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Wang W, Wen H, Zhao C, Ma X, Liao J, Ma L. Green space modified the association between air pollutants and hypertension in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2024; 34:3232-3244. [PMID: 38171020 DOI: 10.1080/09603123.2023.2300047] [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: 08/22/2023] [Accepted: 12/23/2023] [Indexed: 01/05/2024]
Abstract
Evidence regarding the combined effects of green space and air pollutants on hypertension remains limited and complex. This study aims to investigate the varying effects of greenness under different air pollution levels in China, using data from the wave 2018 China Health and Retirement Longitudinal Study (CHARLS) involving 17 468 adults (aged ≥ 45 years). As a result, the prevalence rate of hypertension was 42.04%. Logistic regression analyses revealed the positive associations between air pollution concentrations at the city level and prevalent hypertension and the negative associations between NDVI and prevalent hypertension, all of which were more prominent in the populations of the eastern and rural regions. Notably, the negative effect of green space was greater at the lowest quartiles of each air pollutant (OR for PM2.5 quartiles = 0.724, 0.792, 0.740, and 0.931) . Improving air quality and greenness could potentially reduce hypertension risk, and minimizing air pollution might optimize the protective effects of greenness.
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Affiliation(s)
- Wanyue Wang
- Department of Preventive Medicine, School of Public Health, Wuhan University, Wuhan, PR China
| | - Haoxuan Wen
- Department of Preventive Medicine, School of Public Health, Wuhan University, Wuhan, PR China
| | - Chuanyu Zhao
- Department of Preventive Medicine, School of Public Health, Wuhan University, Wuhan, PR China
| | - Xuxi Ma
- Department of Global Health, School of Public Health, Wuhan University, Wuhan, PR China
| | - Jingling Liao
- Department of Nutrition and Food Hygiene, School of Public Health, Medical College, Wuhan University of Science and Technology, Wuhan, PR China
| | - Lu Ma
- Department of Biostatistics, School of Public Health, Wuhan University, Wuhan, PR China
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Bu Y, Zhang X, Song S, Su H, Yu Z, Guo Y. Association of greenspace with hypertension in adult: a systematic review and meta-analysis of epidemiological studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2024; 34:2556-2577. [PMID: 37742118 DOI: 10.1080/09603123.2023.2259817] [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: 01/21/2023] [Accepted: 09/11/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND Several studies have investigated the relationship of greenspace with blood pressure (BP) and hypertension, but the results were inconsistent. We aimed to assess the relationship of greenspace with BP/hypertension. METHODS We searched PubMed, Embase and Web of Science on greenspace and BP/hypertension published before 5 April 2023. The methodological quality and risk of bias were evaluated. RESULTS Twenty-seven articles were included. Our results suggested that higher normalized difference vegetation index (NDVI) was associated with lower odds of hypertension and levels of SBP [for every 10% increase of NDVI 500-m and NDVI 1000-m, the ORs were 0.95 (95% CI: 0.90-0.99) and 0.95 (95% CI: 0.90-0.99), the ꞵwas -1.32 (95% CI: -2.18, -0.45) and -1.41 (95% CI: -2.57, -0.25), respectively]. CONCLUSION This study indicated that higher exposure to greenspace might be associated with lower levels of BP and risk of hypertension. Increase green spaces should be regarded as an important public health intervention..
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Affiliation(s)
- Yongjun Bu
- College of Public Health, Xinxiang Medical University, Xinxiang, China
| | - Xiaoyu Zhang
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Shuaixing Song
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Hexin Su
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Zengli Yu
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yuewei Guo
- School of Management, Xinxiang Medical University, Xinxiang, China
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Sharifi Y, Sobhani S, Ramezanghorbani N, Payab M, Ghoreshi B, Djalalinia S, Nouri Ghonbalani Z, Ebrahimpur M, Eslami M, Qorbani M. Association of greenspaces exposure with cardiometabolic risk factors: a systematic review and meta-analysis. BMC Cardiovasc Disord 2024; 24:170. [PMID: 38509487 PMCID: PMC10953288 DOI: 10.1186/s12872-024-03830-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/05/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Cardiometabolic conditions are major contributors to the global burden of disease. An emerging body of evidence has associated access to and surrounding public open spaces (POS) and greenspace with cardiometabolic risk factors, including obesity, body mass index (BMI), hypertension (HTN), blood glucose (BG), and lipid profiles. This systematic review aimed to synthesize this evidence. METHODS This systematic review was conducted based on the PRISMA guidelines. Four electronic databases including Web of Science, PubMed, Scopus, and Google Scholar were searched for eligible articles published until July 2023. All observational studies which assessed the association of greenspace and POS with cardiometabolic risk factors including obesity, BMI, HTN, BG, and lipid profiles were included and reviewed by two authors independently. Heterogeneity between studies was assessed using the I2 index and Cochrane's Q test. Random/fixed effect meta-analyses were used to combine the association between greenspace exposure with cardiometabolic risk factors. RESULTS Overall, 118 relevant articles were included in our review. The majority of the articles were conducted in North America or Europe. In qualitative synthesis, access or proximity to greenspaces or POS impacts BMI and blood pressure or HTN, BG, and lipid profiles via various mechanisms. According to the random effect meta-analysis, more access to greenspace was significantly associated with lower odds of HTN (odds ratio (OR): 0.81, 95% confidence intervals (CIs): 0.61-0.99), obesity (OR: 0.83, 95% CIs: 0.77-0.90), and diabetes (OR:0.79, 95% CI: 0.67,0.90). CONCLUSIONS Findings of this systematic review and meta-analysis suggested that greenspace accessibility is associated with some cardiometabolic risk factors. Improving greenspace accessibility could be considered as one of the main strategies to reduce cardiometabolic risk factors at population level.
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Affiliation(s)
- Yasaman Sharifi
- Department of Radiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Sobhani
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Nahid Ramezanghorbani
- Department of Development and Coordination Scientific Information and Publications, Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | - Moloud Payab
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Behnaz Ghoreshi
- Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Shirin Djalalinia
- Development of Research & Technology Center, Ministry of Health and Medical Education, Tehran, Iran
| | - Zahra Nouri Ghonbalani
- Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Mahbube Ebrahimpur
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maysa Eslami
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Qorbani
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.
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Lai KY, Webster C, Gallacher JE, Sarkar C. Associations of Urban Built Environment with Cardiovascular Risks and Mortality: a Systematic Review. J Urban Health 2023; 100:745-787. [PMID: 37580546 PMCID: PMC10447831 DOI: 10.1007/s11524-023-00764-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2023] [Indexed: 08/16/2023]
Abstract
With rapid urbanization, built environment has emerged as a set of modifiable factors of cardiovascular disease (CVD) risks. We conducted a systematic review to synthesize evidence on the associations of attributes of urban built environment (e.g. residential density, land use mix, greenness and walkability) with cardiovascular risk factors (e.g. hypertension and arterial stiffness) and major CVD events including mortality. A total of 63 studies, including 31 of cross-sectional design and 32 of longitudinal design conducted across 21 geographical locations and published between 2012 and 2023 were extracted for review. Overall, we report moderately consistent evidence of protective associations of greenness with cardiovascular risks and major CVD events (cross-sectional studies: 12 of 15 on hypertension/blood pressure (BP) and 2 of 3 on arterial stiffness; and longitudinal studies: 6 of 8 on hypertension/BP, 7 of 8 on CVD mortality, 3 of 3 on ischemic heart disease mortality and 5 of 8 studies on stroke hospitalization or mortality reporting significant inverse associations). Consistently, walkability was associated with lower risks of hypertension, arterial stiffness and major CVD events (cross-sectional studies: 11 of 12 on hypertension/BP and 1 of 1 on arterial stiffness; and longitudinal studies: 3 of 6 on hypertension/BP and 1 of 2 studies on CVD events being protective). Sixty-seven percent of the studies were rated as "probably high" risk of confounding bias because of inability to adjust for underlying comorbidities/family history of diseases in their statistical models. Forty-six percent and 14% of the studies were rated as "probably high" risk of bias for exposure and outcome measurements, respectively. Future studies with robust design will further help elucidate the linkages between urban built environment and cardiovascular health, thereby informing planning policies for creating healthy cities.
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Affiliation(s)
- Ka Yan Lai
- Healthy High Density Cities Lab, HKUrbanLab, The University of Hong Kong, Knowles Building, Pokfulam Road, Hong Kong Special Administrative Region, China.
- Department of Urban Planning and Design, Faculty of Architecture, The University of Hong Kong, Knowles Building, Pokfulam Road, Hong Kong Special Administrative Region, China.
| | - Chris Webster
- Healthy High Density Cities Lab, HKUrbanLab, The University of Hong Kong, Knowles Building, Pokfulam Road, Hong Kong Special Administrative Region, China
- Department of Urban Planning and Design, Faculty of Architecture, The University of Hong Kong, Knowles Building, Pokfulam Road, Hong Kong Special Administrative Region, China
- Urban Systems Institute, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - John Ej Gallacher
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
| | - Chinmoy Sarkar
- Healthy High Density Cities Lab, HKUrbanLab, The University of Hong Kong, Knowles Building, Pokfulam Road, Hong Kong Special Administrative Region, China
- Department of Urban Planning and Design, Faculty of Architecture, The University of Hong Kong, Knowles Building, Pokfulam Road, Hong Kong Special Administrative Region, China
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
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Li B, Cao H, Liu K, Xia J, Sun Y, Peng W, Xie Y, Guo C, Liu X, Wen F, Zhang F, Shan G, Zhang L. Associations of long-term ambient air pollution and traffic-related pollution with blood pressure and hypertension defined by the different guidelines worldwide: the CHCN-BTH study. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:63057-63070. [PMID: 35449329 DOI: 10.1007/s11356-022-20227-9] [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: 01/04/2022] [Accepted: 04/09/2022] [Indexed: 06/14/2023]
Abstract
The assessment of the generalization of the strict hypertension definition in the 2017 ACC/AHA Hypertension Guideline from environmental condition remains sparse. The aims of this study are to investigate and compare the associations of ambient air pollution and traffic-related pollution (TRP) with hypertension defined by the different criteria. A total of 32,135 participants were recruited from the baseline survey of the CHCN-BTH in 2017. We defined hypertension as SBP/DBP ≥ 140/90 mmHg according to the hypertension guidelines in China, Japan, Europe and ISH (traditional criteria) and defined as SBP/DBP ≥ 130/80 mmHg according to the 2017 ACC/AHA Hypertension Guideline (strict criteria). A two-level generalized linear mixed models were applied to investigate the associations of air pollutants (i.e. PM2.5, SO2, NO2) and TRP with blood pressure (BP) measures and hypertension. Stratified analyses and two-pollutant models were also performed. The stronger associations of air pollutants were found in the hypertension defined by the strict criteria than that defined by the traditional criteria. The ORs per an IQR increase in PM2.5 were 1.17 (95% CI: 1.09, 1.25) for the strict criteria and 1.14 (95% CI: 1.06, 1.23) for the traditional criteria. The similar conditions were also observed for TRP. The above results were robust in both stratified analyses and two-pollutant models. Our study assessed the significance of the hypertension defined by the strict criteria from environmental aspect and called attention to the more adverse effects of air pollution and TRP on the earlier stage of hypertension.
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Affiliation(s)
- Bingxiao Li
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No. 10, Xi Toutiao You Anmenwai, Fengtai District, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Han Cao
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No. 10, Xi Toutiao You Anmenwai, Fengtai District, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
- Department of Biostatistics, Peking University First Hospital, Beijing, China
| | - Kuo Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No. 10, Xi Toutiao You Anmenwai, Fengtai District, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Juan Xia
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No. 10, Xi Toutiao You Anmenwai, Fengtai District, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Yanyan Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No. 10, Xi Toutiao You Anmenwai, Fengtai District, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Wenjuan Peng
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No. 10, Xi Toutiao You Anmenwai, Fengtai District, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Yunyi Xie
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No. 10, Xi Toutiao You Anmenwai, Fengtai District, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Chunyue Guo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No. 10, Xi Toutiao You Anmenwai, Fengtai District, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Xiaohui Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No. 10, Xi Toutiao You Anmenwai, Fengtai District, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Fuyuan Wen
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No. 10, Xi Toutiao You Anmenwai, Fengtai District, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Fengxu Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No. 10, Xi Toutiao You Anmenwai, Fengtai District, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Guangliang Shan
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences; School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Ling Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No. 10, Xi Toutiao You Anmenwai, Fengtai District, Beijing, China.
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
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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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Zhao Y, Bao WW, Yang BY, Liang JH, Gui ZH, Huang S, Chen YC, Dong GH, Chen YJ. Association between greenspace and blood pressure: A systematic review and meta-analysis. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 817:152513. [PMID: 35016929 DOI: 10.1016/j.scitotenv.2021.152513] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/08/2021] [Accepted: 12/14/2021] [Indexed: 06/14/2023]
Abstract
Many studies have investigated the association between greenspaces and blood pressure (BP), but the results remain mixed. We conducted a systematic review and meta-analysis to comprehensively evaluate the evidence concerning greenspaces with BP levels and prevalent hypertension. Systematic literature searches were performed in Web of Science, PubMed, and Embase up to 25 April 2021. Combined effect estimates were calculated using random-effect models for each greenspace exposure assessment method that had been examined in ≥3 studies. Sensitivity analysis, subgroup analysis, and publication bias were also conducted. Of 38 articles (including 52 analyses, 5.2 million participants in total) examining the effects of normalized difference vegetation index (NDVI) (n = 23), proportion of greenspace (n = 11), distance to greenspace (n = 9), and others (n = 9) were identified. Most studies (65%) reported beneficial associations between greenspaces and BP levels/hypertension. Our results of meta-analyses showed that higher NDVI500m was significantly associated with lower levels of systolic blood pressure (SBP = -0.77 mmHg, 95%CI: -1.23 to -0.32) and diastolic blood pressure (DBP = -0.32 mmHg, 95%CI: -0.57 to -0.07). We also found that NDVI in different buffers and the proportion of greenspaces were significantly associated with lower odds (1-9%) of hypertension. However, no significant effect was found for distance to greenspaces. In summary, our results indicate the beneficial effects of greenspace exposure on BP and hypertension. However, future better-designed studies, preferably longitudinal, are needed to confirm and better quantify the observed benefits in BP and/or hypertension.
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Affiliation(s)
- Yu Zhao
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Wen-Wen Bao
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Bo-Yi Yang
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangdong Provincial Engineering Technology Research Center of Environmental and Health risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Jing-Hong Liang
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Zhao-Huan Gui
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Shan Huang
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Yi-Can Chen
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Guang-Hui Dong
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangdong Provincial Engineering Technology Research Center of Environmental and Health risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Ya-Jun Chen
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
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Khan JR, Biswas RK, Hossain MB, Archie RJ. Residential area greenness and hypertension: a national assessment on urban adults in Bangladesh. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2022:1-13. [PMID: 35373666 DOI: 10.1080/09603123.2022.2053662] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 03/10/2022] [Indexed: 06/14/2023]
Abstract
This study investigated the associations between greenness and blood pressure (BP) metrics (systolic BP [SBP], diastolic BP [DBP], hypertension) among urban adults in Bangladesh and the potential mediation effects of body mass index (BMI) using 2011 Bangladesh Demographic and Health Survey data for 2360 urban adults (aged ≥35 years). The Enhanced Vegetation Index was used as a measure of residential area greenness. Associations between greenness and BP metrics were estimated using linear and binary logistic regression models. We also conducted mediation analyses. Greater area-level greenness was inversely associated with SBP (β -1.33, 95%CI: -2.46, -.20), DBP (β -.83, 95%CI: -1.64, -.02), and hypertension (adjusted odds ratio .87, 95%CI: .77, .98). BMI substantially mediated associations between greenness and BP metrics. Adopting urban greening policies could reduce the risk of hypertension, thus can contribute to reduction of non-communicable disease burden in Bangladesh. Longitudinal studies are required to further investigate the causal pathways.
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Affiliation(s)
- Jahidur Rahman Khan
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, ACT, Australia
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Climate and Environmental Health, Biomedical Research Foundation, Dhaka, Bangladesh
| | - Raaj Kishore Biswas
- Transport and Road Safety (TARS) Research Centre, School of Aviation, University of New South Wales, Sydney, New South Wales, Australia
| | - Md Belal Hossain
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- BRAC James P Grant School of Public Health, BRAC University, Mohakhali, Dhaka, Bangladesh
| | - Rownak Jahan Archie
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Chen L, Xie J, Ma T, Chen M, Gao D, Li Y, Ma Y, Wen B, Jiang J, Wang X, Zhang J, Chen S, Wu L, Li W, Liu X, Dong B, Wei J, Guo X, Huang S, Song Y, Dong Y, Ma J. Greenness alleviates the effects of ambient particulate matter on the risks of high blood pressure in children and adolescents. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 812:152431. [PMID: 34942264 DOI: 10.1016/j.scitotenv.2021.152431] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/01/2021] [Accepted: 12/11/2021] [Indexed: 06/14/2023]
Abstract
Both ambient particulate matter (PM) and decrease of greenness have been suggested as risk factors for high blood pressure (HBP) in children and adolescents. But most evidence were from cross-sectional studies with limited data from prospective cohorts. In this cohort study, we included 588,004 children and adolescents aged 7 to 18 years without HBP from 2005 to 2018 in Beijing (240,081) and Zhongshan (347,923) city of China. The cumulative incidence of HBP was 32.04%, and incidence rate was 14.86 per 100 person-year. After adjustment for confounders, the ten-unit increase in PM1, PM2.5, and PM10 exposure was significantly associated with 43%, 70%, and 43%- higher risks of HBP, respectively, but the 0.1-unit increase in NDVI exposure was significantly associated with a 25% lower risk of HBP. The HRs of PM1 on the HBP risk were 1.486 and 1.150 in the low and the high-level of greenness, and they were 2.635 and 2.507 for PM2.5, and for PM10 1.367 and 1.702 in the two groups. The attributable fraction (AFs) of PM1, PM2.5, and PM10 on HBP incidents were 13.74%, 40.08%, and 15.47% in the low-level of greenness, which simultaneously was higher than those in the high-level of greenness (AF = 4.62%, 17.28%, and 9.96%). The exposure to higher ambient PM air pollution and lower greenness around schools were associated with a higher risk of HBP in children and adolescents, but higher greenness alleviated the adverse effects of ambient PM1 and PM2.5 on the HBP risks. Our findings highlighted a synergic strategy in preventing childhood HBP by decreasing air pollution reduction and improving greenness concurrently.
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Affiliation(s)
- Li Chen
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing 100191, China
| | - Junqing Xie
- Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
| | - Tao Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing 100191, China
| | - Manman Chen
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing 100191, China
| | - Di Gao
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing 100191, China
| | - Yanhui Li
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing 100191, China
| | - Ying Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing 100191, China
| | - Bo Wen
- School of Public Health and Preventive Medicine, Monash University, Level 2, 553 St Kilda Road, Melbourne, VIC 3004, Australia
| | - Jun Jiang
- Department of Plant Science and Landscape Architecture, University of Maryland, USA
| | - Xijie Wang
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing 100191, China; Wanke School of Public Health, Tsinghua University, Beijing, China
| | - Jingbo Zhang
- Beijing Health Center for Physical Examination, Beijing 100191, China
| | - Shuo Chen
- Beijing Health Center for Physical Examination, Beijing 100191, China
| | - Lijuan Wu
- Department of Epidemiology and Health Statistics, Capital Medical University School of Public Health, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Weiming Li
- Department of Epidemiology and Health Statistics, Capital Medical University School of Public Health, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Xiangtong Liu
- Department of Epidemiology and Health Statistics, Capital Medical University School of Public Health, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Bin Dong
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing 100191, China
| | - Jing Wei
- Department of Atmospheric and Oceanic Science, Earth System Science Interdisciplinary Center, University of Maryland, College Park, MD, USA
| | - Xiuhua Guo
- Department of Epidemiology and Health Statistics, Capital Medical University School of Public Health, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Sizhe Huang
- Zhongshan Health Care Centers for Primary and Secondary School, Zhongshan 528403, China
| | - Yi Song
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing 100191, China
| | - Yanhui Dong
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing 100191, China.
| | - Jun Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing 100191, China.
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10
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Luo YN, Yang BY, Zou Z, Markevych I, Browning MHEM, Heinrich J, Bao WW, Guo Y, Hu LW, Chen G, Ma J, Ma Y, Chen YJ, Dong GH. Associations of greenness surrounding schools with blood pressure and hypertension: A nationwide cross-sectional study of 61,229 children and adolescents in China. ENVIRONMENTAL RESEARCH 2022; 204:112004. [PMID: 34499893 DOI: 10.1016/j.envres.2021.112004] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Greenness exposure may lower blood pressure. However, few studies of this relationship have been conducted with children and adolescents, especially in low and middle-income countries. OBJECTIVES To evaluate associations between greenness around schools and blood pressure among children and adolescents across China. METHODS We recruited 61,229 Chinese citizens aged 6-18 years from 94 schools in a nationwide cross-sectional study in seven Chinese provinces/province-level municipalities. Participants' blood pressures and hypertension were assessed with standardized protocols. Greenness levels within 500 m and 1,000 m of each school were estimated with three satellite-based indices: vegetation continuous fields (VCF), normalized difference vegetation index (NDVI), and soil adjusted vegetation index (SAVI). Generalized linear mixed models were used to evaluate associations between greenness and blood pressure, greenness and prevalent hypertension, using coefficient and odds ratio respectively. Stratified analyses and mediation analyses were also performed. RESULTS One interquartile range increase in greenness was associated with a 17%-20% reduced prevalence of hypertension for all measures of greenness (odds ratios for VCF500m = 20% (95% CI:18%, 23%); for NDVI500m = 17% (95% CI:13%, 21%); and for SAVI500m = 17% (95% CI: 13%, 20%). Increases in greenness were also associated with reductions in systolic blood pressure (0.48-0.58 mmHg) and diastolic blood pressure (0.26-0.52 mmHg). Older participants, boys, and urban dwellers showed stronger associations than their counterparts. No evidence of mediation was observed for air pollution (i.e., NO2 and PM2.5) and body mass index. CONCLUSION Higher greenness around schools may lower blood pressure levels and prevalent hypertension among Chinese children and adolescents, particularly in older subjects, boys, and those living in urban districts. Further studies, preferably longitudinal, are needed to examine causality.
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Affiliation(s)
- Ya-Na Luo
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangdong Provincial Engineering Technology Research Center of Environmental and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Bo-Yi Yang
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangdong Provincial Engineering Technology Research Center of Environmental and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Zhiyong Zou
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, 100191, China
| | - Iana Markevych
- Institute of Psychology, Jagiellonian University, Krakow, Poland
| | - Matthew H E M Browning
- Department of Parks, Recreation and Tourism Management, Clemson University, Clemson, SC, 29634, USA
| | - Joachim Heinrich
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, Ludwig Maximilian University of Munich; Comprehensive Pneumology Center (CPC) Munich, Member DZL; German Center for Lung Research, Ziemssenstrasse 1, 80336, Munich, Germany; Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Wen-Wen Bao
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne VIC, 3004, Australia
| | - Li-Wen Hu
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangdong Provincial Engineering Technology Research Center of Environmental and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Gongbo Chen
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangdong Provincial Engineering Technology Research Center of Environmental and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Jun Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, 100191, China
| | - Yinghua Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, 100191, China.
| | - Ya-Jun Chen
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China.
| | - Guang-Hui Dong
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangdong Provincial Engineering Technology Research Center of Environmental and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China.
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11
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Li X, Zhang W, Laden F, Curhan GC, Rimm EB, Guo X, Hart JE, Wu S. Dietary nitrate intake and vegetable consumption, ambient particulate matter, and risk of hypertension in the Nurses' Health study. ENVIRONMENT INTERNATIONAL 2022; 161:107100. [PMID: 35066305 DOI: 10.1016/j.envint.2022.107100] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/11/2022] [Accepted: 01/14/2022] [Indexed: 05/05/2023]
Abstract
BACKGROUND Studies have suggested that dietary nitrate could lower blood pressure levels whereas ambient particulate matter (PM) may increase risk of hypertension. However, it is unknown if these exposures may modify each other. OBJECTIVES We collected information on dietary nitrate intake and vegetables consumption and estimated long-term exposures to ambient PM for women in the Nurses' Health Study. METHODS Hazard ratios (HRs) and 95% confidence intervals (95% CIs) for risk of hypertension were calculated using Cox proportional hazards models with adjustment for potential demographic, lifestyle and dietary confounders. Interactions were assessed with multiplicative interaction terms and stratified models. RESULTS Increases in dietary nitrate intake (per 150 mg/d) and green leafy vegetables consumption (per serving/day) were both significantly associated with decreases in hypertension risk (both multivariable-adjusted HRs were 0.97, 95% CI: 0.94, 0.99). Long-term exposure to ambient PM with an aerodynamic diameter ≤ 2.5 µm (PM2.5) was associated with an increased risk of hypertension, with a multivariable-adjusted HR of hypertension of 1.06 (95% CI: 1.02, 1.11) per 10 µg/m3 increase in PM2.5. Ambient PM2.5 significantly modified the associations of dietary nitrate intake (Pinteraction = 0.02) and green leafy vegetables consumption (Pinteraction = 0.004). The associations with dietary factors were gradually weakened with increasing PM2.5: the fully-adjusted HRs for risk of hypertension were 0.94 (95% CI: 0.89, 0.99) and 0.94 (95% CI: 0.90, 0.99) for per 150 mg/d increase in nitrate intake and per serving/d increase in green leafy vegetables consumption, respectively, in the lowest PM2.5 quartile, and 1.00 (95% CI: 0.94, 1.06) and 1.02 (95% CI: 0.97, 1.08), respectively, in the highest PM2.5 quartile. CONCLUSION Our research highlights a potentially protective effect of dietary nitrate intake in the prevention of hypertension and suggests that these benefits are attenuated by increasing exposure to ambient PM2.5.
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Affiliation(s)
- Xianggui Li
- Department of Occupational and Environmental Health, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China; Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an, Shaanxi, China; Key Laboratory of Trace Elements and Endemic Diseases in Ministry of Health, Xi'an, Shaanxi, China
| | - Weidong Zhang
- Department of Occupational and Environmental Health, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China; Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an, Shaanxi, China; Key Laboratory of Trace Elements and Endemic Diseases in Ministry of Health, Xi'an, Shaanxi, China
| | - Francine Laden
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Exposure, Epidemiology and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Gary C Curhan
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Division of Renal (Kidney) Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Eric B Rimm
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Xinbiao Guo
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Jaime E Hart
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Exposure, Epidemiology and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Shaowei Wu
- Department of Occupational and Environmental Health, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China; Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an, Shaanxi, China; Key Laboratory of Trace Elements and Endemic Diseases in Ministry of Health, Xi'an, Shaanxi, China.
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12
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Jiang J, Chen G, Li B, Li N, Liu F, Lu Y, Guo Y, Li S, Chen L, Xiang H. Associations of residential greenness with hypertension and blood pressure in a Chinese rural population: a cross-sectional study. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:51693-51701. [PMID: 33988845 DOI: 10.1007/s11356-021-14201-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/27/2021] [Indexed: 06/12/2023]
Abstract
Limited epidemiological literature identified the associations between residential greenness and hypertension in low-/middle-income countries. A random sampling strategy was adopted to recruit 39,259 residents, ≥ 18 years, and from 5 counties in central China. Blood pressure was measured based on the protocol of the American Heart Association. Hypertension was defined according to the 2010 Chinese guidelines for the management of hypertension. The satellite-derived normalized difference vegetation index (NDVI) and enhanced vegetation index (EVI) were applied to estimate the residential greenness. Mixed logit model and mixed linear model were utilized to explore the relationships of residential greenness with hypertension and blood pressure. Higher residential greenness was associated with lower odds of hypertension and blood pressure levels. For instance, an interquartile range (IQR) increase in NDVI500m was linked with lower odds of hypertension (OR = 0.92, 95%CI 0.88 to 0.95), a decrease of -0.88 mm Hg (95% CI -1.17 to -0.58) and -0.64 mm Hg (95% CI -0.82 to -0.46) in SBP and DBP, respectively. The effect of residential greenness was more pronounced in males, smokers, and drinkers. Long-term exposure to residential greenness was linked with lower odds of hypertension. More prospective studies are needed to verify the hypothesis.
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Affiliation(s)
- Jie Jiang
- Department of Global Health, School of Health Sciences, Wuhan University, Wuhan, Hubei, China
- Global Health Institute, Wuhan University, Wuhan, Hubei, China
| | - Gongbo Chen
- Guangdong Provincial Engineering Technology Research Center of Environmental and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Baojing Li
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Na Li
- Department of Global Health, School of Health Sciences, Wuhan University, Wuhan, Hubei, China
- Global Health Institute, Wuhan University, Wuhan, Hubei, China
| | - Feifei Liu
- Department of Global Health, School of Health Sciences, Wuhan University, Wuhan, Hubei, China
- Global Health Institute, Wuhan University, Wuhan, Hubei, China
| | - Yuanan Lu
- Global Health Institute, Wuhan University, Wuhan, Hubei, China
- Environmental Health Laboratory, Department of Public Health Sciences, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Shanshan Li
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Lifeng Chen
- Department of Laboratory Medicine, Wuhan Pulmonary Hospital, Wuhan, Hubei, China.
| | - Hao Xiang
- Department of Global Health, School of Health Sciences, Wuhan University, Wuhan, Hubei, China.
- Global Health Institute, Wuhan University, Wuhan, Hubei, China.
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13
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Huang B, Xiao T, Grekousis G, Zhao H, He J, Dong G, Liu Y. Greenness-air pollution-physical activity-hypertension association among middle-aged and older adults: Evidence from urban and rural China. ENVIRONMENTAL RESEARCH 2021; 195:110836. [PMID: 33549617 DOI: 10.1016/j.envres.2021.110836] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/09/2021] [Accepted: 01/31/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Although some evidence suggests that residential greenness may prevent hypertension in urban areas, limited attention has been paid to urban-rural disparities in the association of greenness with hypertension in rapidly urbanizing developing countries. OBJECTIVES The current study investigated the association between the amount of neighbourhood greenness and hypertension among middle and older aged people in Chinese urban and rural areas. It further examined whether PM2.5 (particulate matter ≤2.5 μm in aerodynamic diameter) concentrations, physical activity, and body mass index (BMI) mediated the association of greenness with hypertension. METHODS We used data from 11 486 adults aged 50 years or above within the first wave of the Study on Global Ageing and Adult Health in China during 2007-2010. Hypertension was assessed by criterion-based measures of blood pressure. Residential greenness was characterized by satellite-derived Normalized Difference Vegetation Index. We employed multilevel generalized structural equation models to estimate the association between neighbourhood greenness and hypertension in urban and rural areas. Serial mediation models have been performed to test potential pathways linking greenness to hypertension. RESULTS In rural areas, a greater amount of residential greenness was directly associated with a decrease in the odds of hypertension (odds ratio = 0.51, 95% confidence interval 0.29-0.89). No direct association was observed in urban areas (odds ratio = 1.33, 95% confidence interval 0.94-1.89). Serial mediation models showed that the association of greenness with hypertension was completely mediated by PM2.5 concentrations in urban areas, while the association of greenness with hypertension was only partially mediated by PM2.5 concentrations and serial PM2.5 concentrations-physical activity path in rural areas. There was no evidence that physical activity, air pollution-BMI path, air pollution-physical activity-BMI path, and physical activity-BMI path mediated the association in both urban and rural areas. CONCLUSIONS Higher neighbourhood greenness was directly associated with a lower prevalence of hypertension among middle and older aged adults in rural China but not in urban areas. The association of greenness with hypertension was completely mediated by air pollution (without any mediation effect of physical activity and BMI) in urban areas. In contrast, the association was partly mediated by air pollution, physical activity, and other unobservables in rural areas. Further longitudinal studies are warranted to prove a cause-and-effect association, which may help policymakers and practitioners to conduce effective interventions to prevent and control the prevalence of hypertension and the attendant disease burden.
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Affiliation(s)
- Baishi Huang
- School of Geography and Planning, Sun Yat-Sen University, Guangzhou, China; Guangdong Key Laboratory for Urbanization and Geo-simulation, Sun Yat-Sen University, Guangzhou, China
| | - Tong Xiao
- School of Geography and Planning, Sun Yat-Sen University, Guangzhou, China; Guangdong Key Laboratory for Urbanization and Geo-simulation, Sun Yat-Sen University, Guangzhou, China
| | - George Grekousis
- School of Geography and Planning, Sun Yat-Sen University, Guangzhou, China; Guangdong Key Laboratory for Urbanization and Geo-simulation, Sun Yat-Sen University, Guangzhou, China.
| | - Hongsheng Zhao
- Department of Land Economy, University of Cambridge, Cambridge, UK
| | - Jiarui He
- School of Geography and Planning, Sun Yat-Sen University, Guangzhou, China; Guangdong Key Laboratory for Urbanization and Geo-simulation, Sun Yat-Sen University, Guangzhou, China
| | - Guanghui Dong
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Ye Liu
- School of Geography and Planning, Sun Yat-Sen University, Guangzhou, China; Guangdong Key Laboratory for Urbanization and Geo-simulation, Sun Yat-Sen University, Guangzhou, China.
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14
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Liu T, Cai B, Peng W, Xiao L, Shi H, Wu X, Gao H, Jia X. Association of neighborhood greenness exposure with cardiovascular diseases and biomarkers. Int J Hyg Environ Health 2021; 234:113738. [PMID: 33752171 DOI: 10.1016/j.ijheh.2021.113738] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 02/09/2021] [Accepted: 03/10/2021] [Indexed: 12/16/2022]
Abstract
AIM Living in areas with neighborhood greenness may be associated with the incidence of cardiovascular diseases (CVDs). However, little evidence in this regard has emerged from developing countries. In the present study, we examined neighborhood greenness associated with CVDs and the lipid accumulation product (LAP) and pulse pressure (PP) in China. METHODS We undertook our analysis using a community cross-sectional survey conducted in Longzihu District of Bengbu from July to August 2015. We measured triglyceride levels, waist circumference, and blood pressure. To assess exposure to neighborhood greenness, we used the average normalized difference vegetation index (NDVI) at 1,000-, 1,500-, and 2,000-m buffers in the participant community. We employed generalized mixed models to determine the association among neighborhood greenness, CVDs, LAP, and PP. We conducted stratified analysis by age, gender, income, and education. We assessed the potential mediating effects of road proximity and physical activity on greenness and CVDs, PP, and LAP. RESULTS The highest tertiles of NDVI1500-m were steadily and significantly associated with lower odds of CVDs prevalence: the adjusted OR of such prevalence was 0.612 (95% CI, 0.462-0.811); higher NDVI was significantly associated with lower PP levels. The NDVI was strongly associated with CVDs prevalence among participants who were male and had high income. Ambient road proximity significantly mediated 9.7% of the estimated association between greenness and PP, there was no evidence of mediation effects for physical activity. CONCLUSIONS Higher neighborhood greenness could have a beneficial effect on CVDs and biomarkers. There were higher associations between residential greenness and CVDs among male and higher-income individuals; road proximity partially mediated the observed association between greenness and PP.
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Affiliation(s)
- Ting Liu
- Department of Epidemiology and Statistics, School of Public Health, Bengbu Medical College, Bengbu, Anhui, China
| | - Ben Cai
- Department of Epidemiology and Statistics, School of Public Health, Bengbu Medical College, Bengbu, Anhui, China
| | - Wenjia Peng
- Department of Epidemiology and Statistics, School of Public Health, Bengbu Medical College, Bengbu, Anhui, China
| | - Liping Xiao
- Department of Epidemiology and Statistics, School of Public Health, Bengbu Medical College, Bengbu, Anhui, China
| | - Hengyuan Shi
- Department of Epidemiology and Statistics, School of Public Health, Bengbu Medical College, Bengbu, Anhui, China
| | - Xuesen Wu
- Department of Epidemiology and Statistics, School of Public Health, Bengbu Medical College, Bengbu, Anhui, China
| | - Huaiquan Gao
- Department of Epidemiology and Statistics, School of Public Health, Bengbu Medical College, Bengbu, Anhui, China.
| | - Xianjie Jia
- Department of Epidemiology and Statistics, School of Public Health, Bengbu Medical College, Bengbu, Anhui, China.
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15
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Garn H, Potaczek DP, Pfefferle PI. The Hygiene Hypothesis and New Perspectives-Current Challenges Meeting an Old Postulate. Front Immunol 2021; 12:637087. [PMID: 33815389 PMCID: PMC8012489 DOI: 10.3389/fimmu.2021.637087] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/04/2021] [Indexed: 01/11/2023] Open
Abstract
During its 30 years history, the Hygiene Hypothesis has shown itself to be adaptable whenever it has been challenged by new scientific developments and this is a still a continuously ongoing process. In this regard, the mini review aims to discuss some selected new developments in relation to their impact on further fine-tuning and expansion of the Hygiene Hypothesis. This will include the role of recently discovered classes of innate and adaptive immune cells that challenges the old Th1/Th2 paradigm, the applicability of the Hygiene Hypothesis to newly identified allergy/asthma phenotypes with diverse underlying pathomechanistic endotypes, and the increasing knowledge derived from epigenetic studies that leads to better understanding of mechanisms involved in the translation of environmental impacts on biological systems. Further, we discuss in brief the expansion of the Hygiene Hypothesis to other disease areas like psychiatric disorders and cancer and conclude that the continuously developing Hygiene Hypothesis may provide a more generalized explanation for health burden in highly industrialized countries also relation to global changes.
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Affiliation(s)
- Holger Garn
- Translational Inflammation Research Division & Core Facility for Single Cell Multiomics, Medical Faculty, Biochemical Pharmacological Center (BPC), Philipps University of Marburg, Marburg, Germany.,German Center for Lung Research (DZL), Marburg, Germany
| | - Daniel Piotr Potaczek
- Translational Inflammation Research Division & Core Facility for Single Cell Multiomics, Medical Faculty, Biochemical Pharmacological Center (BPC), Philipps University of Marburg, Marburg, Germany
| | - Petra Ina Pfefferle
- German Center for Lung Research (DZL), Marburg, Germany.,Comprehensive Biobank Marburg (CBBMR), Medical Faculty, Philipps University of Marburg, Marburg, Germany.,German Biobank Alliance (GBA), Marburg, Germany
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16
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Neighborhood Social and Built Environment and Disparities in the Risk of Hypertension: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207696. [PMID: 33096878 PMCID: PMC7588916 DOI: 10.3390/ijerph17207696] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/17/2020] [Accepted: 10/20/2020] [Indexed: 12/11/2022]
Abstract
Citizens’ participation in urban environmental quality assessment is important when identifying local problems in the sustainable development and environmental planning policy. The principal aim of this study was to analyze whether any social differences exist between the joint effect of built neighborhood quality and exposure to urban green spaces and the risk of hypertension. The study sample consisted of 580 participants residing in 11 districts in Kaunas city, Lithuania. Using geographic information systems (GIS), individual data on the socioeconomic status (SES) and health were linked to the participants’ perceptions of the environmental quality and exposure to green spaces (NDVI). We used multivariate logistic regression to estimate associations as odds ratios (OR). Those study participants with lower education and those study participants with higher education on low incomes rated their health significantly worse. Low SES persons residing in areas with low exposure to green spaces had a significantly higher risk of hypertension when sex, age, family status, smoking, and income were accounted for (OR 1.83, 95% CI 1.01–3.36). This citizen science study provided evidence that the social environment and the quality of the built environment had a complex effect on disparities in the risk of hypertension.
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17
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Urban-Related Environmental Exposures during Pregnancy and Placental Development and Preeclampsia: a Review. Curr Hypertens Rep 2020; 22:81. [PMID: 32880755 DOI: 10.1007/s11906-020-01088-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW To summarize the current knowledge of the pathophysiological implications and the clinical role of urban-related environmental exposures in pregnancy. RECENT FINDINGS The ongoing urbanization worldwide is leading to an increasing number of pregnant women being exposed to higher levels of urban-related environmental hazards such as air pollution and noise and, at the same time, having less contact with natural environments. Pregnancy represents a particular and vulnerable life period both for women and their children. Extensive physiological and metabolic changes, as well as changes to the cardiovascular and respiratory systems during pregnancy, could result in increased sensitivity to damage by environmental factors. Exposure to air pollution and noise is associated with placental dysfunction and damage, which, in turn, could lead to maternal complications such as preeclampsia. In contrast, more contact with greenspace during pregnancy seems to mitigate these adverse impacts. These findings open up new challenges for our understanding of the potential effect of urban living on placental function and preeclampsia, and offer new clinical and research opportunities.
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Akaraci S, Feng X, Suesse T, Jalaludin B, Astell-Burt T. A Systematic Review and Meta-Analysis of Associations between Green and Blue Spaces and Birth Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082949. [PMID: 32344732 PMCID: PMC7215926 DOI: 10.3390/ijerph17082949] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 04/13/2020] [Accepted: 04/21/2020] [Indexed: 12/13/2022]
Abstract
Previous studies suggest that green and blue spaces may promote several health outcomes including birth outcomes. However, no synthesis of previous work has specifically asked policy-relevant questions of how much and what type is needed in every neighborhood to elicit these benefits at the population level. A systematic review and meta-analyses were conducted to synthesize thirty-seven studies on the association between residential green and blue spaces and pregnancy outcomes. Meta-analyses were performed for birth weight (BW), small for gestational age (SGA), low birth weight (LBW) and preterm birth (PTB). Increase in residential greenness was statistically significantly associated with higher BW [β = 0.001, 95%CI: (<0.001, 0.002)] and lower odds of SGA [OR = 0.95, 95%CI: (0.92, 0.97)]. Associations between green space and LBW and PTB were as hypothesized but not statistically significant. Associations between blue spaces and pregnancy outcomes were not evident. No study explicitly examined questions of threshold, though some evidence of nonlinearity indicated that moderate amounts of green space may support more favorable pregnancy outcomes. Policy-relevant green and blue space exposures involving theory-driven thresholds warrant testing to ensure future investments in urban greening promote healthier pregnancy outcomes.
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Affiliation(s)
- Selin Akaraci
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, NSW 2522, Australia; (S.A.); (X.F.)
| | - Xiaoqi Feng
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, NSW 2522, Australia; (S.A.); (X.F.)
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
- Menzies Centre for Health Policy, University of Sydney, Sydney, NSW 2006, Australia
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention (China CDC), Beijing 102206, China
| | - Thomas Suesse
- NIASRA, National Institute for Applied Statistics Research Australia School of Mathematics and Applied Statistics, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, NSW 2522, Australia;
| | - Bin Jalaludin
- Ingham Institute for Applied Medical Research, University of New South Wales, Sydney, NSW 2170, Australia;
| | - Thomas Astell-Burt
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, NSW 2522, Australia; (S.A.); (X.F.)
- Menzies Centre for Health Policy, University of Sydney, Sydney, NSW 2006, Australia
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention (China CDC), Beijing 102206, China
- School of Public Health, Peking Union Medical College and The Chinese Academy of Medical Sciences, Beijing 100730, China
- Correspondence:
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19
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Xiao X, Yang BY, Hu LW, Markevych I, Bloom MS, Dharmage SC, Jalaludin B, Knibbs LD, Heinrich J, Morawska L, Lin S, Roponen M, Guo Y, Lam Yim SH, Leskinen A, Komppula M, Jalava P, Yu HY, Zeeshan M, Zeng XW, Dong GH. Greenness around schools associated with lower risk of hypertension among children: Findings from the Seven Northeastern Cities Study in China. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2020; 256:113422. [PMID: 31672364 DOI: 10.1016/j.envpol.2019.113422] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 10/12/2019] [Accepted: 10/15/2019] [Indexed: 05/12/2023]
Abstract
Evidence suggests that residential greenness may be protective of high blood pressure, but there is scarcity of evidence on the associations between greenness around schools and blood pressure among children. We aimed to investigate this association in China. Our study included 9354 children from 62 schools in the Seven Northeastern Cities Study. Greenness around each child's school was measured by NDVI (Normalized Difference Vegetation Index) and SAVI (Soil-Adjusted Vegetation Index). Particulate matter ≤ 1 μm (PM1) concentrations were estimated by spatiotemporal models and nitrogen dioxide (NO2) concentrations were collected from air monitoring stations. Associations between greenness and blood pressure were determined by generalized linear and logistic mixed-effect models. Mediation by air pollution was assessed using mediation analysis. Higher greenness was consistently associated with lower blood pressure. An increase of 0.1 in NDVI corresponded to a reduction in SBP of 1.39 mmHg (95% CI: 1.86, -0.93) and lower odds of hypertension (OR = 0.76, 95% CI: 0.69, 0.82). Stronger associations were observed in children with higher BMI. Ambient PM1 and NO2 mediated 33.0% and 10.9% of the association between greenness and SBP, respectively. In summary, greater greenness near schools had a beneficial effect on blood pressure, particularly in overweight or obese children in China. The associations might be partially mediated by air pollution. These results might have implications for policy makers to incorporate more green space for both aesthetic and health benefits.
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Affiliation(s)
- Xiang Xiao
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Bo-Yi Yang
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Li-Wen Hu
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Iana Markevych
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstraße 1, 80336, Munich, Germany; Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
| | - Michael S Bloom
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China; Departments of Environmental Health Sciences & Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY, 12144, USA
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, 3004, Australia; Murdoch Children Research Institute, Melbourne, VIC, 3010, Australia
| | - Bin Jalaludin
- Centre for Air Quality and Health Research and Evaluation, Glebe, NSW, 2037, Australia; IIngham Institute for Applied Medial Research, University of New South Wales, Sydney, 2170, Australia
| | - Luke D Knibbs
- School of Public Health, The University of Queensland, Herston, Queensland, 4006, Australia
| | - Joachim Heinrich
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstraße 1, 80336, Munich, Germany; Comprehensive Pneumology Center Munich, German Center for Lung Research, Ziemssenstraße 1, 80336, Munich, Germany
| | - Lidia Morawska
- International Laboratory for Air Quality and Health, Queensland University of Technology (QUT), GPO Box 2434, Brisbane, Queensland, 4001, Australia
| | - Shao Lin
- Departments of Environmental Health Sciences & Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY, 12144, USA
| | - Marjut Roponen
- Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, FI, 70211, Finland
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Steve Hung Lam Yim
- Department of Geography and Resource Management, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong, China; Stanley Ho Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong, China
| | - Ari Leskinen
- Finnish Meteorological Institute, Kuopio, 70211, Finland; Department of Applied Physics, University of Eastern Finland, Kuopio, 70211, Finland
| | - Mika Komppula
- Finnish Meteorological Institute, Kuopio, 70211, Finland
| | - Pasi Jalava
- Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, FI, 70211, Finland
| | - Hong-Yao Yu
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Mohammed Zeeshan
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Xiao-Wen Zeng
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Guang-Hui Dong
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China.
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20
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Nabizadeh R, Yousefian F, Moghadam VK, Hadei M. Characteristics of cohort studies of long-term exposure to PM 2.5: a systematic review. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:30755-30771. [PMID: 31494855 DOI: 10.1007/s11356-019-06382-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 08/29/2019] [Indexed: 06/10/2023]
Abstract
This study systematically reviewed all the cohort studies investigating the relationship between long-term exposure to PM2.5 and any health outcome until February 2018. We searched ISI Web of Knowledge, Pubmed, and Scopus databases for peer-reviewed journal research articles published in English. We only extracted the results of the single-pollutant main analysis of each study, excluding the effect modifications and sensitivity analyses. Out of the initial 9523 articles, 203 articles were ultimately included for analysis. Based on the different characteristics of studies such as study design, outcome, exposure assessment method, and statistical model, we calculated the number and relative frequency of analyses with statistically significant and insignificant results. Most of the studies were prospective (84.8%), assessed both genders (66.5%), and focused on a specific age range (86.8%). Most of the articles (78.1%) had used modeling techniques for exposure assessment of cohorts' participants. Among the total of 317 health outcomes, the most investigated outcomes include mortality due to cardiovascular disease (6.19%), all causes (5.48%), lung cancer (4.00%), ischemic heart disease (3.50%), and non-accidental causes (3.50%). The percentage of analyses with statistically significant results were higher among studies that used prospective design, mortality as the outcome, fixed stations as exposure assessment method, hazard ratio as risk measure, and no covariate adjustment. We can somehow conclude that the choice of right characteristics for cohort studies can make a difference in their results.
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Affiliation(s)
- Ramin Nabizadeh
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Yousefian
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Vahid Kazemi Moghadam
- Department of Environmental Health Engineering, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Mostafa Hadei
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
- Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran.
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21
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Yang BY, Markevych I, Bloom MS, Heinrich J, Guo Y, Morawska L, Dharmage SC, Knibbs LD, Jalaludin B, Jalava P, Zeng XW, Hu LW, Liu KK, Dong GH. Community greenness, blood pressure, and hypertension in urban dwellers: The 33 Communities Chinese Health Study. ENVIRONMENT INTERNATIONAL 2019; 126:727-734. [PMID: 30878868 DOI: 10.1016/j.envint.2019.02.068] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/10/2019] [Accepted: 02/25/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Living in greener areas has many health benefits, but evidence concerning the effects on blood pressure remains mixed. We sought to assess associations between community greenness and both blood pressure and hypertension in Chinese urban dwellers, and whether the associations were mediated by air pollution, body mass index, and physical activity. METHODS We analyzed data from 24,845 adults participating in the 33 Communities Chinese Health Study, which was conducted in Northeastern China during 2009. We measured each participant's blood pressure according to a standardized protocol. We assessed community greenness using two satellite-derived vegetation indexes - the Normalized Difference Vegetation Index (NDVI) and the Soil Adjusted Vegetation Index (SAVI). Particulate matter ≤2.5 μm and nitrogen dioxide were used as proxies of ambient air pollution. We applied generalized linear mixed models to investigate the association between greenness and blood pressure. We also performed mediation analyses. RESULTS Living in greener areas was associated with lower blood pressure and hypertension prevalence; an interquartile range increase in both NDVI500-m and SAVI500-m were significantly associated with reductions in systolic blood pressure of 0.82 mm Hg (95% CI: -1.13, -0.51) and 0.89 mm Hg (95% CI: -1.21, -0.57), respectively. The same increases in greenness were also significantly associated with a 5% (95% CI: 1%, 8%) and 5% (95% CI: 1%, 9%) lower odds of having hypertension, respectively. These associations remained consistent in sensitivity analyses. The associations were stronger among women than men. Air pollutants and body mass index partly mediated the associations, but there was no evidence of mediation effects for physical activity. CONCLUSIONS Our findings indicate beneficial associations between community greenness and blood pressure in Chinese adults, especially for women. Air pollution and body mass index only partly mediated the associations.
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Affiliation(s)
- Bo-Yi Yang
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangdong Provincial Engineering Technology Research Center of Environmental and Health risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Iana Markevych
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstraße 1, 80336 Munich, Germany; Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany; Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, Munich, Ludwig Maximilian University of Munich, Munich, Germany
| | - Michael S Bloom
- Departments of Environmental Health Sciences and Epidemiology and Biostatics, University at Albany, State University of New York, Rensselaer, NY 12144, USA
| | - Joachim Heinrich
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstraße 1, 80336 Munich, Germany; Comprehensive Pneumology Center Munich, German Center for Lung Research, Ziemssenstraße 1, 80336 Munich, Germany
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Lidia Morawska
- International Laboratory for Air Quality and Health, Queensland University of Technology (QUT), GPO Box 2434, Brisbane, Queensland 4001, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population & Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia; Murdoch Children Research Institute, Melbourne, VIC 3010, Australia
| | - Luke D Knibbs
- School of Public Health, The University of Queensland, Herston, Queensland 4006, Australia
| | - Bin Jalaludin
- Centre for Air Quality and Health Research and Evaluation, Glebe, NSW 2037, Australia; Population Health, South Western Sydney Local Health District, Liverpool, NSW 2170, Australia; Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia; School of Public Health and Community Medicine, The University of New South Wales, Kensington, NSW 2052, Australia
| | - Pasi Jalava
- Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio FI 70211, Finland
| | - Xiao-Wen Zeng
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangdong Provincial Engineering Technology Research Center of Environmental and Health risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Li-Wen Hu
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangdong Provincial Engineering Technology Research Center of Environmental and Health risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Kang-Kang Liu
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangdong Provincial Engineering Technology Research Center of Environmental and Health risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Guang-Hui Dong
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangdong Provincial Engineering Technology Research Center of Environmental and Health risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
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22
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Dzhambov AM, Markevych I, Lercher P. Greenspace seems protective of both high and low blood pressure among residents of an Alpine valley. ENVIRONMENT INTERNATIONAL 2018; 121:443-452. [PMID: 30273867 DOI: 10.1016/j.envint.2018.09.044] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 09/24/2018] [Accepted: 09/25/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND There is some data suggesting that residential greenspace may protect against high blood pressure in urbanized areas, but there is no evidence of effects on hypotension, in less urbanized areas, and in idiosyncratic geographic contexts such as mountain valleys. OBJECTIVES The current study aimed to investigate the associations between residential greenspace and blood pressure in an alpine valley in Austria. METHODS We conducted a cross-sectional survey of a representative sample of 555 adults living in the Lower Inn Valley, Austria. Several definitions of blood pressure were employed: continuously-measured systolic (SBP) and diastolic blood pressure (DBP), doctor-diagnosed hyper- and hypotension, and high- and low blood pressure medication use. Greenspace metrics considered were: Normalized Difference Vegetation Index (NDVI), Soil Adjusted Vegetation Index (SAVI), and tree cover as measures of surrounding greenness in circular buffers of 100 m, 300 m, 500 m, and 1000 m around the home; distance to different types of structured green space; and having a domestic garden and a balcony. Relationships were examined across different definitions of blood pressure and greenspace and evaluated for potential effect modification by demographic factors, presence of a domestic garden/balcony, adiposity, and traffic sensitivity. RESULTS Higher overall greenness was associated with 30-40% lower odds of hyper/hypotension and 2-3 mm Hg lower SBP. Similar pattern was revealed for tree cover, however, associations with hypertension were less consistent across buffers, and SBP and DBP were lower only in association with greenness in the 100-m buffer. Having a domestic garden also seemed protective of high DBP. Residing near to forests, agricultural land, or urban green spaces was not related to blood pressure. Higher NDVI500-m was stronger associated with lower SBP in those having a domestic garden, while the effect on DBP was stronger in overweight/obese participants. CONCLUSION These findings support the idea that greenspace should be considered as protective of both high and low blood pressure, however, underlying mechanisms remain insufficiently understood.
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Affiliation(s)
- Angel M Dzhambov
- Department of Hygiene and Ecomedicine, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria.
| | - Iana Markevych
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany; Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, Munich, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Peter Lercher
- Division of Social Medicine, Medical University Innsbruck, Innsbruck, Austria
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