健康是人類福祉最基本之要求。近年隨著社會環境的快速變化，強烈影響人類的健康與疾病負擔。世界衛生組織（WHO）的報告指出，心血管疾病是生理負擔的主要死因，而憂鬱症則為心理負擔的先驅。
許多研究已證明綠蔽度對健康的有益影響，但幾乎沒有研究係針對全球為範疇來探索它們之間的關聯。基於此，本研究基於生態調查研究的實驗證計，針對全球183個國家/地區做為研究試區，以分析綠蔽度與缺血性心臟病（IHD）、中風和憂鬱症所造成全球疾病負擔間之關聯。健康資料庫係使用世界衛生組織提供的2000、2010、2015及2016年等四時期之國家級失能調整生命年（DALY）數據庫，以代表研究國家因IHD、中風和抑鬱症引起的疾病負擔；並利用空間解析度1 x 1 km2之常態化差異植生指標（NDVI），以評估各國之綠蔽度程度；模型中所考量的風險因子包含人口統計學因素（人口、性別及年齡）、社會經濟地位（收入水準和受教育程度）、生活方式（飲酒和吸煙）、共病症因素（肥胖、膽固醇和血壓），醫療保健支出和細懸浮微粒暴露濃度（PM2.5）。本研究應用Global Moran’s I 以及Getis-Ord Gi*來定義綠蔽度以及健康負擔在空間上的熱點分布。在控制所有可取得之風險因子後，應用廣義線性混合模型（GLMMPQL），以評估綠蔽度與全球生心理疾病負擔間的關聯。同時並透過敏感性分析、分層分析及陽性-陰性對照測試，以確認綠暴露與疾病負擔間關聯的穩定性。
研究結果發現，綠蔽度與生心理健康負擔之間始終存在顯著的負相關。主模型的NDVI係數在IHD、中風與憂鬱症分別為 -3.376 (95% CI: -5.083, -1.670), -1.274 (95% CI: -2.354, -0.194）, 和 -0.196 (95% CI: -0.357, -0.036). 在隨後的分析中，敏感性測試結果證實了模型估值的穩定與可靠性，代表綠暴露的增加，對於減輕IHD、中風和憂鬱症的疾病負擔具有顯著的影響。分層分析結果顯示，即使分析國家在性別、年齡和經濟狀況有所差異國家，綠蔽度對於疾病負擔仍具有顯著的有益作用（尤其是IHD和抑鬱症患者）。本研究成果希望有助於釐清綠蔽度與人類健康間的關係。

Physical and psychological health is a fundamental part of human well-being. However, the existence of various problems related to socio-demography, environment, and behavior has resulted in an increasingly severe health burden. The World Health Organization (WHO) reported that cardiovascular disease is a leading cause of death for physical burden and depression as a pioneer for psychological burden.
Recognizing that numerous studies have marked the beneficial effects of greenness on general health, but scarcely explored their linkage globally, thus, this ecological study proposed a novel concept to evaluate the association between greenness and physical-psychological health burdens including ischemic heart disease (IHD), stroke, and depressive disorders in 183 countries worldwide. Country-level disability-adjusted life year (DALY) database provided by the WHO in 2000, 2010, 2015, and 2016 was used to represent the health burdens. Normalized difference vegetation index (NDVI) with spatial resolution 1 x1 km2 was assessed to estimate exposure to greenness. Several potential risk factors associate with corresponding health burdens such as demographic factors, social-economic status, lifestyle behaviors, comorbidities, healthcare expenditure, and fine particulate matter exposure (PM2.5) were considered. Global Moran’s I and Getis-Ord Gi* were applied to identify the spatial pattern and hotspots of greenness and health burdens. After controlling for all risk factors, the generalized linear mixed model penalized quasi-likelihood coupled with sensitivity tests were applied to evaluate the association between greenness and related health burdens. The subgroup analyses were then conducted to investigate the effects of greenness on IHD, stroke, and depressive disorders among various conditions. Positive-negative controls also established to examine the strength of causal findings of an outcome-exposure association when unconsidered variables were thought to be present.
A consistently significant negative association was found between greenness and both physical and psychological health burdens; the coefficients of the main model were -3.376 (95% CI: -5.083, -1.670), -1.274 (95% CI: -2.354, -0.194), and -0.196 (95% CI: -0.357, -0.036) for IHD, stroke and depressive disorders, respectively, in the DALY changes per interquartile unit increment of NDVI (IQR = 0.309). In the subsequent analysis, sensitivity test confirmed the robustness of the models. These findings indicate exposure to greenness has positive impacts on reducing the burden of IHD, stroke, and depressive disorders. The stratified analyses also showed the significantly beneficial effects of greenness on studied diseases regardless of gender difference, various age groups, and low-income countries especially for IHD and depressive disorders. Finally, this study figured out that greenness exposure may contribute to reducing the burden of physical and psychological health. These findings should be interpreted as recommendations for relevant authorities in supporting environmental greenness enhancement to alleviate the health burdens.

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