey, and Michigan
- Lower BCSM and CVD-specific mortality (CVDSM) in California and New Jersey
- Washington, Louisiana, and Georgia showed nonsignificant or inconsistent results
Original publication
Greenspace and Survival Among Older Women With Breast Cancer: Regional Variations Within the U.S. SEER-Medicare-Linked Database. JACC Adv. Published 18 August 2025. doi:10.
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