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Ali MR, Nacer H, Lawson CA, Khunti K. Racial and Ethnic Disparities in Primary Prevention of Cardiovascular Disease. Can J Cardiol 2024; 40:1016-1030. [PMID: 38309463 DOI: 10.1016/j.cjca.2024.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/19/2023] [Accepted: 01/02/2024] [Indexed: 02/05/2024] Open
Abstract
Cardiovascular disease (CVD) disproportionately affects ethnic-minority groups globally. Ethnic-minority groups face particularly high CVD burden and mortality, exacerbated by disparities across modifiable risk factors, wider determinants of health, and limited access to preventative interventions. This narrative review summarizes evidence on modifiable risk factors, such as physical activity, hypertension, diet, smoking, alcohol consumption, diabetes, and the polypill for the primary prevention of CVD in ethnic minorities. Across these factors, we find inequities in risk factor prevalence. The evidence underscores that inequalities in accessibility to interventions and treatments impede progress in reducing CVD risk using primary prevention interventions for ethnic-minority people. Although culturally tailored interventions show promise, further research is required across the different risk factors. Social determinants of health and structural inequities also exacerbate CVD risk for ethnic-minority people and warrant greater attention. Additionally, we find that only limited ethnicity-specific data and guidelines are available on CVD primary prevention interventions for most risk factors. To address these gaps in research, we provide recommendations that include the following: investigating the sustainability and real-world effectiveness of culturally sensitive interventions; ensuring that ethnic-minority peoples' perspectives are considered in research; longitudinal tracking of risk factors; interventions and outcomes in ethnic-minority people; and ensuring that data collection and reporting of ethnicity data are standardized.
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Affiliation(s)
- Mohammad R Ali
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom; National Institute for Health Research (NIHR) Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, United Kingdom; Diabetes Research Centre, University of Leicester, Leicester, United Kingdom.
| | | | - Claire A Lawson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom; National Institute for Health Research (NIHR) Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, United Kingdom
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, United Kingdom; National Institute for Health Research (NIHR) Applied Research Collaboration East Midlands, University of Leicester, Leicester, United Kingdom
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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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Cui Z, Pan R, Liu J, Yi W, Huang Y, Li M, Zhang Z, Kuang L, Liu L, Wei N, Song R, Yuan J, Li X, Yi X, Song J, Su H. Green space and its types can attenuate the associations of PM 2.5 and its components with prediabetes and diabetes-- a multicenter cross-sectional study from eastern China. ENVIRONMENTAL RESEARCH 2024; 245:117997. [PMID: 38157960 DOI: 10.1016/j.envres.2023.117997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/12/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND The effect of fine particulate matter (PM2.5) components on prediabetes and diabetes is of concern, but the evidence is limited and the specific role of different green space types remains unclear. This study aims to investigate the relationship of PM2.5 and its components with prediabetes and diabetes as well as the potential health benefits of different types and combinations of green spaces. METHODS A multicenter cross-sectional study was conducted in eastern China by using a multi-stage random sampling method. Health screening and questionnaires for 98,091 participants were performed during 2017-2020. PM2.5 and its five components were estimated by the inverse distance weighted method, and green space was reflected by the Normalized Difference Vegetation Index (NDVI), percentages of tree or grass cover. Multivariate logistic regression and quantile g-computing were used to explore the associations of PM2.5 and five components with prediabetes and diabetes and to elucidate the potential moderating role of green space and corresponding type combinations in these associations. RESULTS Each interquartile range (IQR) increment of PM2.5 was associated with both prediabetes (odds ratio [OR]: 1.15, 95%CI [confidence interval]: 1.10-1.20) and diabetes (OR: 1.18, 95% CI: 1.11-1.25), respectively. All five components of PM2.5 were related to prediabetes and diabetes. The ORs of PM2.5 on diabetes were 1.49 (1.35-1.63) in the low tree group and 0.90 (0.82-0.98) in the high tree group, respectively. In the high tree-high grass group, the harmful impacts of PM2.5 and five components were significantly lower than in the other groups. CONCLUSION Our study suggested that PM2.5 and its components were associated with the increased risk of prediabetes and diabetes, which could be diminished by green space. Furthermore, the coexistence of high levels of tree and grass cover provided greater benefits. These findings had critical implications for diabetes prevention and green space-based planning for healthy city.
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Affiliation(s)
- Zhiqian Cui
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, 230032, China
| | - Rubing Pan
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, 230032, China
| | - Jintao Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, 230032, China
| | - Weizhuo Yi
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, 230032, China
| | - Yuxin Huang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, 230032, China
| | - Ming Li
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, 230032, China
| | - Zichen Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, 230032, China
| | - Lingmei Kuang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, 230032, China
| | - Li Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, 230032, China
| | - Ning Wei
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, 230032, China
| | - Rong Song
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, 230032, China
| | - Jiajun Yuan
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, 230032, China
| | - Xuanxuan Li
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, 230032, China
| | - Xingxu Yi
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, 230032, China
| | - Jian Song
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, 230032, China
| | - Hong Su
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, 230032, China.
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Li F, Liu W, Hu C, Tang M, Zhang Y, Ho HC, Peng S, Li Z, Wang Q, Li X, Xu B, Li F. Global association of greenness exposure with risk of nervous system disease: A systematic review and meta-analysis. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 877:162773. [PMID: 36933739 DOI: 10.1016/j.scitotenv.2023.162773] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 03/06/2023] [Accepted: 03/06/2023] [Indexed: 05/06/2023]
Abstract
Nervous system disease (NSD) is a global health burden with increasing prevalence in the last 30 years. There is evidence that greenness can improve nervous system health through a variety of mechanisms; however, the evidence is inconsistent. In the present systematic review and meta-analysis, we examined the relationship between greenness exposure and NSD outcomes. Studies on the relationship between greenness and NSD health outcomes published till July 2022 were searched in PubMed, Cochrane, Embase, Scopus, and Web of Science. In addition, we searched the cited literature and updated our search on Jan 20, 2023, to identify any new studies. We included human epidemiological studies that assess the association of greenness exposure with the risk of NSD. Greenness exposure was measured using NDVI (the normalized difference vegetation index) and the outcome was the mortality or morbidity of NSD. The pooled relative risks (RRs) were estimated using a random effects model. Of 2059 identified studies, 15 studies were included in our quantitative evaluation, in which 11 studies found a significant inverse relationship between the risk of NSD mortality or incidence/prevalence and an increase in surrounding greenness. The pooled RRs for cerebrovascular diseases (CBVD), neurodegenerative diseases (ND), and stroke mortality were 0.98 (95 % CI: 0.97, 1.00), 0.98 (95 % CI: 0.98, 0.99), and 0.96 (95 % CI: 0.93, 1.00), respectively. The pooled RRs for PD incidence and stroke prevalence/incidence were 0.89 (95 % CI: 0.78, 1.02) and 0.98 (95 % CI: 0.97, 0.99), respectively. The confidence of evidence for ND mortality, stroke mortality, and stroke prevalence/incidence was downgraded to "low", while CBVD mortality and PD incidence were downgraded to "very low" due to inconsistency. We found no evidence of publication bias and the sensitivity analysis results of all subgroups are robust except for the stroke mortality subgroup. This is the first comprehensive meta-analysis of greenness exposure and NSD outcomes in which an inverse relationship was observed. It is necessary to conduct further research to ascertain the role greenness exposure plays in various NSDs and the management of greenness should be considered a public health strategy.
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Affiliation(s)
- Fangzheng Li
- School of Landscape Architecture, Beijing Forestry University, Beijing 100083, China.
| | - Wei Liu
- School of Art, Qufu Normal University, Rizhao 276826, China
| | - Chengyang Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei 230032, China
| | - Mingcheng Tang
- School of Landscape Architecture and Forestry, Qingdao Agricultural University, Qingdao 266109, China
| | - Yunquan Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University of Science and Technology, Wuhan 430065, China
| | - Hung Chak Ho
- Department of Anaesthesiology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Shijia Peng
- Charles Davis's Lab Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA 02138, USA
| | - Zhouyuan Li
- School of Grassland Science, Beijing Forestry University, Beijing 100083, China
| | - Qing Wang
- China CDC Key Laboratory of Environment and Population Health/National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Xiong Li
- School of Landscape Architecture, Beijing Forestry University, Beijing 100083, China
| | - Bing Xu
- Department of Earth System Science, Tsinghua University, 10084 Beijing, China
| | - Fengyi Li
- School of Landscape Architecture and Forestry, Qingdao Agricultural University, Qingdao 266109, China.
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Wang G, Yang FF, Lin G, Wang Z, Zhang X. Modification of low temperature-related hospital admissions for cardiovascular diseases by multiple green space indicators at multiple spatial scales: Evidence from Guangzhou, China. Int J Hyg Environ Health 2023; 251:114193. [PMID: 37247607 DOI: 10.1016/j.ijheh.2023.114193] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 05/21/2023] [Accepted: 05/24/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Extreme temperatures have an adverse effect on the occurrence of cardiovascular diseases (CVDs). Previous literatures tend to discuss the modification of CVDs occurrence by green space under high temperature. Relatively less attention is paid to the modification under low temperature. The variation of different attributes and spatial scales of green space in affecting CVDs occurrence are also overlooked. METHODS This study collected a total of 4364 first-time admission cases due to CVDs in a tertiary hospital in Guangzhou from 2012 to 2018, measured the scale of green space by greening rate (GR) and percentage of landscape (PLAND), the distribution of green space by patch density (PD), mean nearest neighbor distance (ENN_MN) and largest patch index (LPI), and the accessibility of green space by green patch accessibility index (GPAI). Using the time stratified case crossover design method, the modification of low temperature-related CVDs occurrence by the above green space indicators is evaluated in an area with a radius of 100-1000 m which is further divided at an interval of 100 m. RESULTS We found high GR, high PLAND, high PD, low ENN_MN, high LPI, and low GPAI corresponds to low risk of CVDs occurrence, the optimal modification scale of each green space indicator, which is radius corresponding to the maximum risk difference between high and low indicator subgroups, is around 800 m (GR), 600 m (PLAND and PD), 500 m (GPAI), and 300 m (LPI and ENN_MN), respectively. As the temperature decreases further, the health benefit from low GPAI at the optimal scale is weakened, whereas the benefits from the others are strengthened. CONCLUSIONS Low temperature related CVDs occurrence risk can be modified by multiple green space indicators, and these modifications have spatial scale effect. Our findings have important theoretical and practical significance for the formulation and implementation of local green space policies.
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Affiliation(s)
- Guobin Wang
- School of Geography and Planning, Sun Yat-Sen University, GuangZhou, 510006, China
| | - Fiona Fan Yang
- School of Geography and Planning, Sun Yat-Sen University, GuangZhou, 510006, China
| | - Geng Lin
- School of Geography and Planning, Sun Yat-Sen University, GuangZhou, 510006, China.
| | - Zhuoqing Wang
- Department of Scientific Research & Discipline Development, The First Affiliated Hospital Sun Yat-sen University, 58 Zhongshan Road 2nd, Guangzhou, 510080, China.
| | - Xiangxue Zhang
- State Key Laboratory of Earth Surface Processes and Resource Ecology, Beijing Normal University, Beijing, 100875, China
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Liu Y, Zhao B, Cheng Y, Zhao T, Zhang A, Cheng S, Zhang J. Does the quality of street greenspace matter? Examining the associations between multiple greenspace exposures and chronic health conditions of urban residents in a rapidly urbanising Chinese city. ENVIRONMENTAL RESEARCH 2023; 222:115344. [PMID: 36693460 DOI: 10.1016/j.envres.2023.115344] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 01/10/2023] [Accepted: 01/19/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Numerous studies have demonstrated that greenspace(GS) exposure is associated with health improvements in individuals with hypertension and diabetes. However, studies examining the associations between multiple GS exposures and chronic health conditions in developing countries are limited. METHODS Geospatial data and spatial analysis were employed to objectively measure the total neighbourhood vegetative cover (mean value of normalised difference vegetation index [NDVI] within specific buffer zone) and proximity to park-based GS (network distance from home to the entrance of park-based GS). Street view imagery and machine learning techniques were used to measure the subjective perceptions of street GS quality. A multiple linear regression model was applied to examine the associations between multiple GS exposures and the prevalence of hypertension and diabetes in neighbourhoods located in Qingdao, China. RESULTS The model explained 29.8% and 28.2% of the prevalence of hypertension and diabetes, respectively. The results suggested that: 1) the total vegetative cover of the neighbourhood was inversely correlated with the prevalence of hypertension (β = -0.272, p = 0.013, 95% confidence interval (CI): [-1.332, -0.162]) and diabetes (β = -0.230, p = 0.037, 95% CI: [-0.720, -0.008]). 2) The street GS quality was negatively correlated with the prevalence of hypertension (β = -0.303, p = 0.007, 95% CI: [-2.981, -0.491]) and diabetes (β = -0.309, p = 0.006, 95% CI: [-1.839, -0.314]). 3) Proximity to park-based GS and the prevalence of hypertension and diabetes mellitus were not significantly correlated. CONCLUSIONS This study used subjective and objective methods to comprehensively assess the greenspace exposure from overhead to eye level, from quantity, proximity to quality. The results demonstrated the beneficial relationships between street GS quality, total vegetative cover, and chronic health in a rapidly urbanising Chinese city. Furthermore. the effect of street GS quality was more pronounced in potentially mitigating chronic health problems, and improving the quality of street GS might be an efficient and effective intervention pathway for addressing chronic health issues in densely populated cities.
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Affiliation(s)
- Yawen Liu
- College of Landscape Architecture, Nanjing Forestry University, Nanjing, 210037, China
| | - Bing Zhao
- College of Landscape Architecture, Nanjing Forestry University, Nanjing, 210037, China.
| | - Yingyi Cheng
- College of Landscape Architecture, Nanjing Forestry University, Nanjing, 210037, China
| | - Tianyi Zhao
- College of Acupuncture and Massage, Health and Rehabilitation, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Ao Zhang
- College of Acupuncture and Massage, Health and Rehabilitation, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Siqi Cheng
- College of Horticulture Science, Zhejiang Agriculture & Forestry University, Hangzhou, 310000, China
| | - Jinguang Zhang
- College of Landscape Architecture, Nanjing Forestry University, Nanjing, 210037, China.
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Dopico J, Schäffer B, Brink M, Röösli M, Vienneau D, Binz TM, Tobias S, Bauer N, Wunderli JM. How Do Road Traffic Noise and Residential Greenness Correlate with Noise Annoyance and Long-Term Stress? Protocol and Pilot Study for a Large Field Survey with a Cross-Sectional Design. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3203. [PMID: 36833898 PMCID: PMC9965757 DOI: 10.3390/ijerph20043203] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 05/27/2023]
Abstract
Urban areas are continuously growing, and densification is a frequent strategy to limit urban expansion. This generally entails a loss of green spaces (GSs) and an increase in noise pollution, which has negative effects on health. Within the research project RESTORE (Restorative potential of green spaces in noise-polluted environments), an extended cross-sectional field study in the city of Zurich, Switzerland, is conducted. The aim is to assess the relationship between noise annoyance and stress (self-perceived and physiological) as well as their association with road traffic noise and GSs. A representative stratified sample of participants from more than 5000 inhabitants will be contacted to complete an online survey. In addition to the self-reported stress identified by the questionnaire, hair cortisol and cortisone probes from a subsample of participants will be obtained to determine physiological stress. Participants are selected according to their dwelling location using a spatial analysis to determine exposure to different road traffic noise levels and access to GSs. Further, characteristics of individuals as well as acoustical and non-acoustical attributes of GSs are accounted for. This paper presents the study protocol and reports the first results of a pilot study to test the feasibility of the protocol.
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Affiliation(s)
- Javier Dopico
- Empa, Swiss Federal Laboratories for Materials Science and Technology, 8600 Dubendorf, Switzerland
| | - Beat Schäffer
- Empa, Swiss Federal Laboratories for Materials Science and Technology, 8600 Dubendorf, Switzerland
| | - Mark Brink
- Federal Office for the Environment (FOEN), 3003 Bern, Switzerland
| | - Martin Röösli
- Swiss Tropical and Public Health Institute (Swiss-TPH), 4123 Allschwil, Switzerland
- Faculty of Science, University of Basel, 4001 Basel, Switzerland
| | - Danielle Vienneau
- Swiss Tropical and Public Health Institute (Swiss-TPH), 4123 Allschwil, Switzerland
- Faculty of Science, University of Basel, 4001 Basel, Switzerland
| | - Tina Maria Binz
- Institute of Forensic Medicine, University of Zurich (UZH), 8006 Zurich, Switzerland
| | - Silvia Tobias
- Swiss Federal Institute for Forest, Snow and Landscape Research (WSL), 8903 Birmensdorf, Switzerland
| | - Nicole Bauer
- Swiss Federal Institute for Forest, Snow and Landscape Research (WSL), 8903 Birmensdorf, Switzerland
| | - Jean Marc Wunderli
- Empa, Swiss Federal Laboratories for Materials Science and Technology, 8600 Dubendorf, Switzerland
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He G, He L, Zhang B, Ge T, Chen Y. The greener, the happier? The effects of greenspace on residents' happiness in contemporary urban China. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:2808-2828. [PMID: 35060137 DOI: 10.1002/jcop.22798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 01/04/2022] [Accepted: 01/09/2022] [Indexed: 06/14/2023]
Abstract
In recent years, research has begun to touch upon the associations between the natural environment and individuals' subjective wellbeing; however, whether such associations would vary among different groups of people remains under-studied. Using four waves (2010-2013) of data from the Chinese General Social Survey, we investigate the group-specific correlation between environment-specifically, greenspace exposure-and individuals' happiness in contemporary urban China. For this study, the normalized difference vegetation index at the county level is a proxy for greenspace exposure. The results from the ordered logit model indicate that county-level green vegetation is associated with individuals' happiness level, but such effects vary with a household's relative deprivation. While greenspace exposure is positively associated with happiness among individuals from less deprived families, it is negatively associated with happiness among those from deprived households. These findings contribute to the body of knowledge of the heterogeneous effect of greenspace on residents' subjective well-being.
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Affiliation(s)
- Guangye He
- Department of Sociology, School of Social and Behavioral Sciences, Nanjing University, Nanjing, Jiangsu, China
| | - Li He
- Department of Sociology, School of Humanities and Social Science, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Boyang Zhang
- Department of Sociology, School of Social and Behavioral Sciences, Nanjing University, Nanjing, Jiangsu, China
| | - Ting Ge
- Department of Social Work and Social Policy, School of Social and Behavioral Sciences, Nanjing University, China
| | - Yunsong Chen
- Department of Sociology, School of Social and Behavioral Sciences, Nanjing University, Nanjing, Jiangsu, China
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Sui Y, Ettema D, Helbich M. Longitudinal associations between the neighborhood social, natural, and built environment and mental health: A systematic review with meta-analyses. Health Place 2022; 77:102893. [PMID: 35988452 DOI: 10.1016/j.healthplace.2022.102893] [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] [Received: 04/28/2022] [Revised: 07/24/2022] [Accepted: 08/04/2022] [Indexed: 11/21/2022]
Abstract
This review aimed to assess the longitudinal associations between neighborhood social, natural, and built environments, and multiple mental health outcomes (i.e., depression, anxiety, common mental disorder, and pooled mental disorders). Of 6,785 records retrieved, 30 studies fulfilled the inclusion criteria. Meta-analytical results primarily obtained from developed country studies showed that composite neighborhood socioeconomic status was negatively associated with depression (p = 0.007) and pooled mental disorders (p = 0.002), while neighborhood urbanicity was positively associated with depression (p = 0.012) and pooled mental disorders (p = 0.005). Future longitudinal studies with similar designs and standardized exposure assessments are warranted.
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Affiliation(s)
- Yuwen Sui
- Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Utrecht, 3584 CB, the Netherlands.
| | - Dick Ettema
- Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Utrecht, 3584 CB, the Netherlands
| | - Marco Helbich
- Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Utrecht, 3584 CB, the Netherlands
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10
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Konijnendijk CC. Evidence-based guidelines for greener, healthier, more resilient neighbourhoods: Introducing the 3-30-300 rule. JOURNAL OF FORESTRY RESEARCH 2022; 34:821-830. [PMID: 36042873 PMCID: PMC9415244 DOI: 10.1007/s11676-022-01523-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 08/07/2022] [Indexed: 05/05/2023]
Abstract
The important contributions of urban trees and green spaces to for example, climate moderation and public health have been recognized. This paper discusses guidelines and norms that promote the benefits of viewing green, living amongst green, and having easy access to green spaces for recreational use. Having trees and other vegetation in sight from one's home, place of work, or school has important mental health and performance benefits. Local tree canopy cover is positively associated with cooling and other aspects of climate moderation. With public green spaces in proximity to one's home stimulates regular use of these areas and results in positive impacts on mental, physical, and social health. After analyzing existing guidelines and rules for urban green space planning and provision, a new, comprehensive guideline is presented, known as the '3-30-300 rule' for urban forestry. This guideline aims to provide equitable access to trees and green spaces and their benefits by setting the thresholds of having at least 3 well-established trees in view from every home, school, and place of work, no less than a 30% tree canopy in every neighbourhood; and no more than 300 m to the nearest public green space from every residence. Current implementation of this new guideline is discussed, as well as the advantages and disadvantages of using this evidence-based but also clear and simple rules.
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11
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Murad A, Faruque F, Naji A, Tiwari A, Helmi M, Dahlan A. Modelling geographical heterogeneity of diabetes prevalence and socio-economic and built environment determinants in Saudi City - Jeddah. GEOSPATIAL HEALTH 2022; 17. [PMID: 35579244 DOI: 10.4081/gh.2022.1072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/21/2022] [Indexed: 06/15/2023]
Abstract
Type-2 diabetes is a growing lifestyle disease mainly due to increasing physical inactivity but also associated with various other variables. In Saudi Arabia, around 58.5% of the population is deemed to be physically inactive. Against this background, this study attempts explore the spatial heterogeneity of Type-2 diabetes prevalence in Jeddah and to estimate various socio-economic and built environment variables contributing to the prevalence of this disease based on modelling by ordinary least squares (OLS), weighted regression (GWR) and multi-scale geographically weighted (MGWR). Our OLS results suggest that income, population density, commercial land use and Saudi population characteristics are statistically significant for Type-2 diabetes prevalence. However, by the GWR model, income, commercial land use and Saudi population characteristics were significantly positive while population density was significantly negative in this model for 70.6%, 9.1%, 26.6% and 58.7%, respectively, out of 109 districts investigated; by the MGWR model, the corresponding results were 100%, 22%, 100% and 100% of the districts. With the given data, the corrected Akaike information criterion (AICc), the adjusted R2, the log-likelihood and the residual sum of squares (RSS) indices demonstrated that the MGWR model outperformed the GWR and OLS models explaining 29% more variance than the OLS model, and 10.2% more than the GWR model. These results support the development of evidence-based policies for the spatial allocation of health associated resources for the control of Type-2 diabetes in Jeddah and other cities in the Arabian Gulf.
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Affiliation(s)
- Abdulkader Murad
- Department of Urban and Regional Planning, Faculty of Architecture and Planning, King Abdulaziz University, Jeddah.
| | - Fazlay Faruque
- Department of Preventive Medicine, University of Mississipi, Jackson, MS.
| | - Ammar Naji
- Department of Urban and Regional Planning, Faculty of Architecture and Planning, King Abdulaziz University, Jeddah.
| | - Alok Tiwari
- Department of Urban and Regional Planning, Faculty of Architecture and Planning, King Abdulaziz University, Jeddah.
| | - Mansour Helmi
- Department of Urban and Regional Planning, Faculty of Architecture and Planning, King Abdulaziz University, Jeddah.
| | - Ammar Dahlan
- Department of Architecture, Faculty of Architecture and Planning, King Abdulaziz University, Jeddah.
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12
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Rodriguez-Loureiro L, Casas L, Bauwelinck M, Lefebvre W, Vanpoucke C, Gadeyne S. Long-term exposure to objective and perceived residential greenness and diabetes mortality: A census-based cohort study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 821:153445. [PMID: 35093349 DOI: 10.1016/j.scitotenv.2022.153445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/17/2022] [Accepted: 01/22/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Residing close to green spaces might reduce diabetes mellitus (DM) risk; however, evidence for diabetes mortality is limited. Moreover, individual and neighbourhood social factors may determine DM risk. Exposure to green spaces may also depend on socioeconomic position (SEP). This study examined the associations between residential greenness and diabetes-related mortality, and the role of the social environment in these associations. METHODS We used the 2001 Belgian census linked to mortality register data for the period 2001-2014. We included individuals aged 40-79 years old and residing in the five largest Belgian urban areas at baseline. Exposure to residential greenness was assessed with surrounding greenness using the Normalized Difference Vegetation Index (NDVI) within 500-m of residence (objective indicator), and perceived neighbourhood greenness (subjective indicator). We conducted mixed-effects Cox proportional hazards models to obtain hazard ratios (HR) for diabetes-related mortality per interquartile range (IQR) increments of residential greenness. We assessed effect modification by social factors through stratification. RESULTS From 2,309,236 individuals included at baseline, 1.2% died from DM during follow-up. Both residential greenness indicators were inversely associated with diabetes-related mortality after adjustment for individual social factors. After controlling for neighbourhood SEP, the beneficial association with surrounding greenness disappeared [HR 1.02 (95%CI:0.99,1.06)], but persisted with perceived neighbourhood greenness [HR 0.93 (95%CI:0.91,0.95)]. After stratification the inverse associations with perceived neighbourhood greenness were strongest for women, the lowest educated, and individuals residing in least deprived neighbourhoods. CONCLUSIONS Our findings suggest that an overall positive perception of neighbourhood green spaces reduces independently the risk of diabetes-related mortality, regardless of the neighbourhood social environment. Nevertheless, neighbourhood SEP may be a strong confounder in the associations between diabetes-related mortality and greenness indicators derived from satellite images. Perception factors not captured by objective measurements of green spaces are potentially relevant in the association with DM, especially among disadvantaged groups.
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Affiliation(s)
- Lucía Rodriguez-Loureiro
- Interface Demography, Department of Sociology, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium.
| | - Lidia Casas
- Social Epidemiology and Health Policy, Department of Family Medicine and Population Health, University of Antwerp, Gouverneur Kinsbergencentrum, Doornstraat 331, 2610 Wilrijk, Belgium; Institute for Environment and Sustainable Development (IMDO), University of Antwerp, Campus Groenenborger, Groenenborgerlaan 171, 2020 Antwerp, Belgium
| | - Mariska Bauwelinck
- Interface Demography, Department of Sociology, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium
| | - Wouter Lefebvre
- Flemish Institute for Technological Research (VITO), Boeretang 200, 2400 Mol, Belgium
| | - Charlotte Vanpoucke
- Belgian Interregional Environment Agency (IRCELINE), Gaucheretstraat 92-94, 1030 Brussels, Belgium
| | - Sylvie Gadeyne
- Interface Demography, Department of Sociology, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium
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13
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Liu XX, Ma XL, Huang WZ, Luo YN, He CJ, Zhong XM, Dadvand P, Browning MHEM, Li L, Zou XG, Dong GH, Yang BY. Green space and cardiovascular disease: A systematic review with meta-analysis. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2022; 301:118990. [PMID: 35181451 DOI: 10.1016/j.envpol.2022.118990] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/15/2022] [Accepted: 02/10/2022] [Indexed: 06/14/2023]
Abstract
Exposure to green space has been proposed to be beneficially associated with cardiovascular morbidity and mortality. Many studies have explored this topic, but the results remain conflicting. We aimed to evaluate the epidemiological evidence on this topic by performing a systematic review with meta-analysis. We searched PubMed, Web of Science and Embase for studies on the association between green space and cardiovascular disease (CVD) that were published till January 2022. Two authors independently performed study selection, data extraction, quality assessment, and risk of bias assessment. For studies providing detailed numeric data, we also conducted quantitative meta-analyses and calculated the pooled odd ratios (ORs) for associations between the most commonly used exposure estimate (normalized difference vegetative index [NDVI]) and five CVD events: CVD mortality, ischemic heart disease (IHD) mortality, cerebrovascular disease (CBVD) mortality, and stroke incidence/prevalence. Additional analyses were conducted to explore the geographical scale effects of NDVI. Publication bias tests were also conducted. Of the 6787 records identified, 53 studies were eligible for inclusion. These studies covered 18 countries and included data from more than 100 million persons. Meta-analyses showed that a 0.1 increase in NDVI was significantly associated with 2-3% lower odds of CVD mortality (OR: 0.97, 95% CI: 0.96-0.99), IHD mortality (OR: 0.98, 95% CI: 0.96-1.00), CBVD mortality (OR: 0.98, 95% CI: 0.97-1.00), and stroke incidence/prevalence (OR: 0.98, 95% CI: 0.96-0.99). There was no significant difference between the pooled estimates for different buffer sizes. No evidence of publication bias was detected. We provide strong and robust evidence for the beneficial effects of green space exposure on cardiovascular health. More prospective studies and mechanistic studies, especially that conducted in low- and middle-income countries, are merited to strengthen our conclusions.
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Affiliation(s)
- Xiao-Xuan Liu
- 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
| | - Xin-Li Ma
- Department of Public Health, The First People's Hospital of Kashi (the Affiliated Kashi Hospital of Sun Yat-Sen University), Kashi, China
| | - Wen-Zhong Huang
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Ya-Na Luo
- 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
| | - Chuan-Jiang He
- Department of Clinical Laboratory, The First People's Hospital of Kashi (the Affiliated Kashi Hospital of Sun Yat-Sen University), Kashi, China
| | - Xue-Mei Zhong
- Department of Respiratory and Critical Care Medicine, The First People's Hospital of Kashi (the Affiliated Kashi Hospital of Sun Yat-Sen University), Kashi, China
| | - Payam Dadvand
- ISGlobal, Dr. Aiguader 88, 08003, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Matthew H E M Browning
- Department of Park, Recreation, and Tourism Management, Clemson University, Clemson, SC, 29634, USA
| | - Li Li
- Department of Respiratory and Critical Care Medicine, The First People's Hospital of Kashi (the Affiliated Kashi Hospital of Sun Yat-Sen University), Kashi, China
| | - Xiao-Guang Zou
- Department of Respiratory and Critical Care Medicine, The First People's Hospital of Kashi (the Affiliated Kashi Hospital of Sun Yat-Sen University), Kashi, China
| | - Guang-Hui Dong
- 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
| | - Bo-Yi Yang
- 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; Department of Gynecology and Obstetrics, The First People's Hospital of Kashi Prefecture (the Affiliated Kashi Hospital of Sun Yat-Sen University), Kashi, 844000, China.
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14
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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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15
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Doubleday A, Knott CJ, Hazlehurst MF, Bertoni AG, Kaufman JD, Hajat A. Neighborhood greenspace and risk of type 2 diabetes in a prospective cohort: the Multi-Ethncity Study of Atherosclerosis. Environ Health 2022; 21:18. [PMID: 35034636 PMCID: PMC8762964 DOI: 10.1186/s12940-021-00824-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 12/22/2021] [Indexed: 05/25/2023]
Abstract
BACKGROUND Neighborhood greenspaces provide opportunities for increased physical activity and social interaction, and thus may reduce the risk of Type 2 diabetes. However, there is little robust research on greenspace and diabetes. In this study, we examine the longitudinal association between neighborhood greenspace and incident diabetes in the Multi-Ethnic Study of Atherosclerosis. METHODS A prospective cohort study (N = 6814; 2000-2018) was conducted to examine the association between greenspace, measured as annual and high vegetation season median greenness determined by satellite (Normalized Difference Vegetation Index) within 1000 m of participant homes, and incident diabetes assessed at clinician visits, defined as a fasting glucose level of at least 126 mg/dL, use of insulin or use of hypoglycemic medication, controlling for covariates in stages. Five thousand five hundred seventy-four participants free of prevalent diabetes at baseline were included in our analysis. RESULTS Over the study period, 886 (15.9%) participants developed diabetes. Adjusting for individual characteristics, individual and neighborhood-scale SES, additional neighborhood factors, and diabetes risk factors, we found a 21% decrease in the risk of developing diabetes per IQR increase in greenspace (HR: 0.79; 95% CI: 0.63, 0.99). CONCLUSIONS Overall, neighborhood greenspace provides a protective influence in the development of diabetes, suggesting that neighborhood-level urban planning that supports access to greenspace--along with healthy behaviors--may aid in diabetes prevention. Additional research is needed to better understand how an area's greenness influences diabetes risk, how to better characterize greenspace exposure and usage, and future studies should focus on robust adjustment for neighborhood-level confounders.
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Affiliation(s)
- Annie Doubleday
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA.
| | - Catherine J Knott
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | | | - Alain G Bertoni
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Joel D Kaufman
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Anjum Hajat
- Department of Epidemiology, University of Washington, Seattle, WA, USA
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Horwitz J, Retnakaran R. Neighbourhood Walkability and Risk of Diabetes: Causal Relationship or Epidemiologic Association? Curr Diab Rep 2021; 21:57. [PMID: 34902065 DOI: 10.1007/s11892-021-01419-y] [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: 09/01/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE OF REVIEW We aim to evaluate whether the current literature supports (i) a causal relationship between neighbourhood walkability and risk of diabetes or instead (ii) a strictly epidemiologic association. RECENT FINDINGS Both cross-sectional and longitudinal studies have reported that neighbourhoods that are scored as having higher levels of walkability have lower rates of prevalent and incident diabetes, respectively. However, other studies have been inconclusive, with more nuanced findings suggesting that this association may be limited to particular demographic groups defined by age and socio-economics. Key factors limiting this literature include disparities in the measurement of walkability, the necessary reliance on observational study designs (recognizing the infeasibility of randomized controlled trials for addressing this question), and the difficulty of disentangling the potential concomitant effects of other components of the built environment. At this time, causality cannot be ascertained in the relationship between neighbourhood walkability and risk of diabetes.
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Affiliation(s)
- Jennifer Horwitz
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Canada
| | - Ravi Retnakaran
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Canada.
- Division of Endocrinology, University of Toronto, Toronto, Canada.
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada.
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17
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Nguyen PY, Astell-Burt T, Rahimi-Ardabili H, Feng X. Green Space Quality and Health: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11028. [PMID: 34769549 PMCID: PMC8582763 DOI: 10.3390/ijerph182111028] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/28/2021] [Accepted: 10/08/2021] [Indexed: 12/18/2022]
Abstract
(1) Background: As cities densify, researcher and policy focus is intensifying on which green space types and qualities are important for health. We conducted a systematic review to examine whether particular green space types and qualities have been shown to provide health benefits and if so, which specific types and qualities, and which health outcomes. (2) Methods: We searched five databases from inception up to June 30, 2021. We included all studies examining a wide range of green space characteristics on various health outcomes. (3) Results: 68 articles from 59 studies were found, with a high degree of heterogeneity in study designs, definitions of quality and outcomes. Most studies were cross-sectional, ecological or cohort studies. Environment types, vegetation types, and the size and connectivity of green spaces were associated with improved health outcomes, though with contingencies by age and gender. Health benefits were more consistently observed in areas with greater tree canopy, but not grassland. The main outcomes with evidence of health benefits included allergic respiratory conditions, cardiovascular conditions and psychological wellbeing. Both objectively and subjectively measured qualities demonstrated associations with health outcomes. (4) Conclusion: Experimental studies and longitudinal cohort studies will strengthen current evidence. Evidence was lacking for needs-specific or culturally-appropriate amenities and soundscape characteristics. Qualities that need more in-depth investigation include indices that account for forms, patterns, and networks of objectively and subjectively measured green space qualities.
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Affiliation(s)
- Phi-Yen Nguyen
- School of Population Health, University of New South Wales, Sydney, NSW 2033, Australia; (P.-Y.N.); (H.R.-A.)
- Population Wellbeing and Environment Research Lab (PowerLab), Wollongong, NSW 2522, Australia;
| | - Thomas Astell-Burt
- Population Wellbeing and Environment Research Lab (PowerLab), Wollongong, NSW 2522, Australia;
- School of Health and Society, Faculty of Arts, Social Sciences, and Humanities, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Hania Rahimi-Ardabili
- School of Population Health, University of New South Wales, Sydney, NSW 2033, Australia; (P.-Y.N.); (H.R.-A.)
- Population Wellbeing and Environment Research Lab (PowerLab), Wollongong, NSW 2522, Australia;
| | - Xiaoqi Feng
- School of Population Health, University of New South Wales, Sydney, NSW 2033, Australia; (P.-Y.N.); (H.R.-A.)
- Population Wellbeing and Environment Research Lab (PowerLab), Wollongong, NSW 2522, Australia;
- School of Health and Society, Faculty of Arts, Social Sciences, and Humanities, University of Wollongong, Wollongong, NSW 2522, Australia
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18
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A negative association between prevalence of diabetes and urban residential area greenness detected in nationwide assessment of urban Bangladesh. Sci Rep 2021; 11:19513. [PMID: 34593885 PMCID: PMC8484480 DOI: 10.1038/s41598-021-98585-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 09/06/2021] [Indexed: 12/13/2022] Open
Abstract
Residential area greenness may influence diabetes, but limited studies have explored this relationship in developing countries. This study assessed the association between residential area greenness and diabetes among urban adults in Bangladesh. The mediation effect of the body mass index (BMI) was also assessed. A total of 2367 adults aged ≥ 35 years were extracted from a nationally representative survey. Diabetes was characterised as fasting plasma glucose level be ≥ 7.0 mmol/L or taking prescribed medications to reduce blood sugar level. Residential area greenness was estimated by enhanced vegetation index. Binary logistic regression models were employed to estimate the association between residential area greenness and diabetes adjusting for sociodemographic factors. Mediation analysis was performed to assess whether BMI mediated the association between greenness and diabetes. Greater area greenness was associated with lower odds of diabetes (adjusted odds ratio 0.805, 95% confidence interval 0.693–0.935, p = 0.0052). BMI significantly mediated 36.4% of the estimated association between greenness and diabetes. Presence of areas of greenness adjacent to living area tends to be associated with lower diabetes prevalence. Findings emphasised the importance of preserving the local environment to tackle the growing diabetes prevalence in Bangladesh.
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Aliyas Z. Physical, mental, and physiological health benefits of green and blue outdoor spaces among elderly people. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2021; 31:703-714. [PMID: 31625761 DOI: 10.1080/09603123.2019.1681379] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 10/13/2019] [Indexed: 06/10/2023]
Abstract
This study investigated the influence of designed natural outdoor spaces and space type on the physical, mental, and physiological health status of elderlies. A total of 978 questionnaires were distributed among a population-based randomized sample of elderlies residing in Bandar Abbas city, Iran. Blue space users reported better health status. Park access was associated with physical and physiological health. Those participants who had cardiovascular diseases were more likely to visit the parks more often, while the people with hypertension visited the parks less often. Length of park stay positively was associated with all aspects of health status. In addition, the level of physical activity positively was associated with physical and mental health. The park organizations should work on establishing parks in shorter distances and consider the opportunity for elderlies to participate in social programs to encourage them to frequently visit the parks and increase their length of park stay.
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Affiliation(s)
- Zeinab Aliyas
- Department of Architecture, Bandar Abbas Branch, Islamic Azad University, Bandar Abbas, Iran
- Young Researchers and Elite Club, Bandar Abbas Branch, Islamic Azad University, Bandar Abbas, Iran
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Kwan SC, Ismail R, Ismail NH, Mohamed N. An ecological study of the relationship between urban built environment and cardiovascular hospital admissions (2004-2016) in an Asian developing country. Soc Sci Med 2021; 276:113868. [PMID: 33799201 DOI: 10.1016/j.socscimed.2021.113868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/08/2021] [Accepted: 03/16/2021] [Indexed: 11/26/2022]
Abstract
This study aims to evaluate the relationship between urban built environment and hospital admissions from cardiovascular diseases in Kuala Lumpur, Malaysia. Hospital admission data from 2004 to 2016 for cardiovascular diseases were used with patient residential postcodes as the unit of analysis. Data was split into 2004-2009 (12,551 cases) and 2010-2016 (17,154 cases) periods corresponding to land use data. We used generalized linear mixed model to analyse population density, property value, entropy index, and the kernel density (800 m) of specific land use, bus and rail stations, and road junctions, with time period and postcodes as the random effects to generate incidence rate ratios (IRRs). Results indicated that entropy index and recreational area density were associated with fewer hypertensive disease and ischemic heart disease hospital admissions (IRR range: 0.49-0.68, 95%CI: 0.27, 0.97). Population density and property value were associated with fewer cerebrovascular disease hospital admissions (IRR range: 0.29-0.34, 95%CI: 0.11, 0.75). Contrarily, density of road junctions was associated with 2.5-6.3 times more hospital admissions for cardiovascular disease hospital admissions (IRR range: 2.53-6.34, 95%CI: 1.07,17.91). There were no significant association between hospital admission and density of residential area, undeveloped land, rail and bus stations. The shapes of relationships for all attributes were non-linear, and changed markedly at the third quartile except for recreational area density. The findings suggest that land use attributes have some protective effects on the cardiovascular disease admission cases as compared to the transport attributes. These findings have important merits for integrating health into urban planning.
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Affiliation(s)
- Soo Chen Kwan
- Center for Southeast Asian Studies (CSEAS), Kyoto University, Kyoto, Japan; Center for Toxicology and Health Risk Studies (CORE), Faculty of Health Sciences, National University of Malaysia, Malaysia.
| | - Rohaida Ismail
- Environmental Health Research Centre, Institute for Medical Research, Ministry of Health Malaysia, Malaysia
| | | | - Norlen Mohamed
- Disease Control Division, Ministry of Health Malaysia, Malaysia
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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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22
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Hu CY, Yang XJ, Gui SY, Ding K, Huang K, Fang Y, Jiang ZX, Zhang XJ. Residential greenness and birth outcomes: A systematic review and meta-analysis of observational studies. ENVIRONMENTAL RESEARCH 2021; 193:110599. [PMID: 33307084 DOI: 10.1016/j.envres.2020.110599] [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: 10/27/2020] [Revised: 12/04/2020] [Accepted: 12/04/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND The amount of natural vegetation surrounding homes (residential greenness) has been proposed as a mitigation measure to buffer the adverse health effects of urban living, associated with promoting health and wellbeing including birth outcomes. This study aimed to systematically review the epidemiological evidence on the association of residential greenness with birth outcomes and quantitatively provide summary effect estimates of the current literature. METHODS We extensively searched epidemiological studies related to residential greenness and birth outcomes in three electronic databases (EMBASE, Web of Science, and PubMed) using terms related to residential greenness and birth outcomes before July 10, 2020. Summary effect estimates of residential greenness on birth outcomes including SGA (small for gestational age), PTB (preterm birth), LBW (low birth weight), and birth weight were calculated for each 0.1 unit increase in residential greenness exposure, as well as comparing the highest to the lowest categories using random-effects meta-analyses. We assessed the risk of bias of each individual study, and the overall quality of the body of evidence and level of evidence for each exposure-outcome were also evaluated. RESULTS The initial search identified 161 studies, of which 29 studies were finally included. Meta-analysis for continuous exposure suggested that an increase in residential greenness, measured by NDVI (normalized difference vegetation index) with different buffer sizes, was generally associated with higher birth weights ranging from 7.99 g [95% confidence interval (CI) = 4.29-11.70] to 15.35 g (95% CI = 11.41-19.29) and lower odds of LBW ranging from 0.79 (95% CI = 0.65-0.96) to 0.93 (95% CI = 0.86-1.00), but associations between residential greenness and PTB or SGA were not significant. When introducing the exposure as high versus low categories, similar results were found. The overall evidence for each exposure-outcome combination was considered to be of "moderate" certainty. CONCLUSIONS This study indicated a potential positive association between residential greenness and several birth outcomes. However, because of the moderate to high between-study heterogeneity, further studies with better adjustment of covariates, improved residential greenness assessment in a longitudinal approach throughout pregnancy rather than a cross-sectional approach at time of delivery, and accounting thoroughly for socioeconomic status, are warranted to replicate these findings as well as to explore in greater detail in their implications.
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Affiliation(s)
- Cheng-Yang Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China; Department of Humanistic Medicine, School of Humanistic Medicine, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Xiao-Jing Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Si-Yu Gui
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230601, China
| | - Kun Ding
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Kai Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Yuan Fang
- Department of Public Health, Erasmus University Medical Center, P.O. Box 2040, 3000, CA Rotterdam, the Netherlands
| | - Zheng-Xuan Jiang
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230601, China.
| | - Xiu-Jun Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China; Center for Evidence-Based Practice, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China.
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23
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Li R, Chen G, Jiao A, Lu Y, Guo Y, Li S, Wang C, Xiang H. Residential Green and Blue Spaces and Type 2 Diabetes Mellitus: A Population-Based Health Study in China. TOXICS 2021; 9:11. [PMID: 33467046 PMCID: PMC7830986 DOI: 10.3390/toxics9010011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 01/02/2023]
Abstract
Evidence on the health benefits of green space in residential environments is still limited, and few studies have investigated the potential association between blue space and type 2 diabetes mellitus (T2DM) prevalence. This study included 39,019 participants who had completed the baseline survey from the Henan Rural Cohort Study, 2015-2017. The Normalized Difference Vegetation Index (NDVI) and Enhanced Vegetation Index (EVI) were employed to characterize the residential green space, and the distance from the participant's residential address to the nearest water body was considered to represent the residential blue space. Mixed effect models were applied to evaluate the associations of the residential environment with T2DM and fasting blood glucose (FBG) levels. An interquartile range (IQR) increase in NDVI and EVI was significantly associated with a 13.4% (odds ratio (OR): 0.866, 95% Confidence interval (CI): 0.830,0.903) and 14.2% (OR: 0.858, 95% CI: 0.817,0.901) decreased risk of T2DM, respectively. The residential green space was associated with lower fasting blood glucose levels in men (%change, -2.060 in men vs. -0.972 in women) and the elderly (%change, -1.696 in elderly vs. -1.268 in young people). Additionally, people who lived more than 5 km from the water body had a 15.7% lower risk of T2DM (OR: 0.843, 95% CI: 0.770,0.923) and 1.829% lower fasting blood glucose levels (95% CI: -2.335%,-1.320%) than those who lived closer to the blue space. Our findings suggest that residential green space was beneficially associated with T2DM and fasting blood glucose levels. However, further research is needed to explore more comprehensively the relationship between residential blue space and public health.
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Affiliation(s)
- Ruijia Li
- Department of Global Health, School of Health Sciences, Wuhan University, Wuhan 430071, China; (R.L.); (A.J.)
- Global Health Institute, Wuhan University, Wuhan 430071, China
| | - Gongbo Chen
- Guangdong Environmental and Health Risk Assessment Engineering Technology Research Center, Department of Occupational and Environmental Hygiene, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China;
| | - Anqi Jiao
- Department of Global Health, School of Health Sciences, Wuhan University, Wuhan 430071, China; (R.L.); (A.J.)
- Global Health Institute, Wuhan University, Wuhan 430071, China
| | - Yuanan Lu
- Environmental Health Laboratory, Department of Public Health Sciences, University Hawaii at Manoa, Honolulu, HI 96822, USA;
| | - Yuming Guo
- Department of Epidemiology and Biostatistics, School of Public Health, Zhengzhou University, Zhengzhou 450001, China;
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3010, Australia;
| | - Shanshan Li
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3010, Australia;
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Zhengzhou University, Zhengzhou 450001, China;
| | - Hao Xiang
- Department of Global Health, School of Health Sciences, Wuhan University, Wuhan 430071, China; (R.L.); (A.J.)
- Global Health Institute, Wuhan University, Wuhan 430071, China
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De la Fuente F, Saldías MA, Cubillos C, Mery G, Carvajal D, Bowen M, Bertoglia MP. Green Space Exposure Association with Type 2 Diabetes Mellitus, Physical Activity, and Obesity: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:ijerph18010097. [PMID: 33375559 PMCID: PMC7796153 DOI: 10.3390/ijerph18010097] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 12/12/2020] [Accepted: 12/22/2020] [Indexed: 12/14/2022]
Abstract
Type 2 diabetes mellitus (T2DM) is a public health challenge that must be addressed considering the large number of risk factors involved in its appearance. Some environmental risk factors are currently described as predictors of diabetes, with access to green spaces being an element to consider in urban settings. This review aims to study the association between exposure to green spaces and outcomes such as diabetes, obesity, and physical activity in the general population. A systematic review was carried out using the PubMed, Embase, and LILACS databases and other sources. The search strategy was carried out from October 2019 to October 2020. Cross-sectional and cohort studies were included. The article selection was made by a pair of reviewers, and data extraction was carried out using a data extraction sheet. The quality assessment of the included studies was carried out using a validated tool. Finally, 19 scientific articles were included in this review. Evidence supports that people and communities exposed to green spaces, especially in their neighborhood, reduce the risk of T2DM and reduce the risk of being obese and increase the likelihood of physical activity. The onset of T2DM can be moderated by using green spaces, improving physical activity levels, and reducing the risk of being overweight and obese.
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Affiliation(s)
- Felipe De la Fuente
- Nursing Department, University of Chile, Santiago 8320000, Chile; (F.D.l.F.); (M.A.S.); (C.C.); (G.M.); (D.C.)
| | - María Angélica Saldías
- Nursing Department, University of Chile, Santiago 8320000, Chile; (F.D.l.F.); (M.A.S.); (C.C.); (G.M.); (D.C.)
| | - Camila Cubillos
- Nursing Department, University of Chile, Santiago 8320000, Chile; (F.D.l.F.); (M.A.S.); (C.C.); (G.M.); (D.C.)
| | - Gabriela Mery
- Nursing Department, University of Chile, Santiago 8320000, Chile; (F.D.l.F.); (M.A.S.); (C.C.); (G.M.); (D.C.)
| | - Daniela Carvajal
- Nursing Department, University of Chile, Santiago 8320000, Chile; (F.D.l.F.); (M.A.S.); (C.C.); (G.M.); (D.C.)
| | - Martín Bowen
- Medical School, University of Chile, Santiago 8320000, Chile;
| | - María Paz Bertoglia
- School of Public Health, University of Chile, Santiago 8320000, Chile
- Correspondence:
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25
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Qu Y, Yang B, Lin S, Bloom MS, Nie Z, Ou Y, Mai J, Wu Y, Gao X, Dong G, Liu X. Associations of greenness with gestational diabetes mellitus: The Guangdong Registry of Congenital Heart Disease (GRCHD) study. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2020; 266:115127. [PMID: 32650202 DOI: 10.1016/j.envpol.2020.115127] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 06/11/2023]
Abstract
Gestational diabetes mellitus (GDM) is associated with adverse short- and long-term health outcomes among mothers and their offspring. GDM affects 0.6%-15% of pregnancies worldwide and its incidence is increasing. However, intervention strategies are lacking for GDM. Previous studies indicated a protective association between greenspace and type 2 diabetes mellitus (T2DM), while few studies have explored the association between greenness and GDM. This study aimed to investigate the association between residential greenness and GDM among women from 40 clinical centers in Guangdong province, south China. The study population comprised 5237 pregnant mothers of fetuses and infants without birth defects, from 2004 to 2016. There were n = 157 diagnosed with GDM according to World Health Organization criteria. We estimated residential greenness using the Normalized Difference Vegetation Index (NDVI), derived from satellite imagery using a spatial-statistical model. Associations between greenness during pregnancy and GDM were assessed by confounder-adjusted random effects log-binomial regression models, with participating centers as the random effect. One interquartile increments of NDVI250m, NDVI500m and NDVI1000m were associated with 13% (RR = 0.87, 95%CI: 0.87-0.87), 8% (RR = 0.92, 95%CI: 0.91-0.92) and 3% (RR = 0.97, 95%CI: 0.97-0.97) lower risks for GDM, respectively. However, NDVI3000m was not significantly associated with GDM (RR = 0.96, 95%CI: 0.78-1.19). The risk for GDM decreased monotonically with greater NDVI. The protective effect of greenness on GDM was stronger among women with lower socioeconomic status and in environments with a lower level air pollutants. Our results suggest that greenness might provide an effective intervention to decrease GDM. Greenness and residential proximity to greenspace should be considered in community planning to improve maternal health outcomes.
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Affiliation(s)
- Yanji Qu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong, China
| | - Boyi 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, Guangdong, China
| | - Shao Lin
- Department of Environmental Health Sciences, University at Albany, State University of New York, One University Place, Rensselaer, Albany, NY, 12144, USA; Department of Epidemiology and Biostatistics, University at Albany, State University of New York, One University Place, Rensselaer, Albany, NY, 12144, USA
| | - Michael S Bloom
- Department of Environmental Health Sciences, University at Albany, State University of New York, One University Place, Rensselaer, Albany, NY, 12144, USA; Department of Epidemiology and Biostatistics, University at Albany, State University of New York, One University Place, Rensselaer, Albany, NY, 12144, USA
| | - Zhiqiang Nie
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong, China
| | - Yanqiu Ou
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong, China
| | - Jinzhuang Mai
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong, China
| | - Yong Wu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong, China
| | - Xiangmin Gao
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong, China
| | - Guanghui 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, Guangdong, China
| | - Xiaoqing Liu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong, China.
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Abstract
Background. The salutogenicity of urban environments is significantly affected by their ergonomics, i.e., by the quality of the interactions between citizens and the elements of the built environment. Measuring and modelling urban ergonomics is thus a key issue to provide urban policy makers with planning solutions to increase the well-being, usability and safety of the urban environment. However, this is a difficult task due to the complexity of the interrelations between the urban environment and human activities. The paper contributes to the definition of a generalized model of urban ergonomics and salutogenicity, focusing on walkability, by discussing the relevant parameters from the large and variegated sets proposed in the literature, by discussing the emerging model structure from a data mining process, by considering the background of the relevant functional dependency already established in the literature, and by providing evidence of the solutions’ effectiveness. The methodology is developed for a case study in central Italy, with a focus on the mobility issue, which is a catalyst to generate more salutogenic and sustainable behaviors.
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27
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Yang BY, Hu LW, Jalaludin B, Knibbs LD, Markevych I, Heinrich J, Bloom MS, Morawska L, Lin S, Jalava P, Roponen M, Gao M, Chen DH, Zhou Y, Yu HY, Liu RQ, Zeng XW, Zeeshan M, Guo Y, Yu Y, Dong GH. Association Between Residential Greenness, Cardiometabolic Disorders, and Cardiovascular Disease Among Adults in China. JAMA Netw Open 2020; 3:e2017507. [PMID: 32955574 PMCID: PMC7506516 DOI: 10.1001/jamanetworkopen.2020.17507] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
IMPORTANCE Living in areas with more vegetation (referred to as residential greenness) may be associated with cardiovascular disease (CVD), but little data are available from low- and middle-income countries. In addition, it remains unclear whether the presence of cardiometabolic disorders modifies or mediates the association between residential greenness and CVD. OBJECTIVE To evaluate the associations between residential greenness, cardiometabolic disorders, and CVD prevalence among adults in China. DESIGN, SETTING, AND PARTICIPANTS This analysis was performed as part of the 33 Communities Chinese Health Study, a large population-based cross-sectional study that was conducted in 33 communities (ranging from 0.25-0.64 km2) in 3 cities within the Liaoning province of northeastern China between April 1 and December 31, 2009. Participants included adults aged 18 to 74 years who had resided in the study area for 5 years or more. Greenness levels surrounding each participant's residential community were assessed using the normalized difference vegetation index and the soil-adjusted vegetation index from 2010. Lifetime CVD status (including myocardial infarction, heart failure, coronary heart disease, cerebral thrombosis, cerebral hemorrhage, cerebral embolism, and subarachnoid hemorrhage) was defined as a self-report of a physician diagnosis of CVD at the time of the survey. Cardiometabolic disorders, including hypertension, diabetes, dyslipidemia, and overweight or obese status, were measured and defined clinically. Generalized linear mixed models were used to evaluate the association between residential greenness levels and CVD prevalence. A 3-way decomposition method was used to explore whether the presence of cardiometabolic disorders mediated or modified the association between residential greenness and CVD. Data were analyzed from October 10 to May 30, 2020. MAIN OUTCOMES AND MEASURES Lifetime CVD status, the presence of cardiometabolic disorders, and residential greenness level. RESULTS Among 24 845 participants, the mean (SD) age was 45.6 (13.3) years, and 12 661 participants (51.0%) were men. A total of 1006 participants (4.1%) reported having a diagnosis of CVD. An interquartile range (1-IQR) increase in the normalized difference vegetation index within 500 m of a community was associated with a 27% lower likelihood (odds ratio [OR], 0.73; 95% CI, 0.65-0.83; P < .001) of CVD prevalence, and an IQR increase in the soil-adjusted vegetation index within 500 m of a community was associated with a 26% lower likelihood (OR, 0.74; 95% CI, 0.66-0.84; P < .001) of CVD prevalence. The presence of cardiometabolic disorders was found to mediate the association between residential greenness and CVD, with mediation effects of 4.5% for hypertension, 4.1% for type 2 diabetes, 3.1% for overweight or obese status, 12.7% for hypercholesterolemia, 8.7% for hypertriglyceridemia, and 11.1% for high low-density lipoprotein cholesterol levels. CONCLUSIONS AND RELEVANCE In this cross-sectional study, higher residential greenness levels were associated with lower CVD prevalence, and this association may be partially mediated by the presence of cardiometabolic disorders. Further studies, preferably longitudinal, are warranted to confirm these findings.
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Affiliation(s)
- Bo-Yi Yang
- Guangdong Provincial Engineering Technology Research Center of Environmental and Health Risk Assessment, Department of Occupational and Environmental Health, Sun Yat-sen University School of Public Health, Guangzhou, China
| | - Li-Wen Hu
- Guangdong Provincial Engineering Technology Research Center of Environmental and Health Risk Assessment, Department of Occupational and Environmental Health, Sun Yat-sen University School of Public Health, Guangzhou, China
| | - Bin Jalaludin
- Centre for Air Quality and Health Research and Evaluation, Glebe, New South Wales, Australia
- Population Health, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- University of New South Wales School of Public Health and Community Medicine, Kensington, New South Wales, Australia
| | - Luke D. Knibbs
- University of Queensland School of Public Health, Herston, Queensland, Australia
| | - Iana Markevych
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
- Institute of Epidemiology, Helmholtz Zentrum Munchen–German Research Center for Environmental Health, Neuherberg, Germany
| | - Joachim Heinrich
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center Munich, German Center for Lung Research, Munich, Germany
| | - Michael S. Bloom
- Department of Environmental Health Sciences, University at Albany, State University of New York, Rensselaer
- Department of Epidemiology and Biostatics, University at Albany, State University of New York, Rensselaer
| | - Lidia Morawska
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Shao Lin
- Department of Environmental Health Sciences, University at Albany, State University of New York, Rensselaer
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Pasi Jalava
- Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, Finland
| | - Marjut Roponen
- Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, Finland
| | - Meng Gao
- Department of Geography, Hong Kong Baptist University, Hong Kong SAR, China
| | - Duo-Hong Chen
- Guangdong Environmental Monitoring Center, State Environmental Protection Key Laboratory of Regional Air Quality Monitoring, Guangdong Environmental Protection Key Laboratory of Atmospheric Secondary Pollution, Guangzhou, China
| | - Yang Zhou
- Guangdong Provincial Engineering Technology Research Center of Environmental and Health Risk Assessment, Department of Occupational and Environmental Health, Sun Yat-sen University School of Public Health, Guangzhou, China
| | - Hong-Yao Yu
- Guangdong Provincial Engineering Technology Research Center of Environmental and Health Risk Assessment, Department of Occupational and Environmental Health, Sun Yat-sen University School of Public Health, Guangzhou, China
| | - Ru-Qing Liu
- Guangdong Provincial Engineering Technology Research Center of Environmental and Health Risk Assessment, Department of Occupational and Environmental Health, Sun Yat-sen University School of Public Health, Guangzhou, China
| | - Xiao-Wen Zeng
- Guangdong Provincial Engineering Technology Research Center of Environmental and Health Risk Assessment, Department of Occupational and Environmental Health, Sun Yat-sen University School of Public Health, Guangzhou, China
| | - Mohammed Zeeshan
- Guangdong Provincial Engineering Technology Research Center of Environmental and Health Risk Assessment, Department of Occupational and Environmental Health, Sun Yat-sen University School of Public Health, Guangzhou, China
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Yunjiang Yu
- State Environmental Protection Key Laboratory of Environmental Pollution Health Risk Assessment, South China Institute of Environmental Sciences, Ministry of Environmental Protection, Guangzhou, China
| | - Guang-Hui Dong
- Guangdong Provincial Engineering Technology Research Center of Environmental and Health Risk Assessment, Department of Occupational and Environmental Health, Sun Yat-sen University School of Public Health, Guangzhou, China
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28
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Yang BY, Liu KK, Markevych I, Knibbs LD, Bloom MS, Dharmage SC, Lin S, Morawska L, Heinrich J, Jalaludin B, Gao M, Guo Y, Zhou Y, Huang WZ, Yu HY, Zeng XW, Hu LW, Hu Q, Dong GH. Association between residential greenness and metabolic syndrome in Chinese adults. ENVIRONMENT INTERNATIONAL 2020; 135:105388. [PMID: 31837524 DOI: 10.1016/j.envint.2019.105388] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/28/2019] [Accepted: 12/02/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Residing in greener areas has several health benefits, but no study to date has examined the effects of greenness on metabolic syndrome (MetS). We aimed to assess associations between residential greenness and MetS prevalence in China, and to explore whether air pollution and physical activity mediated any observed associations. METHODS We analyzed data from 15,477 adults who participated in the 33 Communities Chinese Health Study during 2009. We defined MetS according to standard guidelines for Chinese populations. Residential greenness was estimated using the Normalized Difference Vegetation Index (NDVI), the Soil Adjusted Vegetation Index (SAVI), and the Vegetation Continuous Field (VCF). We used generalized linear mixed models to assess the associations between greenness and MetS, and mediation analyses to explore potential mechanisms underlying the associations. RESULTS Higher greenness levels were associated with lower odds of MetS [e.g., for every interquartile range increase of NDVI500-m, SAVI500-m, and VCF500-m, the adjusted odds ratio of MetS was 0.81 (95% confidence interval: 0.70-0.93), 0.80 (95% confidence interval: 0.69-0.93), and 0.91 (95% confidence interval: 0.83-1.00), respectively]. The direction and the magnitude of the associations persisted in several sensitivity analyses. Stratified analyses showed that age and household income modified the associations, with greater effect estimates observed in participants younger than 65 years old or those with higher household income. Particulate matter with an aerodynamic diameter ≤10 μm, nitrogen dioxide, and ozone mediated 2.1-20.3% of the associations between greenness and MetS; no evidence of mediation was observed for physical activity. CONCLUSIONS Our findings suggest a beneficial association for residential greenness and MetS in Chinese urban dwellers, especially for participants younger than 65 years old and those with higher household income. Particulate matter with an aerodynamic diameter ≤10 μm, nitrogen dioxide and ozone, but not physical activity, may only partially mediate the association.
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Affiliation(s)
- Bo-Yi Yang
- 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
- 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
| | - Luke D Knibbs
- School of Public Health, The University of Queensland, Herston, Queensland 4006, Australia
| | - Michael S Bloom
- Departments of Environmental Health Sciences and Epidemiology and Biostatics, University at Albany, State University of New York, Rensselaer, NY 12144, USA
| | - Shaymali 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
| | - Shao Lin
- Departments of Environmental Health Sciences and Epidemiology and Biostatics, University at Albany, State University of New York, Rensselaer, NY 12144, USA
| | - Lidia Morawska
- International Laboratory for Air Quality and Health, Queensland University of Technology (QUT), GPO Box 2434, Brisbane, Queensland 4001, 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
| | - 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
| | - Meng Gao
- Department of Geography, Hong Kong Baptist University, Hong Kong Special Administrative Region
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Yang Zhou
- 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
| | - Wen-Zhong Huang
- 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
| | - Hong-Yao Yu
- 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
| | - Xiao-Wen Zeng
- 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
- 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
| | - Qiang Hu
- Department of Pediatric Surgery, Weifang People's Hospital, Weifang 261041, China.
| | - Guang-Hui Dong
- 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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Moreira TCL, Polizel JL, Santos IDS, Silva Filho DF, Bensenor I, Lotufo PA, Mauad T. Green Spaces, Land Cover, Street Trees and Hypertension in the Megacity of São Paulo. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030725. [PMID: 31979152 PMCID: PMC7038323 DOI: 10.3390/ijerph17030725] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/16/2020] [Accepted: 01/17/2020] [Indexed: 12/31/2022]
Abstract
Proximity to green spaces has been shown to be beneficial to several cardiovascular outcomes in urban spaces. Few studies, however, have analyzed the relationship between these outcomes and green space or land cover uses in low-medium income megacities, where the consequences of rapid and inordinate urbanization impose several health hazards. This study used a subgroup of the dataset from The Brazilian Longitudinal Study of Adult Health ELSA-BRASIL (n= 3418) to identify the correlation between the medical diagnosis of hypertension and green spaces in the megacity of São Paulo. Land cover classification was performed based on the random forest algorithm using geometrically corrected aerial photography (orthophoto). Three different indicators of exposure to green spaces were used: number of street trees, land cover and number of parks within 1 km. We used logistic regression models to obtain the association of the metrics exposure and health outcomes. The number of street trees in the regional governments (OR = 0.937 and number of parks within 1 km (OR = 0.876) were inversely associated with a diagnosis of hypertension. Sixty-three percent of the population had no parks within 1 km of their residence. Our data indicate the need to encourage large-scale street tree planting and increase the number of qualified parks in megacities.
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Affiliation(s)
- Tiana C. L. Moreira
- Faculdade de Medicina, Departamento de Patologia, Universidade de São Paulo, São Paulo 01246-903, Brazil;
- Harvard T. H. CHAN School of Public Health, Environmental Health Department, Boston, MA 02215, USA
- Correspondence:
| | - Jefferson L. Polizel
- Escola Superior de Agricultura “Luiz de Queiroz”, Universidade de São Paulo, Piracicaba 13418-900, Brazil; (J.L.P.); (D.F.S.F.)
| | - Itamar de Souza Santos
- Centro de Pesquisa Clínica, Hospital Universitário, Universidade de São Paulo, São Paulo 05508-000, Brazil; (I.d.S.S.); (I.B.); (P.A.L.)
- Faculdade de Medicina, Departamento de Clínica Médica, Universidade de São Paulo, São Paulo 01246-903, Brazil
| | - Demóstenes F. Silva Filho
- Escola Superior de Agricultura “Luiz de Queiroz”, Universidade de São Paulo, Piracicaba 13418-900, Brazil; (J.L.P.); (D.F.S.F.)
| | - Isabela Bensenor
- Centro de Pesquisa Clínica, Hospital Universitário, Universidade de São Paulo, São Paulo 05508-000, Brazil; (I.d.S.S.); (I.B.); (P.A.L.)
- Faculdade de Medicina, Departamento de Clínica Médica, Universidade de São Paulo, São Paulo 01246-903, Brazil
| | - Paulo A. Lotufo
- Centro de Pesquisa Clínica, Hospital Universitário, Universidade de São Paulo, São Paulo 05508-000, Brazil; (I.d.S.S.); (I.B.); (P.A.L.)
- Faculdade de Medicina, Departamento de Clínica Médica, Universidade de São Paulo, São Paulo 01246-903, Brazil
| | - Thais Mauad
- Faculdade de Medicina, Departamento de Patologia, Universidade de São Paulo, São Paulo 01246-903, Brazil;
- Instituto de Estudos Avançados, Universidade de São Paulo, São Paulo 05508-060, Brazil
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Residential neighbourhood greenspace is associated with reduced risk of cardiovascular disease: A prospective cohort study. PLoS One 2020; 15:e0226524. [PMID: 31899764 PMCID: PMC6941810 DOI: 10.1371/journal.pone.0226524] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 11/26/2019] [Indexed: 11/19/2022] Open
Abstract
Background Living in a greener neighbourhood may reduce the risk of developing incident cardiovascular disease, but evidence is limited by reliance on cross-sectional comparisons. We use data from a longitudinal study with a time-independent measure of risk to explore the association between exposure to greenspace and cardiovascular disease. Methods Data was from the European Prospective Investigation of Cancer Norfolk UK cohort, baseline 1993–1997 (n = 24,420). Neighbourhoods were defined as 800m radius zones around participants’ home, according to their home postcode (zip code) in the year 2000. Greenspace exposure was identified using classified satellite imagery. Adjusted Cox proportional hazards regression examined associations between greenspace and incident cardiovascular disease. Mediation analysis assessed if physical activity mediated associations, whilst modification by rurality, socio-economic status and age was explored. Results The mean age of participants was 59.2 years at baseline, 54.7% were female, and mean follow-up time was 14.5 years. Individuals living in the greenest neighbourhood quartile had a 7% lower relative hazard of developing cardiovascular disease than other neighbourhoods (HR 0.93; 95% CI 0.88, 0.97; p = 0.003) after adjusting for age, sex, BMI, prevalent diabetes and socio-economic status (SES). Physical activity did not mediate the relationship (greenest compared to the least green quartile HR 0.99; 95% CI 0.97, 1.01; p = 0.416). Models predicted incidence of cardiovascular disease in the least green neighbourhoods (19.4% greenspace on average) would fall by 4.8% (95% CI 1.6%, 8.2% p = 0.003) if they were as green as the average neighbourhood (59.0% greenspace). Occupation moderated the relationship, whereby exposure to greenspace was not associated with incident CVD for participants engaged in manual occupations. Conclusions Greener home neighbourhoods may protect against risk of cardiovascular disease even after accounting for SES, whilst the mechanism does not appear to be strongly associated with physical activity. Putative causal mechanisms require investigation.
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McCormack GR, Cabaj J, Orpana H, Lukic R, Blackstaffe A, Goopy S, Hagel B, Keough N, Martinson R, Chapman J, Lee C, Tang J, Fabreau G. A scoping review on the relations between urban form and health: a focus on Canadian quantitative evidence. HEALTH PROMOTION AND CHRONIC DISEASE PREVENTION IN CANADA-RESEARCH POLICY AND PRACTICE 2019; 39:187-200. [PMID: 31091062 DOI: 10.24095/hpcdp.39.5.03] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Despite the accumulating Canadian evidence regarding the relations between urban form and health behaviours, less is known about the associations between urban form and health conditions. Our study aim was to undertake a scoping review to synthesize evidence from quantitative studies that have investigated the relationship between built environment and chronic health conditions, self-reported health and quality of life, and injuries in the Canadian adult population. METHODS From January to March 2017, we searched 13 databases to identify peer-reviewed quantitative studies from all years that estimated associations between the objectively-measured built environment and health conditions in Canadian adults. Studies under-taken within urban settings only were included. Relevant studies were catalogued and synthesized in relation to their reported study and sample design, and health outcome and built environment features. RESULTS Fifty-five articles met the inclusion criteria, 52 of which were published after 2008. Most single province studies were undertaken in Ontario (n = 22), Quebec (n = 12), and Alberta (n = 7). Associations between the built environment features and 11 broad health outcomes emerged from the review, including injury (n = 19), weight status (n = 19), cardiovascular disease (n = 5), depression/anxiety (n = 5), diabetes (n = 5), mortality (n = 4), self-rated health (n = 2), chronic conditions (n = 2), metabolic condi-tions (n = 2), quality of life (n = 1), and cancer (n = 1). Consistent evidence for associations between aggregate built environment indicators (e.g., walkability) and diabetes and weight and between connectivity and route features (e.g., transportation route, trails, pathways, sidewalks, street pattern, intersections, route characteristics) and injury were found. Evidence for greenspace, parks and recreation features impacting multiple health outcomes was also found. CONCLUSION Within the Canadian context, the built environment is associated with a range of chronic health conditions and injury in adults, but the evidence to date has limitations. More research on the built environment and health incorporating rigorous study designs are needed to provide stronger causal evidence to inform policy and practice.
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Affiliation(s)
- Gavin R McCormack
- Department of Community Health Science, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Faculty of Environmental Design, University of Calgary, Alberta, Canada
| | - Jason Cabaj
- Department of Community Health Science, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Alberta Health Services, Alberta, Canada
| | - Heather Orpana
- Public Health Agency of Canada, Ottawa, Ontario, Canada.,School of Psychology, University of Ottawa, Ontario, Canada
| | - Ryan Lukic
- Department of Community Health Science, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Anita Blackstaffe
- Department of Community Health Science, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Suzanne Goopy
- Faculty of Nursing, University of Calgary, Alberta, Canada
| | - Brent Hagel
- Department of Community Health Science, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Department of Paediatrics, Cumming School of Medicine, University of Calgary
| | - Noel Keough
- Faculty of Environmental Design, University of Calgary, Alberta, Canada
| | | | | | - Celia Lee
- Sustainable Calgary, Alberta, Canada
| | | | - Gabriel Fabreau
- Department of Community Health Science, Cumming School of Medicine, University of Calgary, Alberta, Canada
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Fan S, Xue Z, Yuan J, Zhou Z, Wang Y, Yang Z, Yang B, Dong G, Zhang Z. Associations of Residential Greenness with Diabetes Mellitus in Chinese Uyghur Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16245131. [PMID: 31888136 PMCID: PMC6950214 DOI: 10.3390/ijerph16245131] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/26/2019] [Accepted: 12/10/2019] [Indexed: 12/26/2022]
Abstract
Greenness exposure is nominated as a potential beneficial factor for health, but evidence is limited on its diabetes effects. We conducted a cross-sectional study between May and September 2016 in rural areas of northwestern China, including 4670 Uyghur adults, to explore the associations between residential greenness and fasting glucose levels and diabetes prevalence. Fasting glucose levels were determined, and information on covariates was collected by questionnaire. Normalized difference vegetation index (NDVI) and soil-adjusted vegetation index (SAVI) were calculated to assess greenness levels. Generalized linear mixed models were applied to evaluate the associations of greenness with fasting glucose levels and diabetes prevalence. The prevalence of diabetes was 11.6%. We found that living in rural areas characterized by increased amounts of greenness was associated with reduced diabetes prevalence (e.g., NDVI1000m: OR, 0.92; 95% CI, 0.86, 0.99). Stratified analyses showed that the protective effects of greenness on diabetes prevalence were found only in women (NDVI1000m: OR, 0.90; 95% CI, 0.82, 0.99). However, none of the interaction was statistically significant. Our study suggests that greater residential greenness levels were associated with a lower odds ratio of diabetes prevalence in Xinjiang Uyghur adults. Further well-designed longitudinal studies are needed to confirm our findings.
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Affiliation(s)
- Shujun Fan
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China; (S.F.); (J.Y.); (Z.Z.); (Z.Y.)
| | - Zhenxiang Xue
- Shufu Center for Disease Control and Prevention, Kashgar 844100, China; (Z.X.); (Y.W.)
| | - Jun Yuan
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China; (S.F.); (J.Y.); (Z.Z.); (Z.Y.)
| | - Ziyan Zhou
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China; (S.F.); (J.Y.); (Z.Z.); (Z.Y.)
| | - Yuzhong Wang
- Shufu Center for Disease Control and Prevention, Kashgar 844100, China; (Z.X.); (Y.W.)
| | - Zhicong Yang
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China; (S.F.); (J.Y.); (Z.Z.); (Z.Y.)
| | - Boyi 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;
| | - Guanghui 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;
- Correspondence: (G.D.); (Z.Z.); Tel.: +862087333409 (G.D.); +86-20-36052380 (Z.Z.); Fax: +862087330446 (G.D.); +86-20-36052380 (Z.Z.)
| | - Zhoubin Zhang
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China; (S.F.); (J.Y.); (Z.Z.); (Z.Y.)
- Correspondence: (G.D.); (Z.Z.); Tel.: +862087333409 (G.D.); +86-20-36052380 (Z.Z.); Fax: +862087330446 (G.D.); +86-20-36052380 (Z.Z.)
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Urban Green Space Is Spatially Associated with Cardiovascular Disease Occurrence in Women of Mashhad: a Spatial Analysis of Influential Factors on their Presence in Urban Green Spaces. J Urban Health 2019; 96:653-668. [PMID: 31385136 PMCID: PMC6814665 DOI: 10.1007/s11524-019-00373-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Chronic diseases have spread around the world. Cardiovascular diseases (CVD), the most important of the chronic diseases and the leading cause of death in women of Mashhad, are impacted by environmental factors. Urban green spaces (UGSs) are important environmental factors playing a critical role in the prevention and control of CVD. Spatial analysis is useful in understanding the application of UGSs in CVD prevention. To identify the spatial distribution of CVD in Mashhad, Moran's index was used and 7539 home addresses of female patients with CVD were imported into ArcMap. Moran's coefficient was estimated to be 0.34, revealing a clustered distribution of CVD. The spatial autocorrelation between CVD and UGSs was analyzed using Moran's I. Moran's I index value was calculated to be - 0.15, and four types of clusters were identified in eight sub-districts of Mashhad municipality. To find the factors influencing the presence in UGSs among women affected by CVD, 607 female patients living in the selected sub-districts were asked to take part in a telephone survey. Data were analyzed using ordinary least squares (OLS) and geographically weighted regression (GWR) at block level (343 statistical blocks in total). Accordingly, the spatial diversity and effects of three variables of income, level of education, and access to UGSs among female patients with CVD were measured. According to OLS results and the standard residual, two clusters were removed. Finally, vulnerable blocks were identified that could be helpful in the development of prevention policies and place-based interventions.
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Klompmaker JO, Janssen NAH, Bloemsma LD, Gehring U, Wijga AH, van den Brink C, Lebret E, Brunekreef B, Hoek G. Associations of Combined Exposures to Surrounding Green, Air Pollution, and Road Traffic Noise with Cardiometabolic Diseases. ENVIRONMENTAL HEALTH PERSPECTIVES 2019; 127:87003. [PMID: 31393793 PMCID: PMC6792364 DOI: 10.1289/ehp3857] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 05/21/2019] [Accepted: 07/18/2019] [Indexed: 05/19/2023]
Abstract
BACKGROUND Surrounding green, air pollution, and noise have been associated with cardiometabolic diseases, but most studies have assessed only one of these correlated exposures. OBJECTIVES We aimed to evaluate associations of combined exposures to green, air pollution, and road traffic noise with cardiometabolic diseases. METHODS In this cross-sectional study, we studied associations between self-reported physician-diagnosed diabetes, hypertension, heart attack, and stroke from a Dutch national health survey of 387,195 adults and residential surrounding green, annual average air pollutant concentrations [including particulate matter with aerodynamic diameter [Formula: see text] ([Formula: see text]), PM with aerodynamic diameter [Formula: see text] ([Formula: see text]), nitrogen dioxide ([Formula: see text]), and oxidative potential (OP) with the dithiothreitol (DTT) assay ([Formula: see text])] and road traffic noise. Logistic regression models were used to analyze confounding and interaction of surrounding green, air pollution, and noise exposure. RESULTS In single-exposure models, surrounding green was inversely associated with diabetes, while air pollutants ([Formula: see text], [Formula: see text]) and road traffic noise were positively associated with diabetes. In two-exposure analyses, associations with green and air pollution were attenuated but remained. The association between road traffic noise and diabetes was reduced to unity when adjusted for surrounding green or air pollution. Air pollution and surrounding green, but not road traffic noise, were associated with hypertension in single-exposure models. The weak inverse association of surrounding green with hypertension attenuated and lost significance when adjusted for air pollution. Only [Formula: see text] was associated with stroke and heart attack. CONCLUSIONS Studies including only one of the correlated exposures surrounding green, air pollution, and road traffic noise may overestimate the association of diabetes and hypertension attributed to the studied exposure. https://doi.org/10.1289/EHP3857.
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Affiliation(s)
- Jochem O. Klompmaker
- National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, Netherlands
| | - Nicole A. H. Janssen
- National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Lizan D. Bloemsma
- National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, Netherlands
| | - Ulrike Gehring
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, Netherlands
| | - Alet H. Wijga
- National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | | | - Erik Lebret
- National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, Netherlands
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Gerard Hoek
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, Netherlands
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Associations of greenness with diabetes mellitus and glucose-homeostasis markers: The 33 Communities Chinese Health Study. Int J Hyg Environ Health 2018; 222:283-290. [PMID: 30545606 DOI: 10.1016/j.ijheh.2018.12.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/24/2018] [Accepted: 12/02/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Residing in greener places may be protective against diabetes mellitus (DM) but evidence is scarce and comes mainly from developed countries. OBJECTIVES To investigate associations of residential greenness with DM prevalence and glucose-homeostasis markers in Chinese adults and whether these associations were mediated by air pollution, physical activity, and body mass index. METHODS In 2009, a total of 15,477 adults from the cross-sectional 33 Communities Chinese Health Study provided blood samples and completed a questionnaire. We considered fasting and 2-h glucose and insulin concentrations, as well as the homoeostasis model assessment of insulin resistance and β-cell function, as glucose-homeostasis markers. DM was defined according to the American Diabetes Association's recommendations. Residential greenness was estimated by two satellite-derived vegetation indexes - Normalized Difference Vegetation Index (NDVI) and Soil Adjusted Vegetation Index (SAVI). Nitrogen dioxide and particulate matter ≤2.5 μm were used as air pollution proxies. Associations were assessed by two-level adjusted logistic and linear regression models. RESULTS A 0.1-unit increase in NDVI500 m and SAVI500 m was significantly associated with lower odds of DM by factors of 0.88 (95% Confidence Interval 0.82-0.94) and 0.80 (0.72-0.90), respectively. Higher greenness was also significantly associated with lower fasting and 2-h glucose levels, 2-h insulin level, as well as lower insulin resistance and higher β-cell function. Air pollution and body mass index significantly mediated 6.9-51.1% and 8.6-78.7% these associations, respectively, while no mediation role was observed for physical activity. CONCLUSIONS Higher residential greenness appears to be associated with a lower prevalence of DM. This association might be due to glucose and insulin metabolism and pancreatic β-cell function. Lower levels of air pollution and body mass index can be pathways linking greenspace to diabetes.
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Wu J, Rappazzo KM, Simpson RJ, Joodi G, Pursell IW, Mounsey JP, Cascio WE, Jackson LE. Exploring links between greenspace and sudden unexpected death: A spatial analysis. ENVIRONMENT INTERNATIONAL 2018; 113:114-121. [PMID: 29421400 PMCID: PMC5866237 DOI: 10.1016/j.envint.2018.01.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 01/19/2018] [Accepted: 01/21/2018] [Indexed: 05/05/2023]
Abstract
Greenspace has been increasingly recognized as having numerous health benefits. However, its effects are unknown concerning sudden unexpected death (SUD), commonly referred to as sudden cardiac death, which constitutes a large proportion of mortality in the United States. Because greenspace can promote physical activity, reduce stress and buffer air pollutants, it may have beneficial effects for people at risk of SUD, such as those with heart disease, hypertension, and diabetes mellitus. Using several spatial techniques, this study explored the relationship between SUD and greenspace. We adjudicated 396 SUD cases that occurred from March 2013 to February 2015 among reports from emergency medical services (EMS) that attended out-of-hospital deaths in Wake County (central North Carolina, USA). We measured multiple greenspace metrics in each census tract, including the percentages of forest, grassland, average tree canopy, tree canopy diversity, near-road tree canopy and greenway density. The associations between SUD incidence and these greenspace metrics were examined using Poisson regression (non-spatial) and Bayesian spatial models. The results from both models indicated that SUD incidence was inversely associated with both greenway density (adjusted risk ratio [RR] = 0.82, 95% credible/ confidence interval [CI]: 0.69-0.97) and the percentage of forest (adjusted RR = 0.90, 95% CI: 0.81-0.99). These results suggest that increases in greenway density by 1 km/km2 and in forest by 10% were associated with a decrease in SUD risk of 18% and 10%, respectively. The inverse relationship was not observed between SUD incidence and other metrics, including grassland, average tree canopy, near-road tree canopy and tree canopy diversity. This study implies that greenspace, specifically greenways and forest, may have beneficial effects for people at risk of SUD. Further studies are needed to investigate potential causal relationships between greenspace and SUD, and potential mechanisms such as promoting physical activity and reducing stress.
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Affiliation(s)
- Jianyong Wu
- Oak Ridge Institute for Science and Education, US EPA, Office of Research and Development, Research Triangle Park, Durham 27711, NC, USA.
| | - Kristen M Rappazzo
- US EPA, Office of Research and Development, National Health and Environmental Effects Research Laboratory, Research Triangle Park, Durham 27711, NC, USA
| | - Ross J Simpson
- Division of Cardiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Golsa Joodi
- Division of Cardiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Irion W Pursell
- Division of Cardiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; The Department of Cardiovascular Sciences, East Carolina University, Greenville, NC 27834, USA
| | - J Paul Mounsey
- Division of Cardiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; The Department of Cardiovascular Sciences, East Carolina University, Greenville, NC 27834, USA
| | - Wayne E Cascio
- US EPA, Office of Research and Development, National Health and Environmental Effects Research Laboratory, Research Triangle Park, Durham 27711, NC, USA
| | - Laura E Jackson
- US EPA, Office of Research and Development, National Health and Environmental Effects Research Laboratory, Research Triangle Park, Durham 27711, NC, USA.
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den Braver NR, Lakerveld J, Rutters F, Schoonmade LJ, Brug J, Beulens JWJ. Built environmental characteristics and diabetes: a systematic review and meta-analysis. BMC Med 2018; 16:12. [PMID: 29382337 PMCID: PMC5791730 DOI: 10.1186/s12916-017-0997-z] [Citation(s) in RCA: 127] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 12/15/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The built environment influences behaviour, like physical activity, diet and sleep, which affects the risk of type 2 diabetes mellitus (T2DM). This study systematically reviewed and meta-analysed evidence on the association between built environmental characteristics related to lifestyle behaviour and T2DM risk/prevalence, worldwide. METHODS We systematically searched PubMed, EMBASE.com and Web of Science from their inception to 6 June 2017. Studies were included with adult populations (>18 years), T2DM or glycaemic markers as outcomes, and physical activity and/or food environment and/or residential noise as independent variables. We excluded studies of specific subsamples of the population, that focused on built environmental characteristics that directly affect the cardiovascular system, that performed prediction analyses and that do not report original research. Data appraisal and extraction were based on published reports (PROSPERO-ID: CRD42016035663). RESULTS From 11,279 studies, 109 were eligible and 40 were meta-analysed. Living in an urban residence was associated with higher T2DM risk/prevalence (n = 19, odds ratio (OR) = 1.40; 95% CI, 1.2-1.6; I2 = 83%) compared to living in a rural residence. Higher neighbourhood walkability was associated with lower T2DM risk/prevalence (n = 8, OR = 0.79; 95% CI, 0.7-0.9; I2 = 92%) and more green space tended to be associated with lower T2DM risk/prevalence (n = 6, OR = 0.90; 95% CI, 0.8-1.0; I2 = 95%). No convincing evidence was found of an association between food environment with T2DM risk/prevalence. CONCLUSIONS An important strength of the study was the comprehensive overview of the literature, but our study was limited by the conclusion of mainly cross-sectional studies. In addition to other positive consequences of walkability and access to green space, these environmental characteristics may also contribute to T2DM prevention. These results may be relevant for infrastructure planning.
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Affiliation(s)
- N R den Braver
- Department of Epidemiology & Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, De Boelelaan 1089a, 1081HV, Amsterdam, The Netherlands.
| | - J Lakerveld
- Department of Epidemiology & Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, De Boelelaan 1089a, 1081HV, Amsterdam, The Netherlands
| | - F Rutters
- Department of Epidemiology & Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, De Boelelaan 1089a, 1081HV, Amsterdam, The Netherlands
| | | | - J Brug
- Department of Epidemiology & Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, De Boelelaan 1089a, 1081HV, Amsterdam, The Netherlands.,Amsterdam School for Communication Research, University of Amsterdam, Amsterdam, The Netherlands
| | - J W J Beulens
- Department of Epidemiology & Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, De Boelelaan 1089a, 1081HV, Amsterdam, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Müller G, Harhoff R, Rahe C, Berger K. Inner-city green space and its association with body mass index and prevalent type 2 diabetes: a cross-sectional study in an urban German city. BMJ Open 2018; 8:e019062. [PMID: 29358439 PMCID: PMC5781018 DOI: 10.1136/bmjopen-2017-019062] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE The accessibility of green space is an important aspect of the urban residential environment and has been found to be beneficial for health and well-being. This study investigates the association between different indicators of green space and the outcomes body mass index (BMI) and prevalent type 2 diabetes in an urban population. DESIGN Population-based cross-sectional study. SETTING Dortmund, a city located in the industrial Ruhr area in Western Germany. PARTICIPANTS 1312 participants aged 25-74 years from the Dortmund Health Study. METHODS The participants' addresses were geocoded and shapefiles of statistical districts, road network and land use, as well as data on neighbourhood characteristics were obtained at baseline. Three indicators of green space were constructed using geographical information systems: proportion of green space, recreation location quotient (RLQ) weighted by population and distance to the next park or forest. Multilevel linear and logistic regression analyses on the association of green space with BMI and type 2 diabetes were performed, adjusted by individual-level characteristics and neighbourhood unemployment rate. RESULTS The multilevel regression analyses showed no association between green space and BMI. In contrast, the three indicators of green space were significantly associated with type 2 diabetes. Residents of neighbourhoods with a low RLQ had a 2.44 (95% CI 1.01 to 5.93) times higher odds to have type 2 diabetes compared with residents of high RLQ neighbourhoods. Likewise, residing more than 0.8 km away from the nearest park or forest increased the odds of type 2 diabetes (OR 1.71, 95% CI 1.05 to 2.77). CONCLUSIONS This study indicates that green space and its spatial accessibility might play a role in the development of type 2 diabetes. Further research is needed to clarify this association.
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Affiliation(s)
- Grit Müller
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Roland Harhoff
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Corinna Rahe
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Klaus Berger
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
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Reddon JR, Durante SB. Nature exposure sufficiency and insufficiency: The benefits of environmental preservation. Med Hypotheses 2017; 110:38-41. [PMID: 29317065 DOI: 10.1016/j.mehy.2017.10.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 10/19/2017] [Accepted: 10/23/2017] [Indexed: 12/20/2022]
Abstract
Increasing industrialization, urbanization, and a failure of many world leaders to appreciate the consequences of climate change are deleteriously impacting quality of life as well as diminishing the prospects for long term survival. Economic competitiveness and corporate profitability often pre-empt environmental concerns. The calving of an iceberg in Antarctica and the hurricane activity in the Caribbean during 2017 are unfortunate illustrations of the continuing escalation of environmental issues. We provide historical and current evidence for the importance of Nature Exposure (NE) and introduce the continuum Nature Exposure Sufficiency (NES) and Insufficiency (NEI). Insufficiency includes impoverished environments (e.g., slums and prisons) where nature exposure is very limited. Nature Exposure Sufficiency (NES) is an optimal amount of exposure to nature where many benefits such as reinvigoration can be obtained by everyone. NES also has several benefits for individuals with various health conditions such as arthritis, dementia, or depression. The benefits of NE are not just derivable from parks, forests, and other natural settings. Interiors of buildings and homes can be enhanced with plants and even pictures or objects from nature. Additionally, there is abundant evidence indicating that virtual and artificial environments depicting nature can provide substantial NE and therefore contribute to general wellbeing. Besides the difficulty in achieving cooperation amongst nations, corporations, and other collectives in developing and implementing long range plans to deal with climate change, there is also sometimes an aversion at the individual level whereby people are unwilling to experience nature due to insects and other discomforts. Such individuals are often averse to supplanting the comforts of home, even temporarily, with inadequate facilities that are seemingly less pleasant than their typical dwellings. We propose using the term Nature Exposure Aversion (NEA) to describe such behavior and propose that the aversion is largely due to conditioning. Such behavior may be addressed through desensitization in virtual environments which in turn may contribute to an endorsement of the view that climate change is occurring and must be dealt with. The issues of Nature Exposure Sufficiency and Insufficiency are intertwined with the sustainability of the planet and future planning and efforts to deal with the environment. If the outcome is unfavorable, the descent of civilization will be more rapid than the ascent.
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Affiliation(s)
- John R Reddon
- Department of Psychology, University of Alberta, P-217 Biological Sciences Building, Edmonton, Alberta T6G 2R3, Canada; Forensic Psychiatry, Alberta Hospital Edmonton, 17480 Fort Road, Box 307, Edmonton, Alberta T5J 2J7, Canada.
| | - Salvatore B Durante
- Forensic Psychiatry, Alberta Hospital Edmonton, 17480 Fort Road, Box 307, Edmonton, Alberta T5J 2J7, Canada
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Parks and Green Areas Are Associated with Decreased Risk for Hyperlipidemia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13121205. [PMID: 27918478 PMCID: PMC5201346 DOI: 10.3390/ijerph13121205] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 11/10/2016] [Accepted: 11/21/2016] [Indexed: 11/16/2022]
Abstract
This study aimed to investigate the association between parks and green areas and hyperlipidemia in adults with groups stratified by moderate physical activity as a behavioral modification using the 2009 Korean Community Health Survey data and 212,584 participants enrolled in this study. The geographical codes of study participants were all matched on the basis of the amount of parks and green areas in each administrative district. Compared with participants living in the highest quartile of parks and green areas (Quartile 4), those living in the lowest quartile of green and park area (Quartile 1) were at an increased risk of physician-diagnosed hyperlipidemia and hyperlipidemia currently under treatment. Participants in the lowest quartile of parks and green areas were likely not to engage in any moderate physical activity. After classifying hyperlipidemia risk depending on the presence of moderate physical activity, those participating in moderate physical activity were less likely to have hyperlipidemia in all quartiles of parks and green areas than those not engaging in moderate physical activity. We found that parks and green areas were associated with decreased hyperlipidemia risk. Physical activity, which may benefit from the presence of parks and green areas, may reduce hyperlipidemia risk.
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