Abstract：
Green spaces play a crucial role in promoting sustainable and healthy lives. Recent evidence shows that green space also may reduce the need for healthcare, prescription medications, and associated costs. This systematic review provides the first comprehensive assessment of the available literature examining green space exposure and its associations with healthcare prescriptions and expenditures. We applied Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to search MEDLINE, Scopus, and Web of Science for observational studies published in English through May 6, 2023. A quality assessment of the included studies was conducted using the Office of Health Assessment and Translation (OHAT) tool, and the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) assessment was used to evaluate the overall quality of evidence. Our search retrieved 26 studies that met the inclusion criteria and were included in our review. Among these, 20 studies (77 % of the total) showed beneficial associations of green space exposure with healthcare prescriptions or expenditures. However, most studies had risks of bias, and the overall strength of evidence for both outcomes was limited. Based on our findings and related bodies of literature, we present a conceptual framework to explain the possible associations and complex mechanisms underlying green space and healthcare outcomes. The framework differs from existing green space and health models by including upstream factors related to healthcare access (i.e., rurality and socioeconomic status), which may flip the direction of associations. Additional research with lower risks of bias is necessary to validate this framework and better understand the potential for green space to reduce healthcare prescriptions and expenditures.
摘要：
绿色空间在促进可持续和健康生活方面发挥着至关重要的作用。最近的证据表明，绿色空间也可能减少对医疗保健的需求，处方药,以及相关成本。本系统综述提供了对现有文献的首次全面评估，这些文献检查了绿地暴露及其与医疗保健处方和支出的关联。我们应用系统评价和荟萃分析(PRISMA)指南的首选报告项目来搜索MEDLINE，Scopus,和WebofScience的观察研究在2023年5月6日以英文发表。使用健康评估和翻译办公室（OHAT）工具对纳入的研究进行了质量评估，和建议的分级，评估,发展,和评估（GRADE）评估用于评估总体证据质量。我们的搜索检索到26项符合纳入标准的研究，并纳入我们的综述。其中,20项研究（占总数的77％）显示了绿色空间暴露与医疗保健处方或支出的有益关联。然而,大多数研究都有偏见的风险，两种结局的总体证据强度有限.根据我们的发现和相关文献，我们提出了一个概念框架来解释绿地和医疗结果的潜在关联和复杂机制.该框架与现有的绿色空间和健康模型不同，包括与医疗保健访问相关的上游因素(即，农村和社会经济地位)，这可能会翻转联想的方向。有必要进行更低偏见风险的其他研究，以验证此框架并更好地了解绿色空间减少医疗保健处方和支出的潜力。
