Are accessibility and characteristics of public open spaces associated with a better cardiometabolic health?

This study investigated the associations between the accessibility, greenness, size, and type (active vs. passive) of public open spaces (POS) and clinical risk markers for cardiometabolic diseases and whether such associations could be explained (mediated) by physical activity and psychological well-being. Adult participants (n=3754) provided clinical, self-reported, and residential location data. Cardiometabolic risk was defined as the sum of six anthropometric and biochemical risk markers. POS accessibility was defined as the number and proportion of POS within a 1000-m road distance from participants’ residences. Greenness, size and type were respectively defined as the median Normalised Difference Vegetation Index, median size, and proportion of POS with a sporting land use for all accessible POS. Physical activity and psychological well-being were self-reported. Associations were tested using Poisson regression models accounting for spatial clustering of observations and participants’ age, gender, education, income and area-level socioeconomic disadvantage. The number and proportion of POS were not found to be statistically significantly related to cardiometabolic health; however, greenness, size, and type (active) of available POS were inversely related to cardiometabolic risk. The association between POS and cardiometabolic health was partially mediated by physical activity. Psychological well-being was not implicated in the associations tested. These results suggest that the characteristics, not the number or proportion, of locally accessible POS are related to cardiometabolic health and, to some degree, physical activity. Maintaining or improving the quality of locally available POS might be a more effective urban design strategy to support cardiometabolic health than efforts to increase the accessibility of POS.