Association Between Surrounding Greenness and Schizophrenia: A Taiwanese Cohort Study

Abstract

This study aims to investigate the association between surrounding greenness and schizophrenia incidence in Taiwan. Data of 869,484 individuals without a history of schizophrenia were included from the Longitudinal Health Insurance Database from 2000 through 2010 for analysis. The diagnoses of schizophrenia were based on ICD-9 codes. Greenness exposure was assessed using the satellite-based normalized difference vegetation index, assuming individuals lived near the hospital they most often visited for common cold during the study period. Cox proportional hazards models were applied to assess the association between greenness exposure and schizophrenia incidence after adjustments were made for the potential confounders. A total of 5,069 schizophrenia cases were newly diagnosed during the study period. A negative significant (P < 0.05) association found using 2,000-m buffer distances (distance of a moderately paced 20-min walk) in the whole Taiwan island, cities, and metropolitan areas. The results of the stratified analysis based on sex and health insurance rate suggested surrounding greenness has approximately equal effects of reducing the risk of schizophrenia, regardless of sex or financial status. In conclusion, our findings suggest that more surrounding greenness may reduce the risk of schizophrenia.