Abstract：
The global increase in non-communicable diseases (NCDs) presents a critical public health concern. Emerging evidence suggests that exposure to natural environments may reduce the risk of developing NCDs through multiple pathways. The present systematic review aims to synthesize and evaluate the observational evidence regarding associations between exposure to green and blue spaces and hospital admissions related to NCDs. A comprehensive literature search strategy was conducted in Embase (Ovid), PubMed, and Web of Science. The risk of bias and quality of the evidence were assessed using The Navigation Guide methodology, an approach specifically designed for environmental health research. Of 3060 search results, 17 articles were included. Notably, the majority of the studies (n = 14; 82.4%) were published from 2020 onwards. Most studies were conducted in the United States (n = 6; 35.3%) and China (n = 4; 23.5%). Exposure to green spaces was assessed through all studies, while only three included blue spaces. In terms of study design, cohort design was employed in nearly half of the studies (n = 8; 47.1%), followed by case-crossover design (n = 3, 17.6%). Over 75% of the included studies (n = 13) had a high or probably high rating in the risk of bias assessment. The studies encompassed diverse NCD outcome domains; cardiovascular diseases (CVDs) (n = 10), respiratory diseases (RSDs) (n = 2), heat-related diseases (n = 1), metabolic diseases (n = 2), cancer (n = 1), neurodegenerative diseases (NDDs) (n = 2), and mental health disorders (n = 2). The present review suggests that a clear link between blue space exposure and NCD hospital admissions is not evident. However, exposure to green spaces appears to predominantly have a protective effect, although the direction of the association varies across different outcome domains. The heterogeneity among the outcome domains together with the limited number of studies, emphasizes the need for more robust evidence.
摘要：
全球非传染性疾病（NCDs）的增加是一个严重的公共卫生问题。新出现的证据表明，暴露于自然环境可能通过多种途径降低发展非传染性疾病的风险。本系统评价旨在综合和评估有关绿色和蓝色空间暴露与非传染性疾病相关的入院之间的关联的观察证据。在Embase(Ovid)进行了全面的文献检索策略，PubMed,和WebofScience。使用导航指南方法评估偏倚风险和证据质量，专门为环境健康研究设计的方法。在3060个搜索结果中，共包括17篇文章。值得注意的是,大多数研究(n=14;82.4%)从2020年开始发表。大多数研究在美国(n=6;35.3%)和中国(n=4;23.5%)进行。通过所有研究评估了对绿色空间的暴露，而只有三个包含蓝色空间。在研究设计方面，近一半的研究采用队列设计(n=8；47.1%)，其次是病例交叉设计(n=3，17.6%)。超过75％的纳入研究（n=13）在偏倚风险评估中具有较高或可能较高的评级。这些研究涵盖了不同的非传染性疾病结局领域；心血管疾病(CVD)(n=10)，呼吸系统疾病（RSD）（n=2），与热有关的疾病（n=1），代谢性疾病（n=2），癌症（n=1），神经退行性疾病（NDDs）（n=2），和精神健康障碍（n=2）。本审查表明，蓝色空间暴露与NCD住院之间的明确联系并不明显。然而,暴露于绿色空间似乎主要具有保护作用，尽管关联的方向在不同的结果领域有所不同。结果领域之间的异质性以及有限的研究数量，强调需要更有力的证据。
