Neighborhood Greenness Attenuates the Adverse Effect of PM(2.5) on Cardiovascular Mortality in Neighborhoods of Lower Socioeconomic Status

Features of the environment may modify the effect of particulate matter ≤2.5 µm in aerodynamic diameter (PM(2.5)) on health. Therefore, we investigated how neighborhood sociodemographic and land-use characteristics may modify the association between PM(2.5) and cardiovascular mortality. We obtained residence-level geocoded cardiovascular mortality cases from the Massachusetts Department of Public Health (n = 179,986), and PM(2.5) predictions from a satellite-based model (2001–2011). We appended census block group-level information on sociodemographic factors and walkability, and calculated neighborhood greenness within a 250 m buffer surrounding each residence. We found a 2.54% (1.34%; 3.74%) increase in cardiovascular mortality associated with a 10 µg/m(3) increase in two-day average PM(2.5). Walkability or greenness did not modify the association. However, when stratifying by neighborhood sociodemographic characteristics, smaller PM(2.5) effects were observed in greener areas only among cases who resided in neighborhoods with a higher population density and lower percentages of white residents or residents with a high school diploma. In conclusion, the PM(2.5) effects on cardiovascular mortality were attenuated by higher greenness only in areas with sociodemographic features that are highly correlated with lower socioeconomic status. Previous evidence suggests health benefits linked to neighborhood greenness may be stronger among lower socioeconomic groups. Attenuation of the PM(2.5)–mortality relationship due to greenness may explain some of this evidence.