{
  "abstract": "Background: Rising temperatures and the frequency of heat waves are challenges that have an impact on the health and mortality of populations. A high level of greenness is emerging as a strategy to mitigate the effects of extreme heat. Objective: To assess whether higher levels of greenness are associated with reduced mortality compared with lower greenness during periods of extreme heat. Methods: In this systematic review and meta‑analysis, we searched MEDLINE, SCOPUS, WEB OF SCIENCE, CINHAL, Environment Complete, and GreenFILE. Observational studies were included. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated via a random‑effects model. Results: The systematic review and meta‑analysis included 11 articles. These cover data from China, France, Germany, Jordan, Switzerland, and the USA, as well as a global analysis covering 24 countries. The meta‑analysis suggested that heat waves significantly increased mortality in areas with the lowest greenness (RR = 1.33; 95% CI: 1.15–1.55; I2 = 99.4%) and in areas with the highest greenness (RR = 1.18; 95% CI: 1.03–1.36; I2 = 97.9%). The pooled ratio of RR (RoR) indicated that the association was significantly stronger in low‑greenness areas than in high‑greenness areas (RoR = 1.11; 95% CI: 1.06–1.15; I2 = 90.5%), indicating that the heat–mortality association was 11% stronger in low‑greenness areas. The pooled associations varied descriptively across subgroup analyses, although no statistically significant differences were observed between geographical regions or study settings. Conclusion: Higher temperatures were associated with increased mortality in both low‑ and high‑greenness areas; however, the heat–mortality association was 11% stronger in low‑greenness areas. These findings suggest that greater greenness may attenuate vulnerability to extreme heat, although the limited evidence base and considerable between‑study heterogeneity warrant cautious interpretation.",
  "abstract_shown": true,
  "affiliations": [
    "Health and Social Research Center, Universidad de Castilla‑La Mancha‑Campus de Cuenca, 16071, Cuenca; Research Group Health, Gender, and Social Determinants, Universidad de Castilla‑La Mancha‑Campus de Cuenca, 16071, Cuenca; Research Group Health, Gender, and Social Determinants, Instituto de Investigación Sanitaria de Castilla‑La Mancha (IDISCAM)",
    "Health and Social Research Center, Universidad de Castilla‑La Mancha‑Campus de Cuenca, 16071, Cuenca; Research Group Health, Gender, and Social Determinants, Instituto de Investigación Sanitaria de Castilla‑La Mancha (IDISCAM); Faculty of Nursing of Albacete, Universidad de Castilla‑La Mancha‑Campus de Albacete, 02071, Albacete",
    "Health and Social Research Center, Universidad de Castilla‑La Mancha‑Campus de Cuenca, 16071, Cuenca; Research Group Health, Gender, and Social Determinants, Universidad de Castilla‑La Mancha‑Campus de Cuenca, 16071, Cuenca; Faculty of Nursing of Cuenca, Universidad de Castilla‑La Mancha‑Campus de Cuenca, 16071, Cuenca",
    "Health and Social Research Center, Universidad de Castilla‑La Mancha‑Campus de Cuenca, 16071, Cuenca; Research Group Health, Gender, and Social Determinants, Instituto de Investigación Sanitaria de Castilla‑La Mancha (IDISCAM)",
    "Health and Social Research Center, Universidad de Castilla‑La Mancha‑Campus de Cuenca, 16071, Cuenca; Research Group Health, Gender, and Social Determinants, Instituto de Investigación Sanitaria de Castilla‑La Mancha (IDISCAM); Faculty of Nursing of Cuenca, Universidad de Castilla‑La Mancha‑Campus de Cuenca, 16071, Cuenca",
    "Health and Social Research Center, Universidad de Castilla‑La Mancha‑Campus de Cuenca, 16071, Cuenca; Research Group Health, Gender, and Social Determinants, Universidad de Castilla‑La Mancha‑Campus de Cuenca, 16071, Cuenca",
    "Health and Social Research Center, Universidad de Castilla‑La Mancha‑Campus de Cuenca, 16071, Cuenca, Spain; Higher Institute of Physical Education, Universidad de la República, 20000, Maldonado, Uruguay; Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet and Stockholm University, 17165, Stockholm"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 8,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Ana Perez‑Moreno"
    },
    {
      "affs": [
        1
      ],
      "name": "Maria Martinez‑Andres"
    },
    {
      "affs": [
        2
      ],
      "name": "Blanca Notario‑Pacheco"
    },
    {
      "affs": [
        1
      ],
      "name": "Irene Marcilla‑Toribio"
    },
    {
      "affs": [
        3
      ],
      "name": "Shkelzen Cekrezi"
    },
    {
      "affs": [
        4
      ],
      "name": "Lidia Lucas‑de la Cruz"
    },
    {
      "affs": [
        5
      ],
      "name": "Antonio Miguel Caraballo‑Betancort"
    },
    {
      "affs": [
        6
      ],
      "name": "Bruno Bizzozero‑Peroni"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/3g16nqvrzjfks.bib",
  "cited_by": 0,
  "doi": "10.5334/aogh.5216",
  "fulltext_url": "https://account.annalsofglobalhealth.org/index.php/up-j-agh/article/view/5216",
  "id": "3g16nqvrzjfks",
  "issns": [
    "2214-9996"
  ],
  "landing_url": "https://doi.org/10.5334/aogh.5216",
  "language": "en",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "lcc",
      "RA1-1270"
    ],
    [
      "lcc",
      "RC109-216"
    ],
    [
      "openalex",
      "2307|Climate Change and Health Impacts"
    ]
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  "openalex": "W7214327072",
  "pdf_url": "https://annalsofglobalhealth.org/articles/5216/files/6ab660bba8032.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-09-01",
  "publisher": "Ubiquity Press",
  "ris": "https://research.draconitic.com/paper/3g16nqvrzjfks.ris",
  "sources": [
    {
      "first_seen": "2026-10-31T14:22:05Z",
      "native_id": "013d727f3f754918b38dba6ea87bd996",
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      "url": "https://doi.org/10.5334/aogh.5216"
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2307|Climate Change and Health Impacts",
      "subfield": "pharmacology-toxicology"
    }
  ],
  "title": "The Role of Greenness in Heat‑Related Mortality: A Systematic Review and Meta‑Analysis",
  "title_text": "The Role of Greenness in Heat‑Related Mortality: A Systematic Review and Meta‑Analysis",
  "type": "peer-reviewed",
  "updated_at": "2026-10-31T14:22:05Z",
  "url": "https://research.draconitic.com/paper/3g16nqvrzjfks",
  "venue": "Annals of Global Health",
  "versions": []
}