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Zeng D, Yang Y, Tang Y, Zhao L, Wang X, Yun D, Chen W, Shang Y, Xu A, Liao H, Zhang X, Lin D, Lin H. Shaping school for childhood myopia: the association between floor area ratio of school environment and myopia in China. Br J Ophthalmol 2024; 109:146-151. [PMID: 38955480 DOI: 10.1136/bjo-2024-325448] [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: 02/29/2024] [Accepted: 05/27/2024] [Indexed: 07/04/2024]
Abstract
AIM To investigate the association of floor area ratio (FAR), an indicator of built environments, and myopia onset. METHODS This prospective cohort study recruited 136 753 children aged 6-10 years from 108 schools in Shenzhen, China at baseline (2016-2017). Refractive power was measured with non-cycloplegic autorefraction over a 2-year follow-up period. FAR was objectively evaluated using geographical information system technology. Mixed-effects logistic regression models were constructed to examine the association of FAR with a 2-year cumulative incidence of myopia among individuals without baseline myopia; multiple linear regression model, with a 2-year cumulative incidence rate of myopia at each school. RESULTS Of 101 624 non-myopic children (56.3% boys; mean (SE) age, 7.657±1.182 years) included in the study, 26 391 (26.0%) of them developed myopia after 2 years. In the individual-level analysis adjusting for demographic, socioeconomic and greenness factors, an IQR in FAR was associated with a decreased risk of 2-year myopia incidence (OR 0.898, 95% CI 0.866 to 0.932, p<0.001). Similar findings were observed in the analysis additionally adjusted for genetic and behavioural factors (OR 0.821, 95% CI 0.766 to 0.880, p<0.001). In the school-level, an IQR increase in FAR was found to be associated with a 2.0% reduction in the 2-year incidence rate of myopia (95% CI 1.3% to 2.6%, p<0.001). CONCLUSIONS Exposure to higher FAR was associated with a decreased myopia incidence, providing insights into myopia prevention through school built environments in China.
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Affiliation(s)
- Danqi Zeng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Yahan Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Yang Tang
- Department of Civil, Environmental and Geodetic Engineering, The Ohio State University, Columbus, Ohio, USA
| | - Lanqin Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Xun Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Dongyuan Yun
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Wenben Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Yuanjun Shang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Andi Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Huipeng Liao
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Xingying Zhang
- Key Laboratory of Radiometric Calibration and Validation for Environmental Satellites, Beijing, China
| | - Duoru Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
- Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Haikou, Hainan, China
- Center for Precision Medicine and Department of Genetics and Biomedical Informatics, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China
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Cui Q, Xu Y, Li F, Zhou F, Xiao D, Chen Z, Hua X, Hua D. Impacts of environments on school myopia by spatial analysis techniques in Wuhan. Sci Rep 2024; 14:29941. [PMID: 39623021 PMCID: PMC11612477 DOI: 10.1038/s41598-024-81270-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 11/25/2024] [Indexed: 12/06/2024] Open
Abstract
The prevalence of myopia in China has increased significantly in recent years, and the age of onset has become younger. Previous studies have indicated that various environmental factors can influence the development of school myopia. However, the environmental impacts on school myopia remains to be investigated. Discoveries in this field may contribute to better urban planning. This study involved 7,610 students (aged 6-12 years, 4084 boys and 3526 girls) from six primary schools in Wuhan, China. We evaluated the associations between school myopia and the environment by analyzing the geographical distribution of myopic children. We utilized the spatial statistical analysis model. The Normalized Difference Vegetation Index (NDVI) risk coefficient for a 5,000-m radius around target schools was 0.379 (p = 0.008), while the NDVI risk coefficient for a 100-m radius around target schools was 0.241 (p = 0.047). The sports area risk coefficient for a 5,000-m radius around target schools was 0.234 (p = 0.016). We found that the specific buffers of NDVI and sports area around schools were associated with the prevalence of school myopia in schools, which worth further research to guide future initiatives on school myopia from an environmental perspective.
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Affiliation(s)
- Qi Cui
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, China
- School of Geodesy, Wuhan University, Wuhan, 430079, Hubei, China
| | - Yishuang Xu
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, China
| | - Fan Li
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, China
| | - Fangyuan Zhou
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, China
| | - Di Xiao
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, China
| | - Zhen Chen
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, China.
| | - Xianghong Hua
- School of Geodesy, Wuhan University, Wuhan, 430079, Hubei, China.
| | - Dihao Hua
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, China.
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Yan JM, Zhang MZ, Yu HJ, He QQ. Residential greenness, air pollution and visual impairment: a prospective cohort study. BMC Public Health 2024; 24:3332. [PMID: 39614249 DOI: 10.1186/s12889-024-20853-7] [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: 10/01/2024] [Accepted: 11/25/2024] [Indexed: 12/01/2024] Open
Abstract
OBJECTIVE The aim of this study was to investigate the associations between residential greenness, air pollution (PM2.5, PM10, and NO2), and the risk of visual impairment in Chinese middle-aged and elderly adults. METHODS The data were used from the China Health and Retirement Longitudinal Study (CHARLS), focusing on adults aged 45 years and older. Exposure to residential greenness was assessed using the Normalized Difference Vegetation Index (NDVI), while air pollution exposure (PM2.5, PM10, and NO2) was estimated from the ChinaHighAirPollutants dataset. Visual impairment was self-reported and categorized as distance visual impairment (DVI) and near visual impairment (NVI). Cox proportional hazards models were applied to investigate the associations between residential greenness, air pollution, and visual impairment. Furthermore, we investigated the potential modification and mediation relationship between residential greenness, air pollution and visual impairment. RESULTS A total of 9,591 participants were included in this study. During a 7-year period, 2,650 cases of DVI and 3,130 cases of NVI were identified. In the single exposure model, a higher level of residential greenness was associated with a significantly reduced risk of both DVI and NVI. Specifically, for every 0.1 unit increase in NDVI, the hazard ratio (HR) was 0.68 (95%CI: 0.65,0.71) for DVI, and 0.67 (95%CI: 0.64,0.69) for NVI. Conversely, exposure to air pollution was positively associated with increased risks for both DVI and NVI. For each 10 µg/m3 increase in PM2.5, the HR was 1.60 (95%CI: 1.56,1.65) for DVI and 1.64 (95%CI: 1.60,1.69) for NVI. Similarly, PM10 and NO2 exposure showed elevated risks with HR of 1.28 (95%CI: 1.27,1.30) and 1.73 (95%CI: 1.62,1.85) for DVI, and 1.30 (95%CI: 1.28,1.32) and 1.82 (95%CI: 1.72,1.94) for NVI, respectively. The multiple exposure model also showed significant association between residential greenness, air pollution and visual impairment risk. Additionally, the adverse effects of PM2.5, PM10, and NO2 were attenuated in areas with the highest levels of residential greenness. Mediation analysis revealed that air pollution mediated a significant portion of the association between residential greenness and visual impairment. CONCLUSION This study suggests that increased residential greenness may reduce the risk of visual impairment, partially by mitigating air pollution exposure. These findings highlight the environmental benefits to improve air quality and enhance green spaces, thereby promoting visual health in aging populations.
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Affiliation(s)
- Jia-Min Yan
- Department of Laboratory Medicine, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, P. R. China.
| | - Min-Zhe Zhang
- School of Public Health, Wuhan University, Wuhan, China
| | - Hong-Jie Yu
- School of Public Health, Wuhan University, Wuhan, China
| | - Qi-Qiang He
- School of Public Health, Wuhan University, Wuhan, China
- Hubei Biomass-Resource Chemistry and Environmental Biotechnology Key Laboratory, Wuhan University, Wuhan, China
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Zhang H, Zhang N, Li Z, Yang J, Zhu Y, Liu Z, Chen L. A higher shadow ratio of the living environment on the remote sensing digital image is possibly protective for adolescent myopia. Sci Rep 2024; 14:23824. [PMID: 39394394 PMCID: PMC11470056 DOI: 10.1038/s41598-024-75486-y] [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: 07/08/2024] [Accepted: 10/07/2024] [Indexed: 10/13/2024] Open
Abstract
This study aims to assess how the construction patterns within residential communities influence the adolescent myopia using general survey. In a private high school from a megacity in mid-west China, a questionnaire gathered data on the 10th-grade students' level of myopia, home address, and some potential confounding factors. Additionally, satellite digital images were utilized to calculate the proportion of shadow area (PSA) and the proportion of greenness area (PGA) within a 500 m×500 m area centered on each student's home address. Correlations between myopia levels and PSA, along with other variables, were analyzed. The prevalence of mild, moderate, and high myopia were 39.2%, 32.5%, and 8.3%, respectively. A negative correlation was observed between myopia levels and PSA, albeit marginally significant (r=-0.189*, P = 0.05). Upon dividing the sample into higher and lower PSA groups using a cut-off point of 20%, a significant difference in myopia levels was evident (χ2 = 8.361, P = 0.038), while other confounding factors remained comparable. In conclusion, high-rise apartment constructions, which often cast more shadows on digital satellite maps, may not exacerbate myopia progression. Instead, they could potentially serve as a protective factor against adolescent myopia in densely populated megacities, as they allow for more ground space allocation.
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Affiliation(s)
- Hanze Zhang
- Department of Ophthalmology, First affiliated hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Ningyuan Zhang
- International course class, Xi'an Gao Xin No.1 High school, Xi'an, Shaanxi, China
| | - Zeyu Li
- International course class, Xi'an Gao Xin No.1 High school, Xi'an, Shaanxi, China
| | - Jingyuan Yang
- International course class, Xi'an Gao Xin No.1 High school, Xi'an, Shaanxi, China
| | - Yucheng Zhu
- International course class, Xi'an Gao Xin No.1 High school, Xi'an, Shaanxi, China
| | - Zhao Liu
- Department of Ophthalmology, First affiliated hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Li Chen
- Department of Ophthalmology, First affiliated hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
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Barnett-Itzhaki G, Barnett-Itzhaki Z, Mezad-Koursh D. The protective role of green spaces in mitigating myopia prevalence. Front Public Health 2024; 12:1473995. [PMID: 39430709 PMCID: PMC11486636 DOI: 10.3389/fpubh.2024.1473995] [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: 07/31/2024] [Accepted: 09/25/2024] [Indexed: 10/22/2024] Open
Abstract
Near-sightedness, or myopia, is becoming more prevalent worldwide, but its etiopathogenesis is not fully understood. This review examines the potential protective role of green spaces in reducing myopia prevalence among children and adolescents, based on recent epidemiological studies from various countries. The studies consistently used the Normalized Difference Vegetation Index (NDVI) to quantify green space exposure. The analysis reveals a significant inverse relationship between exposure to green space and the risk of developing myopia, across multiple studies. For example, a 0.1 increase in NDVI within various buffer zones around schools was associated with a 6.3-8.7% reduction in myopia prevalence. Higher residential greenness within a 100-meter buffer around homes was linked to a 38% reduction in the risk of developing myopia among preschool children. The protective effect was observed across different age groups, from preschoolers to high school students. Urban planning factors, such as the size, connectivity, and aggregation of green spaces, also influenced myopia risk. These findings suggest that increasing access to green spaces in urban environments may be an effective strategy for myopia prevention, with important implications for public health and urban planning policies.
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Affiliation(s)
- Guy Barnett-Itzhaki
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Zohar Barnett-Itzhaki
- Ruppin Research Group in Environmental and Social Sustainability, Ruppin Academic Center, Emek Hefer, Israel
| | - Daphna Mezad-Koursh
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
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Liu T, Tan W, Fu Y, Cheng B, Tian H, Liu C, Wang Z, Zhang Y, Guan S, Liu Z. Association of outdoor artificial light at night with myopia among Chinese adolescents: a representative cross-sectional study. Front Med (Lausanne) 2024; 11:1469422. [PMID: 39399108 PMCID: PMC11466777 DOI: 10.3389/fmed.2024.1469422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Accepted: 09/18/2024] [Indexed: 10/15/2024] Open
Abstract
Background The association between the rapid increase in myopia among adolescents and the amount of outdoor artificial light at night (ALAN) remains unclear. The aim of this study was to investigate the association between outdoor ALAN and myopia in adolescents. Methods Stratified cluster random sampling was used to obtain a sample of 33,160 students (age range: 9-18 years; mean: 13.51 years) with complete data from 120 primary and secondary schools across the Ningxia region in China in 2021. Myopia was defined as a spherical equivalent (SE) ≤-0.5 diopters (D) in at least one eye, determined by automated refractometers without cycloplegia. Outdoor ALAN data were obtained from satellite data and the two-year average outdoor ALAN exposure for each participant was determined by matching it to their school address (home addresses were not available). The association between ALAN and myopia was assessed using multiple logistic regression models and restricted cubic spline (RCS) regression. Stratified analyses were performed by age, sex, residence, school level, and outdoor exercise time. Results The myopia group had higher outdoor ALAN levels than the non-myopia group [median (interquartile spacing): 14.44 (3.88-26.56) vs. 6.95 (1.21-21.74) nanoWatts/cm2/sr]. After adjusting for covariates identified through stepwise regression, it was observed that the prevalence of myopia increased by 4% for every 10-unit change [95% confidence interval (CI): 1.02-1.07]. Compared to the first quantile (Q1) of outdoor ALAN exposure, the odds ratio (OR) of myopia was 1.20 (95% CI: 1.08-1.34) in the fourth quantile. RCS further showed a positive nonlinear relationship between outdoor ALAN exposure and myopia (p for nonlinear <0.001). Stronger effects were not found in subgroup analyses. Conclusion Outdoor ALAN exposure is positively and nonlinearly associated with the prevalence of myopia in adolescents. Controlling outdoor light pollution may constitute a potential strategy to reduce the incidence of myopia in adolescents.
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Affiliation(s)
- Ting Liu
- School of Public Health, Ningxia Medical University, Yinchuan, China
- Hospital Infection Management Department, People's Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University, Yinchuan, China
- Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan, China
| | - Weixing Tan
- School Health Section, Ningxia Center for Disease Control and Prevention, Yinchuan, China
| | - Youjuan Fu
- School of Inspection, Ningxia Medical University, Yinchuan, China
| | - Beijing Cheng
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, China
| | - Hua Tian
- School Health Section, Ningxia Center for Disease Control and Prevention, Yinchuan, China
| | - Can Liu
- School of Public Health, Ningxia Medical University, Yinchuan, China
- Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan, China
| | - Zhixiang Wang
- Hospital Infection Management Department, People's Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University, Yinchuan, China
| | - Yanting Zhang
- School Health Section, Ningxia Center for Disease Control and Prevention, Yinchuan, China
| | - Suzhen Guan
- School of Public Health, Ningxia Medical University, Yinchuan, China
- Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan, China
| | - Zhihong Liu
- School of Public Health, Ningxia Medical University, Yinchuan, China
- Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan, China
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Zhao GH, Wang JD, Liu MR, Zhang LJ, Sun Y, Cao K. The Distribution and Influence Factors of Non-Invasive Tear Film Break-Up Time in Children. Clin Ophthalmol 2024; 18:2697-2704. [PMID: 39346970 PMCID: PMC11438460 DOI: 10.2147/opth.s475970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 09/10/2024] [Indexed: 10/01/2024] Open
Abstract
Objective To explore the distribution and influence factors of non-invasive tear film break-up time (NIBUT) in children. Methods This is a hospital-based cross-sectional study. Spherical equivalent error (SER) was measured with cycloplegia. NIBUT was measured by an ocular surface integrated analyzer. Results A total of 1269 children (1269 eyes) were included in this study. Participants' median age was 11 (range 6-18) years. 47.1% (598/1269) of participants were boys. The median NIBUT of myopic children and non-myopic children were 9.9 seconds (s) (Inter-quartile range, IQR: 6.4 to 16.1) and 10.9 s (IQR: 8.8 to 17.9), respectively, which was statistically significant (p = 0.004). In myopic children, 49.9% (573/1148) were able to achieve NIBUT of 10 s or more, compared to 67.8% (82/121) in non-myopic children, which was statistically significant (p < 0.001). There were 41 (3.57%) children in the myopic group and none (0%) in the non-myopic group with dry eye disease (p = 0.028). There was a positive correlation between NIBUT and age: NIBUT = 9.256 + 0.352*Age. 71.8% (824/1148) of myopic children used electronic products almost every day, compared to 37.2% (45/121) of non-myopic children, which was statistically significant (p < 0.001). Conclusion The NIBUT of myopic children was significantly shorter than that of non-myopic children. Children with myopia are more likely to have dry eyes. NIBUT increases with age. High frequency of electronic product use may be an important cause to NIBUT shortening in children.
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Affiliation(s)
- Guo-Hong Zhao
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Jin-Da Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Mei-Rui Liu
- Department of Pulmonary Rehabilitation, Emergency General Hospital, Beijing, People’s Republic of China
- School of Public Health, North China University of Science and Technology, Tangshan, Hebei, People’s Republic of China
| | - Li-Jun Zhang
- Department of Obstetrics and Gynecology, Linyi Hospital of Traditional Chinese Medicine, Linyi, Shandong, People’s Republic of China
| | - Yan Sun
- Department of Ophthalmology, Linyi Hospital of Traditional Chinese Medicine, Linyi, Shandong, People’s Republic of China
| | - Kai Cao
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China
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Bao WW, Zhao Y, Dadvand P, Jiang N, Chen G, Yang B, Huang W, Xiao X, Liang J, Chen Y, Huang S, Pu X, Huang S, Lin H, Guo Y, Dong G, Chen Y. Urban greenspace and visual acuity in schoolchildren: a large prospective cohort study in China. ENVIRONMENT INTERNATIONAL 2024; 184:108423. [PMID: 38241831 DOI: 10.1016/j.envint.2024.108423] [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: 06/08/2023] [Revised: 10/28/2023] [Accepted: 01/03/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND Greenspace is known to have a positive impact on human health and well-being, but its potential effects on visual acuity have not been extensively studied. OBJECTIVES Our aim was to examine the relationship between long-term greenspace exposure and visual acuity in children, while also exploring the potential mechanisms in this association. METHODS We conducted this prospective cohort study based on the Children's growth environment, lifestyle, physical, and mental health development project (COHERENCE), which screened 286,801 schoolchildren in Guangzhou, China, starting in the 2016/17 academic year and followed them up for three academic years (2017/18-2019/20). Visual acuity was measured using a standardized logarithmic chart, and visual impairment was defined as visual acuity worse than 0.0 logarithm of the minimum angle of resolution (LogMAR) units in the better eye. We used the Normalized Difference Vegetation Index (NDVI), the Soil-Adjusted Vegetation Index (SAVI), and the Enhanced Vegetation Index (EVI) to assess the greenspace surrounding child's geocoded home and school at each visit. RESULTS Our analysis indicated that higher greenspace exposure was associated with greater visual acuity z-score at baseline and with slower decline in visual acuity z-score during the 3-year follow-up. An interquartile range increase in home-school-based NDVI 300m was associated with a 7% decrease [hazard ratios (HRs): 0.93, 95% confidence interval (CI): 0.92, 0.94] in the risk of visual impairment. We also found that air pollution, physical activity, outdoor time, and recreational screen time partially mediated the greenspace-visual acuity association. CONCLUSION Our findings suggest that increasing greenspace exposure could benefit children's visual acuity development and reduce the risk of visual impairment by reducing air pollution and recreational screen time while increasing physical activity and outdoor time. All results could have potential policy implications, given the individual and societal burdens associated with visual impairment.
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Affiliation(s)
- Wen-Wen Bao
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Yu Zhao
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Payam Dadvand
- ISGlobal, Barcelona, Spain, CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Nan Jiang
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Gongbo Chen
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Boyi Yang
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Wenzhong Huang
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Xiang Xiao
- Department of Geography, Hong Kong Baptist University, Hong Kong SAR; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, China
| | - Jinghong Liang
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Yican Chen
- 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
| | - Xueya Pu
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Shaoyi Huang
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Haotian Lin
- Zhongshan Ophthalmic Centre, Sun Yat-sen University, 7# Jinsui Road, Guangzhou, 510623, China
| | - Yuming Guo
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Guanghui Dong
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Yajun Chen
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
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Biswas S, El Kareh A, Qureshi M, Lee DMX, Sun CH, Lam JSH, Saw SM, Najjar RP. The influence of the environment and lifestyle on myopia. J Physiol Anthropol 2024; 43:7. [PMID: 38297353 PMCID: PMC10829372 DOI: 10.1186/s40101-024-00354-7] [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: 10/23/2023] [Accepted: 01/05/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Myopia, commonly known as near-sightedness, has emerged as a global epidemic, impacting almost one in three individuals across the world. The increasing prevalence of myopia during early childhood has heightened the risk of developing high myopia and related sight-threatening eye conditions in adulthood. This surge in myopia rates, occurring within a relatively stable genetic framework, underscores the profound influence of environmental and lifestyle factors on this condition. In this comprehensive narrative review, we shed light on both established and potential environmental and lifestyle contributors that affect the development and progression of myopia. MAIN BODY Epidemiological and interventional research has consistently revealed a compelling connection between increased outdoor time and a decreased risk of myopia in children. This protective effect may primarily be attributed to exposure to the characteristics of natural light (i.e., sunlight) and the release of retinal dopamine. Conversely, irrespective of outdoor time, excessive engagement in near work can further worsen the onset of myopia. While the exact mechanisms behind this exacerbation are not fully comprehended, it appears to involve shifts in relative peripheral refraction, the overstimulation of accommodation, or a complex interplay of these factors, leading to issues like retinal image defocus, blur, and chromatic aberration. Other potential factors like the spatial frequency of the visual environment, circadian rhythm, sleep, nutrition, smoking, socio-economic status, and education have debatable independent influences on myopia development. CONCLUSION The environment exerts a significant influence on the development and progression of myopia. Improving the modifiable key environmental predictors like time spent outdoors and engagement in near work can prevent or slow the progression of myopia. The intricate connections between lifestyle and environmental factors often obscure research findings, making it challenging to disentangle their individual effects. This complexity underscores the necessity for prospective studies that employ objective assessments, such as quantifying light exposure and near work, among others. These studies are crucial for gaining a more comprehensive understanding of how various environmental factors can be modified to prevent or slow the progression of myopia.
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Affiliation(s)
- Sayantan Biswas
- School of Optometry, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Antonio El Kareh
- Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Mariyem Qureshi
- School of Optometry, College of Health and Life Sciences, Aston University, Birmingham, UK
| | | | - Chen-Hsin Sun
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Janice S H Lam
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Seang-Mei Saw
- Singapore Eye Research Institute, Singapore, Singapore
- Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Raymond P Najjar
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Singapore Eye Research Institute, Singapore, Singapore.
- Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.
- Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore, Singapore, Singapore.
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Li T, Yang J, Yan J, Yao X, Du B, Wu Q, Meng X, Liu Y, Lu Y, Wang Q, Yang Q, Kee CS, Tham CC, Wei R, Huang G, Yan H. Interaction between parental myopia and children lifestyle on the incidence of myopia among children aged 6-18 years: a cross-sectional study in Tianjin, China. BMJ Open 2024; 14:e080929. [PMID: 38238173 PMCID: PMC10806635 DOI: 10.1136/bmjopen-2023-080929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
OBJECTIVES This study aimed to explore the influence of the interaction between parental myopia and lifestyle on myopia among school-age children. DESIGN Cross-sectional study. SETTING This study used data from the Tianjin Child and Adolescent Research of Eye between August and October 2022. PARTICIPANTS A total of 49 035 participants between 6 and 18 years of age were eligible for this study. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the interaction between eye-healthy lifestyle and parental myopia on myopia. Parental myopia and eye-healthy lifestyle were ascertained by a Child and Adolescent Behavior Questionnaire. The lifestyle risk score (LRS) of eye health was calculated based on beta-coefficient in the backward regression model. The interaction between LRS and parental myopia was analysed by multivariate logistic regression. The predictive value of different predicted models was estimated using receiver operating characteristic curves. Multiple linear regression was used to evaluate the associations of lifestyle risk factors and parental myopia with spherical equivalent refraction, which were defined as the secondary outcomes. RESULTS A total of 31 839 participants aged 6-18 years were included, and the myopia prevalence was 55.46%. Eye-healthy lifestyle and parental myopia were significantly associated with myopia, as was interaction. The predictive value for LRS & parental myopia was 0.714 (95% CI: 0.709 to 0.720), which was higher than LRS (0.693, 95% CI: 0.687 to 0.699) and parental myopia (0.710, 95% CI: 0.704 to 0.716) separately. CONCLUSIONS High-risk lifestyles of myopia and parental myopia were significantly associated with a higher risk of myopia, and the combination had the strongest effect. For children, lifestyle adjustment should be prioritised in preventing myopia, especially for those with parental myopia.
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Affiliation(s)
- Tongtong Li
- School of Public Health, Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Ocular Trauma, Tianjin, China
| | - Jing Yang
- Department of Ophthalmology, Tianjin Medical University General Hospital, Laboratory of Molecular Ophthalmology, Tianjin Medical University, Tianjin, China
| | - Jing Yan
- School of Public Health, Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Ocular Trauma, Tianjin, China
| | - Xuyang Yao
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Bei Du
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Qi Wu
- School of Public Health, Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Ocular Trauma, Tianjin, China
| | - Xiangda Meng
- Tianjin Key Laboratory of Ocular Trauma, Tianjin, China
- Department of Ophthalmology, Tianjin Medical University General Hospital, Laboratory of Molecular Ophthalmology, Tianjin Medical University, Tianjin, China
| | - Yuanyuan Liu
- Tianjin Key Laboratory of Ocular Trauma, Tianjin, China
- Department of Ophthalmology, Tianjin Medical University General Hospital, Laboratory of Molecular Ophthalmology, Tianjin Medical University, Tianjin, China
| | - Yuezhu Lu
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Qihua Wang
- Department of Ophthalmology, Tianjin Medical University General Hospital, Laboratory of Molecular Ophthalmology, Tianjin Medical University, Tianjin, China
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Qiang Yang
- Shenyang Xingqi Pharmaceutical Co., Ltd, Shenyang, China
| | - Chea-Su Kee
- School of Optometry, Centre for Myopia Research, Research Centre for SHARP Vision, The Hong Kong Polytechnic University, Hong Kong, China
| | - Clement C Tham
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong KonSARg, China
| | - Ruihua Wei
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Guowei Huang
- School of Public Health, Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Ocular Trauma, Tianjin, China
| | - Hua Yan
- Tianjin Key Laboratory of Ocular Trauma, Tianjin, China
- Department of Ophthalmology, Tianjin Medical University General Hospital, Laboratory of Molecular Ophthalmology, Tianjin Medical University, Tianjin, China
- School of Medicine, Nankai University, Tianjin, China
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Li X, Li L, Qin W, Cao Q, Mu X, Liu T, Li Z, Zhang W. Urban Living Environment and Myopia in Children. JAMA Netw Open 2023; 6:e2346999. [PMID: 38064211 PMCID: PMC10709769 DOI: 10.1001/jamanetworkopen.2023.46999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/27/2023] [Indexed: 12/18/2023] Open
Abstract
Importance The global prevalence of myopia has shown a steady increase over recent decades, with urban areas seemingly experiencing a more significant impact. Objective To assess the association between urbanization and the prevalence, incidence, progression, and severity of myopia. Design, Setting, and Participants This cohort study included students in grades 1 to 6 in Tianjin, China, who underwent 3 vision examinations conducted over a 2-year period, from March 1, 2021, to March 31, 2023. Participants from grades 1 to 4 completed the 2-year follow-up. Exposures Urban living environment. Main Outcomes and Measures The association of urbanization with the incidence, progression, prevalence, and severity of myopia. To quantify urbanization, an urban score was constructed using satellite data and an iterative exploratory factor analysis. Results Of 177 894 students (51.7% male; mean [SD] age, 10.27 [1.75] years) included in the study, 137 087 students (52.3% male; mean [SD] age, 8.97 [1.21] years) were followed up for 2 years. A positive association was identified between myopia incidence and urbanization. Specifically, each 1-unit increment in the urban score was associated with an increased risk of myopia over a 1-year period (odds ratio [OR], 1.09; 95% CI, 1.01-1.15; P = .02) and a 2-year period (OR, 1.53; 95% CI, 1.50-1.57; P < .001). Conversely, each 1-unit increase in the urban score was associated with a significant decrease in myopia progression at 1 year (OR, 0.84; 95% CI, 0.82-0.86; P < .001) and 2 years (OR, 0.73; 95% CI, 0.70-0.75, P < .001). In a cross-sectional data analysis, the urban score was positively associated with myopia prevalence (OR, 1.62; 95% CI, 1.08-2.42; P = .02) and negatively associated with myopia severity, as indicated by spherical equivalent refraction (OR, 1.46; 95% CI, 1.07-1.99; P = .02). Conclusions and Relevance This study exploring urban living environments and myopia revealed dual associations of urban living with both the incidence and the progression of myopia. The observed patterns emphasize the urgency of promptly implementing myopia control strategies in less urbanized regions, where myopia progression may be accentuated.
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Affiliation(s)
- Xiaotong Li
- Nankai University Affiliated Eye Hospital, Nankai University, Tianjin, China
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin, China
| | - Lihua Li
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin, China
- Tianjin Eye Hospital Optometric Center, Tianjin, China
| | - Wen Qin
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin, China
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Qing Cao
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin, China
- Tianjin Eye Hospital Optometric Center, Tianjin, China
| | - Xin Mu
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin, China
- Tianjin Eye Hospital Optometric Center, Tianjin, China
| | - Tiange Liu
- Nankai University Affiliated Eye Hospital, Nankai University, Tianjin, China
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin, China
| | - Zhen Li
- Nankai University Affiliated Eye Hospital, Nankai University, Tianjin, China
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin, China
| | - Wei Zhang
- Nankai University Affiliated Eye Hospital, Nankai University, Tianjin, China
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin, China
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12
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Ding Z, Chen G, Zhang L, Baheti B, Wu R, Liao W, Liu X, Hou J, Mao Z, Guo Y, Wang C. Residential greenness and cardiac conduction abnormalities: epidemiological evidence and an explainable machine learning modeling study. CHEMOSPHERE 2023; 339:139671. [PMID: 37517666 DOI: 10.1016/j.chemosphere.2023.139671] [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: 06/09/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Previous studies indicated the beneficial influence of residential greenness on cardiovascular disease (CVD), however, the association of residential greenness with cardiac conduction performance remains unclear. This study aims to examine the epidemiological associations between residential greenness and cardiac conduction abnormalities in rural residents, simultaneously exploring the role of residential greenness for cardiac health in an explainable machine learning modeling study. METHODS A total of 27,294 participants were derived from the Henan Rural Cohort. Two satellite-based indices, the normalized difference vegetation index (NDVI) and the enhanced vegetation index (EVI), were used to estimate residential greenness. Independent and combined associations of residential greenness indices and physical activities with electrocardiogram (ECG) parameter abnormalities were evaluated using the logistic regression model and generalized linear model. The Gradient Boosting Machine (GBM) and the SHapely Additive exPlanations (SHAP) were employed in the modeling study. RESULTS The odds ratios (OR) and 95% confidence interval (CI) for QRS interval, heart rate (HR), QTc interval, and PR interval abnormalities with per interquartile range in NDVI were 0.896 (0.873-0.920), 0.955 (0.926-0.986), 1.015 (0.984-1.047), and 0.986 (0.929-1.045), respectively. Furthermore, the participants with higher physical activities plus residential greenness (assessed by EVI) were related to a 1.049-fold (1.017-1.081) and 1.298-fold (1.245-1.354) decreased risk for abnormal QRS interval and HR. Similar results were also observed in the sensitivity analysis. The NDVI ranked fifth (SHAP mean value 0.116) in the analysis for QRS interval abnormality risk in the modeling study. CONCLUSION A higher level of residential greenness was significantly associated with cardiac conduction abnormalities. This effect might be strengthened in residents with more physical activities. This study indicated the cruciality of environmental greenness to cardiac functions and also contributed to refining preventive medicine and greenness design strategies.
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Affiliation(s)
- Zhongao Ding
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Gongbo Chen
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Liying Zhang
- Department of Software Engineering, School of Computer and Artificial Intelligence, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Bota Baheti
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Ruiyu Wu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Wei Liao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Xiaotian Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Jian Hou
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Zhenxing Mao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Yuming Guo
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China; Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China; NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Diseases, Zhengzhou, Henan, PR China.
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