越来越多的证据表明，暴露在自然环境（如绿地）中可能在健康方面起着有益的作用。然而，目前关于接触蓝色空间与死亡率的影响的证据非常有限。我们使用生态研究设计，调查在希腊暴露于蓝色空间与自然和特定病因死亡率之间的关联。方法：我们从2011年人口普查数据中获取了1,035个市政单元的死亡率和社会经济数据。为了定义“蓝色”暴露，我们使用了与蓝色空间相关的土地覆盖类别的比率，根据CORINE 2012地图每10,000人在市政单位内的比例来进行评估。我们还使用到海岸线的距离作为接近蓝色空间的代理来评估在希腊海岸线上的市政单位的蓝色空间暴露。通过土地利用回归模型预测了2010年的年PM2.5、NO2、BC和O3浓度，使用归一化植被指数来评估绿色程度。我们应用单一和二元曝露的Poisson回归模型，考虑空间自相关并调整失业率和肺癌死亡率、25-64岁受过高等教育或有大专以上学历的人口比例，以及出生在希腊的人口比例和城市化程度。该分析是针对整个国家进行的，并按不同的地理定义进行单独分析。每10,000人的蓝色空间中的四分位数范围内的增加与自然死亡风险减少有关（相对风险（RR）：0.98（95%置信区间（CI）：0.98，0.99），以及心血管原因、呼吸原因和神经系统疾病的死亡率为0.98（95% CI：0.97，0.99）；0.97（95% CI：0.95，0.99）；0.94（95% CI：0.88，1.00））。我们估计缺血性心脏病（IHD）死亡（每IQR RR = 0.98、95% CI：0.97、1.00）；COPD死亡（每IQR RR = 0.97、95% CI：0.93、1.00）和脑血管疾病死亡（每IQR RR = 0.97（95% CI：0.96，0.99）。我们估计了与神经系统疾病的死亡相关的距离保护性关联（每IQR RR = 0.75，95% CI：0.61-0.92，距离海岸线≤1km与>1km）。我们的结果更加显著适用于希腊岛屿、海岸线以及农村地区的居民，而估计值对于共同暴露调整是健壮的。我们在希腊发现了接触蓝色空间对自然、心血管和呼吸原因死亡率、神经系统疾病、脑血管疾病和缺血性心脏病有统计学意义的保护效应，在海岸线和岛屿上估计值更高。需要进一步研究来阐明我们的发现。 版权 © 2023 Elsevier GmbH。保留所有权利。

A growing body of evidence suggests that exposure to natural environments, such as green space, may have a beneficial role in health. However, there is limited evidence regarding the effects of exposure to blue spaces and mortality. We investigated the association of exposure to blue spaces with natural and cause-specific mortality in Greece using an ecological study design METHODS: Mortality and socioeconomic data were obtained from 1,035 municipal units (MUs) from the 2011 census data. To define exposure to "blue" we used a rate of the land cover categories related to blue space from the COoRdination and INformation on the Environmental (CORINE) 2012 map per 10,000 persons in the municipal unit. We further assessed the exposure to blue space in the MUs that are located in the coastline of Greece using the distance to the coast as a proxy for proximity to blue space. the Annual PM2.5, NO2, BC and O3 concentrations for 2010 were predicted by land use regression models while the normalized difference vegetation index was used to assess greenness. We applied single and two exposure Poisson regression models accounting for spatial autocorrelation and adjusting for unemployment and lung cancer mortality rates, percentages of the population aged 25-64 with upper secondary or tertiary education attainment and of those born in Greece, and urbanicity. The analysis was conducted for the whole country and separately by varying geographical definitions.An interquartile range (IQR) increase of blue space per 10,000 persons was associated with decreased risk in natural mortality (Relative Risk (RR): 0.98 (95% confidence interval (CI): 0.98, 0.99), as well as in mortality due to cardiovascular causes, respiratory causes and diseases of the nervous system 0.98 (95% CI: 0.97, 0.99); 0.97 (95% CI: 0.95, 0.99); 0.94 (95% CI: 0.88, 1.00) respectively). We estimated protective associations for ischemic heart disease (IHD) mortality (RR = 0.98, 95% CI: 0.97, 1.00 per IQR); COPD mortality (RR = 0.97, 95% CI: 0.93, 1.00 per IQR) and mortality from cerebrovascular disease (RR = 0.97 (95% CI: 0.96, 0.99 per IQR). We estimated protective associations for the distance from the coast and mortality from the diseases of the nervous system (RR = 0.75, 95% CI: 0.61, 0.92, ≤1 km from the coast versus >1 km). Our results were stronger for inhabitants of the islands, the coastline and in the rural areas of Greece while the estimates were robust to co-exposure adjustment.We estimated statistically significant protective effects of exposure to blue space on mortality from natural, cardiovascular and respiratory causes, diseases of the nervous system, cerebrovascular and ischemic heart disease for in Greece with higher estimates in the coastline and the islands. Further research is needed to elaborate our findings.Copyright © 2023 Elsevier GmbH. All rights reserved.