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Axmon A, Mattisson K, Lethin C, Fänge AM, Carlsson G, Stroh E. 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. BMC Geriatr 2024; 24:489. [PMID: 38834961 PMCID: PMC11151513 DOI: 10.1186/s12877-024-05112-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 05/28/2024] [Indexed: 06/06/2024] Open
Abstract
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.
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Affiliation(s)
- Anna Axmon
- EPI@LUND (Epidemiology, population research, and infrastructures), Department of Laboratory Medicine, Lund University, Biskopsgatan 9, Lund, SE-223 62, Sweden.
| | - Kristoffer Mattisson
- Planetary Health, Department of Laboratory Medicine, Lund University, Biskopsgatan 9, Lund, SE- 223 62, Sweden
| | - Connie Lethin
- Department of Health Sciences, Lund University, P.O. Box 117, Lund, SE-22362, Sweden
| | - Agneta Malmgren Fänge
- Department of Health Sciences, Lund University, P.O. Box 117, Lund, SE-22362, Sweden
| | - Gunilla Carlsson
- Department of Health Sciences, Lund University, P.O. Box 117, Lund, SE-22362, Sweden
| | - Emilie Stroh
- EPI@LUND (Epidemiology, population research, and infrastructures), Department of Laboratory Medicine, Lund University, Biskopsgatan 9, Lund, SE-223 62, Sweden
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Scheer C, Plans-Beriso E, Pastor-Barriuso R, Ortolá R, Sotos-Prieto M, Cabañas-Sánchez V, Gullón P, Ojeda Sánchez C, Ramis R, Fernández-Navarro P, Rodríguez-Artalejo F, García-Esquinas E. Exposure to green spaces, cardiovascular risk biomarkers and incident cardiovascular disease in older adults: The Seniors-Enrica II cohort. ENVIRONMENT INTERNATIONAL 2024; 185:108570. [PMID: 38484611 DOI: 10.1016/j.envint.2024.108570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/07/2024] [Accepted: 03/07/2024] [Indexed: 03/26/2024]
Abstract
INTRODUCTION The impact of residential green spaces on cardiovascular health in older adults remains uncertain. METHODS Cohort study involving 2114 adults aged ≥ 65 years without cardiovascular disease (CVD), residing in five dense municipalities (Prince et al., 2015) of the Madrid region and with detailed characterization of their socioeconomic background, health behaviors, CVD biological risk factors, and mental, physical, and cognitive health. Greenness exposure was measured using the Normalized Difference Vegetation Index (NDVI) at varying distances from participants' homes. Traffic exposure, neighborhood environment, neighborhood walkability, and socioeconomic deprivation at the census level were also assessed. Serum N-terminal pro-B-type natriuretic peptide (NT-ProBNP), high-sensitivity troponin T (hs-TnT), interleukin 6 (IL-6), and Growth Differentiation Factor 15 (GDF-15) were measured at baseline, and incident CVD events identified through electronic medical records (International Classification of Primary Care-2 codes K74, K75, K77, K90, and K92). RESULTS After adjusting for sex, age, educational attainment, financial hardship and socioeconomic deprivation at the census level, an interquartile range (IQR) increase in NDVI at 250, 500, 750, and 1000 m around participants' homes was associated with mean differences in ProBNP of -5.56 % (95 %CI: -9.77; -1.35), -5.05 % (-9.58; -0.53), -4.24 % (-8.19, -0.19), and -4.16 % (-7.59; -0.74), respectively; and mean differences in hs-TnT among diabetic participants of -8.03 % (95 %CI: -13.30; -2.77), -9.52 % (-16.08; -2.96), -8.05 % (-13.94, -2.16) and -5.56 % (-10.75; -0.54), respectively. Of similar magnitude, although only statistically significant at 250 and 500 m, were the observed lower IL-6 levels with increasing greenness. GDF-15 levels were independent of NDVI. In prospective analyses (median follow-up 6.29 years), an IQR increase in residential greenness at 500, 750, and 1000 m was associated with a lower risk of incident CVD. The variables that contributed most to the apparent beneficial effects of greenness on CVD were lower exposure to traffic, improved cardiovascular risk factors, and enhanced physical performance. Additionally, neighborhood walkability and increased physical activity were notable contributors among individuals with diabetes. CONCLUSION Increased exposure to residential green space was associated with a moderate reduction in CVD risk in older adults residing in densely populated areas.
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Affiliation(s)
- Cara Scheer
- Fulda University of Applied Sciences. Fulda, Germany
| | - Elena Plans-Beriso
- Public Health and Epidemiology Research Group, School of Medicine, Universidad de Alcala, 28871 Madrid, Spain; Department of Chronic Diseases, National Center of Epidemiology, Carlos III Health Institute, Madrid, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Roberto Pastor-Barriuso
- Department of Chronic Diseases, National Center of Epidemiology, Carlos III Health Institute, Madrid, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Rosario Ortolá
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid. Madrid, Spain/ CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Mercedes Sotos-Prieto
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid. Madrid, Spain/ CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; IMDEA Food Institute. CEI UAM+CSIC, Madrid, Spain
| | - Verónica Cabañas-Sánchez
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid. Madrid, Spain/ CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Pedro Gullón
- Department of Surgery, Social and Medical Sciences. School of Medicine and Health Sciences, Universidad de Alcala. Alcala de Henares, Madrid, Spain; Centre for Urban Research, RMIT University, Melbourne, Australia
| | | | - Rebeca Ramis
- Department of Chronic Diseases, National Center of Epidemiology, Carlos III Health Institute, Madrid, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Pablo Fernández-Navarro
- Department of Chronic Diseases, National Center of Epidemiology, Carlos III Health Institute, Madrid, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Fernando Rodríguez-Artalejo
- Department of Chronic Diseases, National Center of Epidemiology, Carlos III Health Institute, Madrid, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain; IMDEA Food Institute. CEI UAM+CSIC, Madrid, Spain
| | - Esther García-Esquinas
- Department of Chronic Diseases, National Center of Epidemiology, Carlos III Health Institute, Madrid, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
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Tan X, Zhang H, Ren X. The effects of neighborhood socioeconomic status on ADL/IADL among Chinese older adults-neighborhood environments as mediators. Front Public Health 2024; 11:1202806. [PMID: 38298263 PMCID: PMC10828966 DOI: 10.3389/fpubh.2023.1202806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 12/20/2023] [Indexed: 02/02/2024] Open
Abstract
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.
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Affiliation(s)
- Xiaoshuang Tan
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Hong Zhang
- Integrated Care Management Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaohui Ren
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
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Feng C, Yu B, Fei T, Jia P, Dou Q, Yang S. 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. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 858:159604. [PMID: 36272487 DOI: 10.1016/j.scitotenv.2022.159604] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 10/17/2022] [Accepted: 10/17/2022] [Indexed: 06/16/2023]
Abstract
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 (EVI500m). Causal mediation analysis was conducted to assess the total effect (TE) of residential greenness and the natural indirect effect (NIE) through PM2.5, CO, NO2, SO2, and O3 on all-cause mortality. RESULTS The TE of EVI500m on the all-cause mortality risk in overall participants showed negative, which, decreased from the 2nd quartile (HR = 0.93, 95 % CI: 0. 91, 0.95) to the 4th quartile (HR = 0.81, 95 % CI: 0.76, 0.85); the NIE through the five air pollutants also decreased from the 2nd quartile (HR = 0.96, 95 % CI: 0.95, 0.98) to the 4th 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.
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Affiliation(s)
- Chuanteng Feng
- Institute for Disaster Management and Reconstruction, Sichuan University-The Hong Kong Polytechnic University, Chengdu, China; West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Bin Yu
- Institute for Disaster Management and Reconstruction, Sichuan University-The Hong Kong Polytechnic University, Chengdu, China; West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Teng Fei
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, China
| | - Peng Jia
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, China; International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China
| | - Qingyu Dou
- National Clinical Research Center of Geriatrics, Geriatric Medicine Center, West China Hospital, Sichuan University, Chengdu, China.
| | - Shujuan Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China; International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China; Department of Health Management Center, Clinical Medical College & Affiliated Hospital, Chengdu University, Chengdu, China.
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Cao M, Guan T, Tong M, Li J, Lu H, Yang X, Wang R, Liu H, Chao B, Liu Y, Xue T. Greenspace exposure and poststroke disability: A nationwide longitudinal study. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2022; 246:114195. [PMID: 36265403 DOI: 10.1016/j.ecoenv.2022.114195] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
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.
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Affiliation(s)
- Man Cao
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Tianjia Guan
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Mingkun Tong
- Institute of Reproductive and Child Health / National Health Commission Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Jiajianghui Li
- Institute of Reproductive and Child Health / National Health Commission Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Hong Lu
- Institute of Reproductive and Child Health / National Health Commission Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Xinyue Yang
- College of Environmental Sciences and Engineering, Peking University, Beijing, China
| | - Ruohan Wang
- Institute of Reproductive and Child Health / National Health Commission Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Hengyi Liu
- Institute of Reproductive and Child Health / National Health Commission Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Baohua Chao
- The General Office of Stroke Prevention Project Committee, National Health Commission of the People's Republic of China, Beijing, China
| | - Yuanli Liu
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
| | - Tao Xue
- Institute of Reproductive and Child Health / National Health Commission Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.
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Klicnik I, Putman A, Doiron D, Barakat C, Ardern CI, Rudoler D, Dogra S. Neighborhood greenness, but not walkability, is associated with self-rated measures of health in older adults: An analysis of the Canadian Longitudinal Study on Aging. Prev Med Rep 2022; 30:102018. [PMID: 36245807 PMCID: PMC9563631 DOI: 10.1016/j.pmedr.2022.102018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/05/2022] [Accepted: 10/09/2022] [Indexed: 11/05/2022] Open
Abstract
The purpose of this analysis was to determine whether older Canadians residing in neighborhoods characterized by denser greenness or higher walkability have better self-reported health outcomes at 3-year follow-up. Data on self-reported chronic diseases (composite score of 10 conditions) and self-rated measures of health (general health, mental health, and healthy aging) from the Canadian Longitudinal Study on Aging (CLSA) were used as outcomes. The CLSA database was linked with the Canadian Active Living Environments (Can-ALE), a measure of walkability, and Normalized Difference Vegetation Index (NDVI), a measure of greenness. The analytic sample consisted of adults aged 65 and older (n = 15339, age 72.9 ± 5.6, 50 % female). Crude and adjusted associations were assessed using Poisson regression and proportional odds regression modelling. The 4th quartile of greenness was associated with the chronic disease index and all three measures of self-rated health (general health, mental health, and healthy aging); living in a neighborhood with the highest greenness was associated with better health three years later when compared to those in the lowest quartile of greenness. After adjustment for covariates of age, sex, income, education, and physical activity levels, only the association for the 3rd quartile of greenness was significantly associated with general health (OR: 0.90, 95 %CI: 0.81–0.99) and mental health (OR: 0.88, 95 %CI: 0.79-0.97). Can-ALE was not associated with any of the outcomes assessed. Future research assessing perceived environmental walkability and geriatric relevant health outcomes rather than chronic disease may provide greater insight into our understanding of age-friendly environments.
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Affiliation(s)
- Irmina Klicnik
- University of Ontario Institute of Technology, 2000 Simcoe St N, Oshawa, Ontario L1G 0C5, Canada
| | - Andrew Putman
- University of Ontario Institute of Technology, 2000 Simcoe St N, Oshawa, Ontario L1G 0C5, Canada
| | - Dany Doiron
- Research Institute of the McGill University Health Centre, 5252 De Maisonneuve, Montreal, Quebec H4A 3S5, Canada
| | - Caroline Barakat
- University of Ontario Institute of Technology, 2000 Simcoe St N, Oshawa, Ontario L1G 0C5, Canada
| | - Chris I. Ardern
- York University, 4700 Keele St, Toronto, Ontario M3J 1P3, Canada
| | - David Rudoler
- University of Ontario Institute of Technology, 2000 Simcoe St N, Oshawa, Ontario L1G 0C5, Canada
| | - Shilpa Dogra
- University of Ontario Institute of Technology, 2000 Simcoe St N, Oshawa, Ontario L1G 0C5, Canada,Corresponding author.
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Wensu Z, Wenjuan W, Fenfen Z, Wen C, Li L. The effects of greenness exposure on hypertension incidence among Chinese oldest-old: a prospective cohort study. Environ Health 2022; 21:66. [PMID: 35820901 PMCID: PMC9277785 DOI: 10.1186/s12940-022-00876-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 06/27/2022] [Indexed: 06/13/2023]
Abstract
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.
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Affiliation(s)
- Zhou Wensu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Wang Wenjuan
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Zhou Fenfen
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Chen Wen
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China.
| | - Ling Li
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China.
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Association between residential greenspace structures and frailty in a cohort of older Chinese adults. COMMUNICATIONS MEDICINE 2022; 2:43. [PMID: 35603272 PMCID: PMC9053290 DOI: 10.1038/s43856-022-00093-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 03/03/2022] [Indexed: 01/12/2023] Open
Abstract
Background Frailty is a late-life clinical syndrome resulting from the accumulation of aging-induced decline. Greenspaces measured with normalized difference vegetation index (NDVI) are protective of frailty. However, NDVI is not as informative as structure indices in describing greenspaces' constitution, shape, and connectivity measured by the largest patch index (LPI), shape index, and cohesion index representing larger, more complex, and more dense greenspaces through higher values. We aim to study the association between greenness structures and frailty in a cohort of Chinese older adults. Methods We included older adults from 2008-2014 China Longitudinal Healthy Longevity Survey (CLHLS). We used greenspace indices from satellite to quantify structures (area-edge, shape, proximity) at county-level, and calculated frailty index (FI) as an outcome. We did cross-sectional analyses using linear and logistical regression, and longitudinal analyses using the generalized estimating equations (GEE). Results Among 8776 baseline participants, mean LPI, shape, cohesion, and FI are 7.93, 8.11, 97.6, and 0.17. In cross-sectional analyses, we find negative dose-response relationships for greenspace structures and frailty, especially in females, centenarians, illiterate people, city residents, unmarried people, and individuals with increased frailty. Participants living in the highest quartile of LPI, shape, and cohesion have 32% (95%CI: 21-42%), 35% (95%CI: 24-44%), and 37% (95%CI: 26%-46%) lower odds of frailty than the lowest quartile. However, we do not find a significant association in longitudinal analyses. Conclusions Higher levels of greenness structures (area-edge, shape, and proximity) might be related to lower frailty, while a clear longitudinal benefit cannot be identified in this analysis.
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Green Space and Health in Mainland China: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189937. [PMID: 34574854 PMCID: PMC8472560 DOI: 10.3390/ijerph18189937] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/03/2021] [Accepted: 09/13/2021] [Indexed: 12/12/2022]
Abstract
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.
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Zhang T, Yan LL, Chen HS, Jin HY, Wu C. Association between allostatic load and mortality among Chinese older adults: the Chinese Longitudinal Health and Longevity Study. BMJ Open 2021; 11:e045369. [PMID: 34344673 PMCID: PMC8336121 DOI: 10.1136/bmjopen-2020-045369] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Allostatic load (AL) has shown that high burden of AL is associated with increased risk of adverse outcomes, but little attention has been paid to China with largest ageing population in the world. OBJECTIVE This study is to examine the association between AL and all-cause mortality among Chinese adults aged at least 60 years. DESIGN Population-based prospective cohort study. SETTING In 2011-2012, an ancillary study, in which a blood test was added, including a total of 2439 participants, was conducted in eight longevity areas in the Chinese Longitudinal Healthy Longevity Survey. PARTICIPANTS The final analytical sample consisted of 1519 participants (mean±SD age: men 80.5±11.3 years; women 90.2±11.8 years and 53% women). PRIMARY OUTCOME MEASURE Cox models were used to examine the association between AL and mortality among men and women, separately. Analyses were also adjusted for potential confounders including age, ethnicity, education and marital status, smoking and exercise. RESULTS Male with a medium AL burden (score: 2-4) and high AL burden (score: 5-9) had a 33% and 118% higher hazard of death, respectively, than those with a low AL burden (score: 0-1). We did not find significant difference between females with different levels of AL burden. CONCLUSION Higher AL burden was associated with increased all-cause mortality among Chinese men aged at least 60 years. However, we did not find strong association among women. In conclusion, Intervention programmes targeting modifiable components of the AL burden may help prolong lifespan for older adults, especially men, in China.
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Affiliation(s)
- Tianhang Zhang
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
- School of Public Health, Imperial College London, London, UK
| | - Lijing L Yan
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
- Duke Global Health Institute, Durham, North Carolina, USA
| | - Hua-Shuai Chen
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina, USA
| | - Hai-Yu Jin
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
| | - Chenkai Wu
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
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11
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Lu S, Liu Y, Guo Y, Ho HC, Song Y, Cheng W, Chui CHK, Chan OF, Webster C, Chiu RLH, Lum TYS. Neighbourhood physical environment, intrinsic capacity, and 4-year late-life functional ability trajectories of low-income Chinese older population: A longitudinal study with the parallel process of latent growth curve modelling. EClinicalMedicine 2021; 36:100927. [PMID: 34189445 PMCID: PMC8219998 DOI: 10.1016/j.eclinm.2021.100927] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/04/2021] [Accepted: 05/10/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Knowledge of how intrinsic capacity (IC) and neighbourhood physical environment shape functional ability (FA) trajectories in later life remains understudied. We investigated four-year trajectories of IC and their impact on FA trajectories and the association between neighbourhood physical environment and FA trajectories among community-dwelling older adults in Hong Kong, China. METHODS We conducted a four-wave longitudinal study from 2014 to 2017 in Hong Kong with 2,081 adults aged 65 and above. FA was assessed by The Chinese Lawton Instrumental Activities of Daily Living Scale. We used cognition, affect, locomotion, sensory capacity, and vitality to capture the multiple domains of IC. Neighbourhood physical environment attributes included green space, land use diversity, and availability of facilities, assessed within 200- and 500-meter buffers of respondents' homes. We used the parallel process of latent growth curve model. FINDINGS IC (Unstandardized coefficient, β = -0.02, p<0.001) and FA (β = -0.20, p<0.001) each decreased significantly over time. Individuals with declines in IC experienced a faster decline in FA over time. Green space within a 200-meter buffer (β = 1.15, p = 0.023), the number of leisure (β = 0.03, p = .0.043) and public transport (β = 0.08, p = .0.003) facilities within a 500-meter buffer slowed the rate of FA decline. INTERPRETATION The level of FA decreased over time in later life. Changes in IC shaped FA trajectories. Increased residential green space and the number of leisure and public transport facilities in the neighbourhood may help slow FA decline over time. FUNDING The Hong Kong Housing Society.
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Affiliation(s)
- Shiyu Lu
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong, China
| | - Yuqi Liu
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Yingqi Guo
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Hung Chak Ho
- Department of Urban Planning and Design, The University of Hong Kong, Hong Kong, China
| | - Yimeng Song
- Department of Land Surveying and Geo-Informatics, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China
- Smart Cities Research Institute, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China
| | - Wei Cheng
- Department of Urban Planning and Design, The University of Hong Kong, Hong Kong, China
| | - Cheryl Hiu Kwan Chui
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - On Fung Chan
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong, China
| | - Chris Webster
- Faculty of Architecture, The University of Hong Kong, Hong Kong, China
| | - Rebecca Lai Har Chiu
- Department of Urban Planning and Design, The University of Hong Kong, Hong Kong, China
| | - Terry Yat Sang Lum
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong, China
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
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12
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Park JY, Jung J, Kim YC, Lee H, Kim E, Kim YS, Kim H, Lee JP. Effects of residential greenness on clinical outcomes of patients with chronic kidney disease: a large-scale observation study. Kidney Res Clin Pract 2021; 40:272-281. [PMID: 34162051 PMCID: PMC8237126 DOI: 10.23876/j.krcp.20.224] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/28/2021] [Indexed: 12/18/2022] Open
Abstract
Background As industrialization and urbanization are accelerating, the distribution of green areas is decreasing, particularly in developing countries. Since the 2000s, the effects of surrounding greenness on self-perceived health, including physical and mental health, longevity, and obesity have been reported. However, the effects of surrounding green space on chronic kidney disease are not well understood. Therefore, we investigated the impact of residential greenness on the mortality of chronic kidney disease patients and progression from chronic kidney disease to end-stage renal disease (ESRD). Methods Using a large-scale observational study, we recruited chronic kidney disease patients (n = 64,565; mean age, 54.0 years; 49.0% of male) who visited three Korean medical centers between January 2001 and December 2016. We investigated the hazard ratios of clinical outcomes per 0.1-point increment of exposure to greenness using various models. Results During the mean follow-up of 6.8 ± 4.6 years, 5,512 chronic kidney disease patients developed ESRD (8.5%) and 8,543 died (13.2%). In addition, a 0.1-point increase in greenness reduced all-cause mortality risk in chronic kidney disease and ESRD patients and progression of chronic kidney disease to ESRD in a fully adjusted model. The association between mortality in ESRD patients and the normalized difference vegetation index was negatively correlated in people aged >65 years, who had normal weight, were nonsmokers, and lived in a nonmetropolitan area. Conclusion Chronic kidney disease patients who live in areas with higher levels of greenness are at reduced risk of all-cause mortality and progression to ESRD.
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Affiliation(s)
- Jae Yoon Park
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Ilsan, Republic of Korea.,Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju, Republic of Korea
| | - Jiyun Jung
- Data Management and Statistics Institute, Dongguk University Ilsan Hospital, Ilsan, Republic of Korea
| | - Yong Chul Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyewon Lee
- Department of Health Administration and Management, College of Medical Sciences, Soonchunhyang University, Asan, Republic of Korea
| | - Ejin Kim
- Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ho Kim
- Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea.,Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
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13
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Peng W, Jiang M, Shi H, Li X, Liu T, Li M, Jia X, Wang Y. Cross-sectional association of residential greenness exposure with activities of daily living disability among urban elderly in Shanghai. Int J Hyg Environ Health 2020; 230:113620. [PMID: 32950769 DOI: 10.1016/j.ijheh.2020.113620] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/27/2020] [Accepted: 08/27/2020] [Indexed: 12/22/2022]
Abstract
AIM Residential greenness exposure is associated with many health outcomes, including obesity, cardiovascular disease, and mental disorders. However, few studies have assessed the effects of greenness exposure on activities of daily living (ADL). This study evaluated the relationship between greenness and ADL among elderly residents with long-term care insurance (LTCI) in Shanghai, China. METHODS We conducted a cross-sectional survey using stratified random sampling among elderly residents with LTCI in six districts of Shanghai in August 2018. We quantitatively assessed residential greenness using satellite-derived normalized difference vegetation index (NDVI) values with 250-, 500-, and 1000-m buffers around each participant's residential address. We calculated the walk score to assess neighborhood walkability. Physical function was assessed using basic ADL (BADL) and instrumental ADL (IADL). We performed binary logistic regression and restricted cubic splines with R software. RESULTS The study participants were 1067 adults with a mean age of 82.40 years (standard deviation, 7.68 years). The mean NDVI value was 0.311. In the fully adjusted model, being in the highest-tertile NDVI500-m had a significant protective effect on BADL mild to none disability (odds ratio, 2.143; 95% confidence interval, 1.489-3.084) compared with participants in the lowest-tertile NDVI500-m. Restricted cubic spline showed a non-linearity association between NDVI values and BADL and IADL mild to none disability. CONCLUSIONS Our results indicate the importance of residential greenness exposure to physical function-especially for BADL disability. Well-designed longitudinal studies are needed to confirm our findings and investigate the underlying mechanisms.
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Affiliation(s)
- Wenjia Peng
- Epidemiology and Health Statistics, School of Public Health, Bengbu Medical College, Bengbu, Anhui, China
| | - Man Jiang
- Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Hengyuan Shi
- Epidemiology and Health Statistics, School of Public Health, Bengbu Medical College, Bengbu, Anhui, China
| | - Xinghui Li
- School of Public Health/Key Lab of Health Technology Assessment, National Health and Family Planning Commission of the People's Republic of China, Fudan University, Shanghai, China
| | - Ting Liu
- Epidemiology and Health Statistics, School of Public Health, Bengbu Medical College, Bengbu, Anhui, China
| | - Mengying Li
- School of Public Health/Key Lab of Health Technology Assessment, National Health and Family Planning Commission of the People's Republic of China, Fudan University, Shanghai, China
| | - Xianjie Jia
- Epidemiology and Health Statistics, School of Public Health, Bengbu Medical College, Bengbu, Anhui, China
| | - Ying Wang
- School of Public Health/Key Lab of Health Technology Assessment, National Health and Family Planning Commission of the People's Republic of China, Fudan University, Shanghai, China.
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14
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Zhu A, Zeng Y, Ji JS. Residential Greenness Alters Serum 25(OH)D Concentrations: A Longitudinal Cohort of Chinese Older Adults. J Am Med Dir Assoc 2020; 21:1968-1972.e2. [PMID: 32605814 PMCID: PMC7723982 DOI: 10.1016/j.jamda.2020.04.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/22/2020] [Accepted: 04/26/2020] [Indexed: 12/18/2022]
Abstract
Objectives Vitamin D deficiency is prevalent among older adults. We aimed to study whether residential greenness could alter serum 25(OH)D concentrations as a possible mechanism of residential greenness's positive health effects. Design A longitudinal cohort study. Setting and Participants We included older adults aged ≥65 years from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) with follow-up between 2012 and 2014. Methods We measured residential greenness by calculating annual average Normalized Difference Vegetation Index (NDVI) in a 500 m radius by using satellite images around each participant's residential address. Serum 25-hydroxyvitamin D (25(OH)D) concentration was dichotomized into 2 categories: nondeficiency (≥50 nmol/L) and deficiency (<50 nmol/L). We used the generalized estimating equation to examine the relationship between annual average NDVI and serum 25(OH)D. Results We included 1336 participants in our analysis. The annual average NDVI was 0.49, and mean serum 25(OH)D was 43 nmol/L at baseline. Each 0.1-unit increase in annual average NDVI was associated with a 13% higher odds of vitamin D nondeficiency [95% confidence interval (CI): 1.01, 1.26]. The association was stronger among men [odds ratio (OR): 1.17, 95% CI: 1.02, 1.35] than women (OR: 1.08, 95% CI: 0.91, 1.29) and also stronger among those who were free of activities of daily living (ADL) disability at baseline (OR: 1.12, 95% CI: 1.00, 1.25). During the follow-up period, the participants who lived in greener areas were more likely to have an improved, rather than stable or deteriorated, vitamin D status (OR: 1.94, 95% CI: 1.51, 2.51). Conclusions and Implications Our study suggests that higher levels of residential greenness are associated with higher serum 25(OH)D concentrations, which has implications for prevention of vitamin D deficiency among older adults.
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Affiliation(s)
- Anna Zhu
- Environmental Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
| | - Yi Zeng
- Center for the Study of Aging and Human Development, Duke Medical School, Durham, NC, USA; Center for Healthy Aging and Development Studies, National School of Development, Peking University, Beijing, China
| | - John S Ji
- Environmental Research Center, Duke Kunshan University, Kunshan, Jiangsu, China; Nicholas School of the Environment, Duke University, Durham, NC, USA.
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15
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Zhu A, Yan L, Wu C, Ji JS. Residential Greenness and Frailty Among Older Adults: A Longitudinal Cohort in China. J Am Med Dir Assoc 2020; 21:759-765.e2. [PMID: 31870716 PMCID: PMC7303951 DOI: 10.1016/j.jamda.2019.11.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/31/2019] [Accepted: 11/10/2019] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Frailty is an accumulation of deficits characterized by reduced resilience to stressors and increased vulnerability to adverse outcomes. There is evolving evidence on the health benefits of residential greenness, but little is known about its impact on frailty. DESIGN A longitudinal cohort study. SETTING AND PARTICIPANTS We included older adults aged ≥65 years from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) with a 12-year follow-up. METHODS We assessed residential greenness by calculating the Normalized Difference Vegetation Index (NDVI) in the 500 m radius around participants' residence. We used 39 self-reported health items to construct a frailty index (FI) as a proportion of accumulated deficits. We defined an FI of ≤0.21 as nonfrail and prefrail, and an FI of >0.21 as frail. We used the mixed effects logistic regression models to examine the association between residential greenness and frailty, adjusted for a number of covariates. RESULTS We had 16,238 participants, with a mean age of 83.0 years (standard deviation: 11.5). The mean baseline NDVI and FI were 0.40, and 0.12, respectively. Compared to the participants living in the lowest quartile of residential greenness, those in the highest quartile had a 14% [odds ratio (OR): 0.86, 95% confidence interval (CI): 0.77, 0.97] lower odds of frailty. The association was stronger among urban vs rural residents. Additionally, each 0.1-unit increase in annual average NDVI was related to a 2% higher odds of improvement in the frailty status (OR: 1.02, 95% CI: 1.00, 1.04). CONCLUSIONS AND IMPLICATIONS Our study suggests that higher levels of residential greenness are related to a lower likelihood of frailty, specifically in urban areas.
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Affiliation(s)
- Anna Zhu
- Environmental Research Center, Duke Kunshan University, Kunshan, China
| | - Lijing Yan
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Chenkai Wu
- Global Health Research Center, Duke Kunshan University, Kunshan, China.
| | - John S Ji
- Environmental Research Center, Duke Kunshan University, Kunshan, China; Nicholas School of the Environment, Duke University, Durham, North Carolina.
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16
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Liu L, Zhu A, Shu C, Zeng Y, Ji JS. Gene-Environment Interaction of FOXO and Residential Greenness on Mortality Among Older Adults. Rejuvenation Res 2020; 24:49-61. [PMID: 32364002 DOI: 10.1089/rej.2019.2301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Residential greenness is an important environmental factor that is strongly associated with mortality. To our knowledge, there was no previous study on the gene-environment interaction analysis between residential greenness and forkhead box O (FOXO) gene, a candidate longevity gene. Our sample consisted of 3179 participants aged 65 and older from the Chinese Longitudinal Healthy Longevity Survey. Residential greenness was measured by satellite-derived normalized difference vegetation index (NDVI) using a 500-m radius around each residential location. Contemporaneous NDVI, cumulative NDVI, and changes in NDVI over time were calculated. We used Cox-proportional hazard regression models to assess the main effect and gene-environment interaction effect of FOXO single nucleotide polymorphism (SNP) and residential greenness on mortality. We found that participants carrying two minor alleles of the three studied FOXO3A SNPs had lower mortality risk than those without minor allele (hazard ratio [HR]: 0.803 95% confidence interval [CI]: 0.654-0.987 for rs4946936, HR: 0.807 95% CI: 0.669-0.974 for rs2802292, HR: 0.803 95% CI: 0.666-0.968 for rs2253310). We found no difference in mortality among the genotypes of the other three FOXO1A SNPs (rs17630266, rs2755213, or rs2755209). Higher contemporaneous NDVI was associated with lower mortality risk (HR: 0.887 95% CI: 0.863-0.911 for 0.1-U of NDVI). The protective effect of both contemporaneous NDVI and cumulative NDVI was stronger for two minor allele carriers compared with zero minor allele carriers of the three FOXO3A SNPs. Compared with the zero minor allele genotype of the three FOXO3A SNPs, the protective effect on the mortality risk of minor allele homozygotes also increased with the increasing NDVI level at percentile 25, 50, and 75 (interaction term coefficient p < 0.05). We found gene-environment interaction between FOXO and residential greenness on mortality in this population study. A higher level of greenness may interact with FOXO pathways.
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Affiliation(s)
- Linxin Liu
- Environmental Research Center, Duke Kunshan University, Kunshan, China
| | - Anna Zhu
- Environmental Research Center, Duke Kunshan University, Kunshan, China
| | - Chang Shu
- School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Yi Zeng
- Center for the Study of Aging and Human Development, Duke Medical School, Durham, North Carolina, USA.,Center for Healthy Aging and Development Studies, National School of Development, Peking University, Beijing, China
| | - John S Ji
- Environmental Research Center, Duke Kunshan University, Kunshan, China.,Nicholas School of the Environment, Duke University, Durham, North Carolina, USA
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