Green Spaces, Land Cover, Street Trees and Hypertension in the Megacity of Sao Paulo

Proximity to green spaces has been shown to be beneficial to several cardiovascular outcomes in urban spaces. Few studies, however, have analyzed the relationship between these outcomes and green space or land cover uses in low-medium income megacities, where the consequences of rapid and inordinate urbanization impose several health hazards. This study used a subgroup of the dataset from The Brazilian Longitudinal Study of Adult Health ELSA-BRASIL (n = 3418) to identify the correlation between the medical diagnosis of hypertension and green spaces in the megacity of Sao Paulo. Land cover classification was performed based on the random forest algorithm using geometrically corrected aerial photography (orthophoto). Three different indicators of exposure to green spaces were used: number of street trees, land cover and number of parks within 1 km. We used logistic regression models to obtain the association of the metrics exposure and health outcomes. The number of street trees in the regional governments (OR = 0.937 and number of parks within 1 km (OR = 0.876) were inversely associated with a diagnosis of hypertension. Sixty-three percent of the population had no parks within 1 km of their residence. Our data indicate the need to encourage large-scale street tree planting and increase the number of qualified parks in megacities.