Associations of street-view greenspace with Parkinson’s disease hospitalizations in an open cohort of elderly US Medicare beneficiaries

2024  Journal Article

Associations of street-view greenspace with Parkinson’s disease hospitalizations in an open cohort of elderly US Medicare beneficiaries


This study underscores the potential health benefits of specific types of greenspace, particularly trees and diverse plantings, in reducing the risk of Parkinson’s disease hospitalizations. It also highlights the need for targeted urban planning and public health policies to enhance greenspace, especially in marginalized communities, to promote health equity and overall well-being.


College of Health researcher(s)


Protective Associations of Trees and Other Green Features

The study found that increased visual exposure to trees and other green features (e.g., plants, flowers, fields) is associated with a reduced risk of first-time hospitalizations involving PD. Specifically, the hazard ratio (HR) per interquartile range (IQR) increase was 0.96 for trees and 0.97 for other green features, indicating a protective effect.

Harmful Association of Grass

In contrast, increased exposure to grass was associated with a higher risk of PD-involved hospitalizations, with an HR of 1.06 per IQR increase. This suggests that not all types of greenspace have the same health benefits.

Stronger Protective Effects for Marginalized Groups

The protective associations of trees and other green features were generally stronger for marginalized individuals, such as those eligible for Medicaid (low-income individuals) and Black individuals. This indicates that greenspace may help reduce health disparities.

Urban and High-Density Areas

The protective effects of trees were more pronounced in areas with lower median household income, higher population density, and higher nitrogen dioxide (NO2) concentrations. This suggests that urban greenspaces might be particularly beneficial in densely populated and polluted areas.



Protective associations of greenspace with Parkinson’s disease (PD) have been observed in some studies. Visual exposure to greenspace seems to be important for some of the proposed pathways underlying these associations. However, most studies use overhead-view measures (e.g., satellite imagery, land-classification data) that do not capture street-view greenspace and cannot distinguish between specific greenspace types. We aimed to evaluate associations of street-view greenspace measures with hospitalizations with a PD diagnosis code (PD-involved hospitalization).


We created an open cohort of about 45.6 million Medicare fee-for-service beneficiaries aged 65 + years living in core based statistical areas (i.e. non-rural areas) in the contiguous US (2007–2016). We obtained 350 million Google Street View images across the US and applied deep learning algorithms to identify percentages of specific greenspace features in each image, including trees, grass, and other green features (i.e., plants, flowers, fields). We assessed yearly average street-view greenspace features for each ZIP code. A Cox-equivalent re-parameterized Poisson model adjusted for potential confounders (i.e. age, race/ethnicity, socioeconomic status) was used to evaluate associations with first PD-involved hospitalization.


There were 506,899 first PD-involved hospitalizations over 254,917,192 person-years of follow-up. We found a hazard ratio (95% confidence interval) of 0.96 (0.95, 0.96) per interquartile range (IQR) increase for trees and a HR of 0.97 (0.96, 0.97) per IQR increase for other green features. In contrast, we found a HR of 1.06 (1.04, 1.07) per IQR increase for grass. Associations of trees were generally stronger for low-income (i.e. Medicaid eligible) individuals, Black individuals, and in areas with a lower median household income and a higher population density.


Increasing exposure to trees and other green features may reduce PD-involved hospitalizations, while increasing exposure to grass may increase hospitalizations. The protective associations may be stronger for marginalized individuals and individuals living in densely populated areas.

Klompmaker, J.O., Mork, D., Zanobetti, A., Braun, D., Hankey, S., Hart, J.E., Hystad, P., Jimenez, M.P., Laden, F., Larkin, A., Lin, P.I., Suel, E., Yi, L., Zhang, W., Delaney, S.W., James, P.(2024)Associations of street-view greenspace with Parkinson’s disease hospitalizations in an open cohort of elderly US Medicare beneficiariesEnvironment International188