Cross-sectional association of residential greenness exposure with activities of daily living disability among urban elderly in Shanghai

Short-term air pollution and greenness exposures on oxidative stress in urban and peri-urban residents in Beijing: A part of AIRLESS study

BACKGROUND

Exposure to air pollution has been associated with increased risks of cardiopulmonary diseases, cancer, and mortality, whereas residing near green spaces may reduce the risks. However, limited research explores their combined effect on oxidative stress.

METHODS

A total of 251 participants with multi-time measurements were included in the longitudinal-designed study. Personal gaseous air pollutants (CO, NO, NO2, and O3,) and particulate pollution (PM1, PM2.5, and PM10) were measured and followed in two 7-day windows while ambient exposure levels and urine samples were collected simultaneously. Participants' Normalized Difference Vegetation Index (NDVI) was estimated and used to represent greenness exposure. Urinary oxidative stress biomarkers include free malondialdehyde (MDA), total MDA, and 8-hydroxydeoxyguanosine (8-OHdG). Linear mixed-effects models were used to independently and jointly estimate the associations of greenness and air pollution with oxidative stress biomarkers.

RESULTS

We found consistent positive associations of personal ozone (O3) exposure with 8-OHdG percent changes, and this association was modified by gender and outdoor activity frequency. Consistent positive associations of personal lag 2-day carbon monoxide (CO) exposure with the percent changes of the three oxidative stress biomarkers were significant. We additionally observed that individuals who lived in greener areas had lower levels of urinary-free and total MDA. Participants in the highest NDVI tertile had 0.38 and 0.46 lower free and total MDA levels, [95 % CI: (-0.70, -0.05) and (-0.78, -0.13)], compared to the lowest NDVI tertile. There was also evidence indicating the modification effects by area, education, and outdoor activity frequency on associations between NDVI exposure and creatinine adjusted free MDA (all Pfor interaction < 0.05). Additional greenness modification effects on personal O3 exposure with urinary 8-OHdG was observed.

CONCLUSION

Our study provides biological evidence of the modification effect of the built environment on the impact of air pollution.

Associations between the urban neighbourhood built and social environment characteristics with physical functioning among mid- and older-aged adults: A systematic review

There is growing recognition of the association between neighbourhood factors and individuals' health. This systematic review examines the associations between urban neighbourhood built and social environment characteristics with different measures of physical functioning among mid- and older-aged adults over 45 years, focusing on cross-sectional and longitudinal study designs. It responds to the increase in publications on this topic following the COVID-19 pandemic. The systematic review included 25 studies written in English from 2018 onwards sourced from 8 databases. Studies were imported into Covidence and reviewed following the 'Preferred Reporting Items for Systematic Reviews and Meta-Analysis' (PRISMA) protocols. Findings were assessed according to 13 neighbourhood environment variables: aesthetics, crime safety, greenness and parks, land use mix and destinations, neighbourhood disadvantage, pedestrian/street infrastructure, public transport, residential density, social environment, street connectivity, traffic safety, walkability, and composite variables. Significant associations in the expected direction were found for land use mix and destinations, walkability, crime safety, greenness and parks, social environment, and neighbourhood disadvantage with physical functioning in mid- and older-aged adults. Weaker evidence of expected associations was found for residential density and aesthetics. Future research avenues on this topic include investigating built and social neighbourhood environments in diverse geographies and populations, considering housing status and length of exposure to the neighbourhood environment, using longitudinal surveys over longer time periods and objective measurements.

Access to urban green spaces and use of social services and institutional long-term care among older people in Malmö, Sweden: a longitudinal register study

BACKGROUND

Finding ways to prolong independence in daily life among older people would be beneficial for both individuals and society. Urban green spaces have been found to improve health, but only a few studies have evaluated the association between urban green spaces and independence in daily life. The aim of this study was to assess the long-term effect of urban green spaces on independence in daily life, using social services and support, mobility aids, and relocation to institutional long-term care as proxies, among community dwelling people 65 + years.

METHODS

We identified 40 357 people 65 + years living in the city of Malmö, Sweden in 2010. Using geographical information systems (GIS), we determined the amount of urban green spaces (total, public, and quiet) within 300 m of each person's residence. All three measures were categorized based on their respective percentiles, so that the first quartile represented the 25% with the least access and the fourth quartile the 25% with the most access. In 2015 and 2019, we assessed the outcomes minor assistance (non-personal support), major assistance (personal support), and relocation into institutional long-term care. These three outcome measures were used as proxies for independence in daily life. The effect of amount of urban green spaces in 2010 on the three outcomes in 2015 and 2019, respectively, was assessed by pairwise comparing the three highest quartiles to the lowest.

RESULTS

Compared to the lowest quartile, those in the highest quartile of quiet green spaces in 2010 were less likely to receive minor assistance in both 2015 and 2019. Besides this, there were no indications that any of the measures of urban green space affected independence in daily life at the five- and nine-year follow-up, respectively.

CONCLUSION

Although urban green spaces are known to have positive impact on health, physical activity, and social cohesion among older people, we found no effect of total, public, or quiet green spaces on independence in daily life. This could possibly be a result of the choice of measures of urban green spaces, including spatial and temporal aspects, an inability to capture important qualitative aspects of the green spaces, or the proxy measures used to assess independence in daily life.

The effects of neighborhood socioeconomic status on ADL/IADL among Chinese older adults-neighborhood environments as mediators

Background

There have been few consistencies in the effects and pathways of neighborhood socioeconomic status (SES) on functional limitations. This study aimed to investigate whether neighborhood socioeconomic status influences ADL/IADL in older residents in China through the neighborhood built environment and social environment.

Methods

Activities of daily living/IADL were assessed in a sample of 5,887 Chinese individuals aged 60 or older, utilizing data obtained from the 2011 China Health and Retirement Longitudinal Study (CHARLS 2011). Neighborhood SES was measured by the neighborhood per-capita net income. Neighborhood built environment was measured by the security resources, motion resources, living resources, service resources for older adults, and medical resources of neighborhood. Neighborhood social environment was measured by the organizations, unemployment subsidies, minimum living allowance, subsidies to persons older than 65, and pensions to persons older than 80 of the neighborhood. The two-level logistical regression model and multilevel structural equation model (MSEM) were used.

Results

The rate of ADL/IADL loss among Chinese older adults aged 60 and above in 2011 were 32.17 and 36.87%, respectively. Neighborhood SES was significantly associated with ADL/IADL in older adults. Compared with the respondents living in communities with lower SES, those living in communities with higher SES possessed better ADL (β = -0.33, p < 0.05) and IADL (β = -0.36, p < 0.05) status. The path of neighborhood socioeconomic status on ADL was completely mediated by the neighborhood built environment (β = -0.110, p < 0.05) and neighborhood social environment (β = -0.091, p < 0.05). Additionally, the effect of neighborhood socioeconomic status on IADL was fully mediated by the neighborhood built environment (β = -0.082, p < 0.05) and neighborhood social environment (β = -0.077, p < 0.05).

Conclusion

Neighborhood SES was significantly correlated with ADL/IADL through the neighborhood environment. Improving the ADL/IADL status of older adults residing in low socioeconomic neighborhoods requires enhancing the built and social environment by provisioning additional neighborhood resources.

Residential greenness exposure and decreased prevalence of diabetic retinopathy: A nationwide analysis in China

OBJECTIVE

Diabetic retinopathy (DR) is a leading cause of vision impairment and blindness among diabetics. We aimed to explore whether long-term exposure to residential greenness was beneficial to DR.

RESEARCH DESIGN AND METHODS

We used data from a large-scale, cross-sectional screening survey conducted in 129 cities of 27 provincial regions of China from 2018 to 2021 among patients with diabetes. We measured residential greenness exposure as the 3-year average of annual maximum Normalized Difference Vegetation Index (NDVI) at a spatial resolution of 250 m. DR was assessed by ophthalmologists based on fundus photographs. The primary outcome was DR, and secondary outcome included DR severity status (i.e., nonproliferative and proliferative), hallmarks of retinal lesions and macular oedema.

RESULTS

A total of 484,380 adult participants with diabetes were included in the current analysis, and 15.7% of them were diagnosed with DR. NDVI was inversely and linearly associated with DR prevalence, and an increment of 0.1 NDVI was associated with a 10% (9%-10%) decrease in DR prevalence. Significant and inverse associations were further found for nonproliferative and proliferative DR, hallmarks of lesions and macular oedema. The association between greenness and DR was stronger among participants who were older, obese, lived in the south, had longer duration of diabetes or did not take antidiabetic medications.

CONCLUSIONS

This large-scale nationwide study provides the first-hand epidemiological evidence on the associations of residential greenness with DR. Our findings highlight the importance of residential greenness in alleviating DR risk especially in an era of aging and urbanization.

Association between residential greenness and all-cause mortality and the joint mediation effect of air pollutants among old people with disability: A prospective cohort study

BACKGROUND

Residential greenness offers health benefits to old people, but evidence of its association with the health of old people with disability is scarce. Moreover, due to the limited mobility of this vulnerable population, air pollutants may play an indispensable mediating role in that association, which however remains understudied.

OBJECTIVES

This study aimed to investigate the association between residential greenness and all-cause mortality risk and the joint mediation effect of air pollutants among old people with disability.

METHODS

A total of 34,075 old people with disability were included in the Chengdu Long-term Care Insurance cohort. Participants' residential greenness exposure was measured by an enhanced vegetation index within the 500 m buffer zone (EVI_500m). Causal mediation analysis was conducted to assess the total effect (TE) of residential greenness and the natural indirect effect (NIE) through PM_2.5, CO, NO₂, SO₂, and O₃ on all-cause mortality.

RESULTS

The TE of EVI_500m on the all-cause mortality risk in overall participants showed negative, which, decreased from the 2^nd quartile (HR = 0.93, 95 % CI: 0. 91, 0.95) to the 4^th quartile (HR = 0.81, 95 % CI: 0.76, 0.85); the NIE through the five air pollutants also decreased from the 2^nd quartile (HR = 0.96, 95 % CI: 0.95, 0.98) to the 4^th quartile (HR = 0.90, 95 % CI: 0.88, 0.93), with the proportion mediated decreased from 48 % to 44 %. The stronger TE or NIE were observed in participants aged <80 years old, men, with mild-moderate disability, and having outdoor experience every week.

CONCLUSION

Exposure to residential greenness was associated with a decreased risk of mortality, partially through the pathways of air pollutants, which varied by age, sex, degree of disability, and frequency of weekly outdoors. Our findings would provide evidence to develop aging-friendly cities.

Concurrent dietary intake to nitrate, thiocyanate, and perchlorate is negatively associated with hypertension in adults in the USA

We aimed to comprehensively evaluate the association of urinary nitrate, thiocyanate, and perchlorate metabolites with hypertension among a nationally representative sample of the US adult population. This cross-sectional study investigated data from 15,717 adults aged more than 20 years obtained from the National Health and Nutritional Examination Survey (NHANES) for the years 2005-2016. In the survey, urinary levels of nitrate, thiocyanate, and perchlorate were measured using ion chromatography combined with electrospray tandem mass spectrometry. Blood pressure was calculated as the mean of three measurements. Hypertension was defined as (a) systolic BP ≥130 and/or diastolic BP ≥80 mmHg and/or (b) self-report. Multivariate logistic regression and weighted quantile sum (WQS) regression models were applied to estimate the association between exposure to multiple inorganic anions and hypertension. Restricted cubic spline (RCS) regressions were fitted to discern the potential relationship between the anion exposure and hypertension. These innovation methods used to support our results. Overall, 7533 (49.95%) people with and 7638 (50.35%) without hypertension were included in this study. In the multivariable-adjusted logistic regression models, urinary nitrate (P < 0.001) and perchlorate (P < 0.001) were independently negatively associated with increased occurrence of hypertension, while urinary thiocyanate was insignificantly associated with hypertension (P = 0.664). The WQS regression index showed that, in combination, the three inorganic anions mixture were negatively correlated with hypertension (adjusted OR 0.89; 95% CI 0.83-0.95, P < 0.001). Urinary nitrate was the most heavily weighted component in the hypertension model (weight = 0.784). RCS regression demonstrated that nitrate (nonlinearity P = 0.205) and perchlorate (nonlinearity P = 0.701) were linearly associated with decreased occurrence of hypertension. Concurrent exposure to nitrate, thiocyanate, and perchlorate is associated with a decreased risk of hypertension, with the greatest influence coming from nitrate probably; urinary specific thiocyanate alone had an insignificant association with hypertension.

Association of greenness with COVID-19 deaths in India: An ecological study at district level

BACKGROUND

The world has witnessed a colossal death toll due to the novel coronavirus disease-2019 (COVID-19). A few environmental epidemiology studies have identified association of environmental factors (air pollution, greenness, temperature, etc.) with COVID-19 incidence and mortality, particularly in developed countries. India, being one of the most severely affected countries by the pandemic, still has a dearth of research exploring the linkages of environment and COVID-19 pandemic.

OBJECTIVES

We evaluate whether district-level greenness exposure is associated with a reduced risk of COVID-19 deaths in India.

METHODS

We used average normalized difference vegetation index (NDVI) from January to March 2019, derived by Oceansat-2 satellite, to represent district-level greenness exposure. COVID-19 death counts were obtained through May 1, 2021 (around the peak of the second wave) from an open portal: covid19india.org. We used hierarchical generalized negative binomial regressions to check the associations of greenness with COVID-19 death counts. Analyses were adjusted for air pollution (PM2.5), temperature, rainfall, population density, proportion of older adults (50 years and above), sex ratio over age 50, proportions of rural population, household overcrowding, materially deprived households, health facilities, and secondary school education.

RESULTS

Our analyses found a significant association between greenness and reduced risk of COVID-19 deaths. Compared to the districts with the lowest NDVI (quintile 1), districts within quintiles 3, 4, and 5 have respectively, around 32% [MRR = 0.68 (95% CI: 0.51, 0.88)], 39% [MRR = 0.61 (95% CI: 0.46, 0.80)], and 47% [MRR = 0.53 (95% CI: 0.40, 0.71)] reduced risk of COVID-19 deaths. The association remains consistent for analyses restricted to districts with a rather good overall death registration (>80%).

CONCLUSION

Though cause-of-death statistics are limited, we confirm that exposure to greenness was associated with reduced district-level COVID-19 deaths in India. However, material deprivation and air pollution modify this association.

Greenspace exposure and poststroke disability: A nationwide longitudinal study

INTRODUCTION

Exposure to greenspace has been reported to reduce stroke mortality, but there is a lack of evidence regarding poststroke disability. This study aimed to investigate the association between long-term greenspace exposure and the risk of poststroke disability.

METHODS

Based on the China National Stroke Screening Survey from 2013 to 2019, a total of 65,892 visits from 28,085 stroke survivors with ≥ 2 visits were included in this longitudinal study. Long-term greenspace exposure was assessed by a 3-year average of the Normalized Difference Vegetation Index (NDVI) and the proportion of green land cover according to participants' residential communities. Poststroke functional status was assessed with the modified Ranking Score (mRS) at each visit; a cutoff score > 2 indicated disability. Fixed effects regressions were used to examine the association of greenspace exposure with continuous mRS scores or binary indicators for disability.

RESULTS

The annual mean NDVI value was 0.369 (standard deviation = 0.120) for all visits among stroke survivors. With full adjustments, each 0.05 increase in NDVI was associated with a 0.056-unit (95 % confidence interval (CI): 0.034, 0.079) decrease in the mRS score and a 46.6 % (95 % CI: 10.0 %, 68.3 %) lower risk of poststroke disability. An L-shaped curve was observed for the nonlinear associations between NDVI and mRS score or disability. Additionally, each 1 % increase in grasslands, savannas, forest, and croplands was associated with 0.008- (95 % CI: 0.002, 0.014), 0.003- (95 % CI: 0.001, 0.005), 0.001- (95 % CI: -0.015, 0.018), and 0.002-unit (95 % CI: -0.003, 0.007) decreases in the mRS score, respectively.

CONCLUSIONS

Increasing greenspace was inversely associated with mRS score. Greenspace planning can be a potential intervention to prevent poststroke disability.

The effects of greenness exposure on hypertension incidence among Chinese oldest-old: a prospective cohort study

BACKGROUND

Although the oldest-old (those aged over 80 years) are vulnerable to environmental factors and have the highest prevalence of hypertension, studies focusing on greenness exposure and the development of hypertension among them are insufficient. The aim of this study was to explore the association between residential greenness and hypertension in the oldest-old population.

METHODS

This cohort study included data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). The oldest-old were free of hypertension at baseline (2008), and hypertension events were assessed by follow-up surveys in 2011, 2014, and 2018. The one-year averages of the normalized difference vegetation index (NDVI) and enhanced vegetation index (EVI) at 500-m buffer before the interview year of incident hypertension or last censoring interview were collected at the level of 652 residential units (district or county). The linear or nonlinear association between greenness and hypertension incidence was analyzed using the Cox proportional hazards model with penalized splines. The linear links between greenness and hypertension incidence were determined using the Cox proportional hazards model included a random effect term.

RESULTS

Among 5253 participants, the incidence rate of hypertension was 7.25 (95% confidence interval [CI]: 6.83-7.67) per 100 person-years. We found a nonlinear association between greenness exposure and hypertension risk, and the exposure-response curve showed that 1 change point existed. We examined the linear effect of greenness on hypertension by categorizing the NDVI/EVI into low and high-level exposure areas according to the change point. We found more notable protective effects of each 0.1-unit increase in greenness on hypertension incidence for participants living in the high-level greenness areas (hazard ratio (HR) = 0.60; 95% CI: 0.53-0.70 for NDVI; HR = 0.46; 95% CI: 0.37-0.57 for EVI). In contrast, no significant influence of greenness exposure on hypertension risk was found for participants living in the low-level greenness areas (HR = 0.77; 95% CI: 0.38-1.55 for NDVI; HR = 0.73; 95% CI: 0.33-1.63 for EVI).

CONCLUSIONS

Greenness exposure is nonlinearly associated with hypertension risk among the oldest-old, presenting its relationship in an inverse "U-shaped" curve. Greenness is a protective factor that decreases the risk of hypertension.

Green Space and Health in Mainland China: A Systematic Review

Non-communicable diseases (NCDs) have become a major cause of premature mortality and disabilities in China due to factors concomitant with rapid economic growth and urbanisation over three decades. Promoting green space might be a valuable strategy to help improve population health in China, as well as a range of co-benefits (e.g., increasing resilience to climate change). No systematic review has so far determined the degree of association between green space and health outcomes in China. This review was conducted to address this gap. Five electronic databases were searched using search terms on green space, health, and China. The review of 83 publications that met eligibility criteria reports associations indicative of various health benefits from more green space, including mental health, general health, healthier weight status and anthropometry, and more favorable cardiometabolic and cerebrovascular outcomes. There was insufficient evidence to draw firm conclusions on mortality, birth outcomes, and cognitive function, and findings on respiratory and infectious outcomes were inconsistent and limited. Future work needs to examine the health benefits of particular types and qualities of green spaces, as well as to take advantage of (quasi-)experimental designs to test greening interventions within the context of China's rapid urbanization and economic growth.