1
|
Li Z, Wu W, Huang Y, Lawrence WR, Lin S, Du Z, Wang Y, Hu S, Hao Y, Zhang W. Urban residential greenness and cancer mortality: Evaluating the causal mediation role of air pollution in a large cohort. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2024; 360:124704. [PMID: 39127332 PMCID: PMC11401763 DOI: 10.1016/j.envpol.2024.124704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 08/06/2024] [Accepted: 08/07/2024] [Indexed: 08/12/2024]
Abstract
Evidence linking greenness to all-site and site-specific cancers remains limited, and the complex role of air pollution in this pathway is unclear. We aimed to fill these gaps by using a large cohort in southern China. A total of 654,115 individuals were recruited from 2009 to 2015 and followed-up until December 2020. We calculated the normalized difference vegetation index (NDVI) in a 500-m buffer around the participants' residences to represent the greenness exposure. Cox proportional-hazards models were used to evaluate the impact of greenness on the risk of all-site and site-specific cancer mortality. Additionally, we assessed both the mediation and interaction roles of air pollution (i.e., PM2.5, PM10, and NO2) in the greenness-cancer association through a causal mediation analysis using a four-way decomposition method. Among the 577,643 participants, 10,088 cancer deaths were recorded. We found a 10% (95% CI: 5-16%) reduction in all-site cancer mortality when the NDVI increased from the lowest to the highest quartile. When stratified by cancer type, our estimates suggested 18% (95% CI: 8-27%) and 51% (95% CI: 16-71%) reductions in mortality due to respiratory system cancer and brain and nervous system cancer, respectively. For the above protective effect, a large proportion could be explained by the mediation (all-site cancer: 1.0-27.7%; respiratory system cancer: 1.2-32.3%; brain and nervous system cancer: 3.6-109.1%) and negative interaction (all-site cancer: 2.1-25.7%; respiratory system cancer: 2.0-25.7%; brain and nervous system cancer: not significant) effects of air pollution. We found that particulate matter (i.e., PM2.5 and PM10) had a stronger causal mediation effect (25.0-109.1%) than NO2 (1.0-3.6%), while NO2 had a stronger interaction effect (25.7%) than particulate matter (2.0-2.8%). In summary, greenness was significantly beneficial in reducing the mortality of all-site, respiratory system, and brain and nervous system cancer in southern China, with the impact being modulated and mediated by air pollution.
Collapse
Affiliation(s)
- Zhiqiang Li
- Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, 266000, Shandong, China; Department of Medical Statistics, School of Public Health & Research Center for Health Information & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Wenjing Wu
- Department of Medical Statistics, School of Public Health & Research Center for Health Information & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Yongshun Huang
- Department of Medical Statistics, School of Public Health & Research Center for Health Information & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China; Guangdong Province Hospital for Occupational Disease Prevention and Treatment, Guangzhou, 510300, Guangdong, China
| | - Wayne R Lawrence
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, United States
| | - Shao Lin
- Department of Environmental Health Sciences, School of Public Health, University at Albany, the State University of New York, 12222, Rensselaer, NY, United States
| | - Zhicheng Du
- Department of Medical Statistics, School of Public Health & Research Center for Health Information & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Ying Wang
- Department of Medical Statistics, School of Public Health & Research Center for Health Information & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Shijie Hu
- Department of Medical Statistics, School of Public Health & Research Center for Health Information & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China; Guangdong Province Hospital for Occupational Disease Prevention and Treatment, Guangzhou, 510300, Guangdong, China
| | - Yuantao Hao
- Peking University Center for Public Health and Epidemic Preparedness & Response & Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Peking University, Beijing, 100871, China
| | - Wangjian Zhang
- Department of Medical Statistics, School of Public Health & Research Center for Health Information & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China.
| |
Collapse
|
2
|
Gogna P, Borghese MM, Villeneuve PJ, Kumarathasan P, Johnson M, Shutt RH, Ashley-Martin J, Bouchard MF, King WD. A cohort study of the multipollutant effects of PM 2.5, NO 2, and O 3 on C-reactive protein levels during pregnancy. Environ Epidemiol 2024; 8:e308. [PMID: 38799262 PMCID: PMC11115979 DOI: 10.1097/ee9.0000000000000308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 03/18/2024] [Indexed: 05/29/2024] Open
Abstract
Background PM2.5, NO2, and O3 contribute to the development of adverse pregnancy complications. While studies have investigated the independent effects of these exposures, literature on their combined effects is limited. Our objective was to study the multipollutant effects of PM2.5, NO2, and O3 on maternal systemic C-reactive protein (CRP) levels. Methods We used data from 1170 pregnant women enrolled in the Maternal-Infant Research on Environmental Chemicals Study (MIREC) study in Canada. Air pollution exposures were assigned to each participant based on residential location. CRP was measured in third-trimester blood samples. We fit multipollutant linear regression models and evaluated the effects of air pollutant mixtures (14-day averages) using repeated-holdout Weighted Quantile Sum (WQS) regression and by calculating the Air Quality Health Index (AQHI). Results In multipollutant models adjusting for NO2, O3, and green space, each interquartile range (IQR) increase in 14-day average PM2.5 (IQR: 6.9 µg/m3) was associated with 27.1% (95% confidence interval [CI] = 6.2, 50.7) higher CRP. In air pollution mixture models adjusting for green space, each IQR increase in AQHI was associated with 37.7% (95% CI = 13.9, 66.5) higher CRP; and an IQR increase in the WQS index was associated with 78.6% (95% CI = 29.7, 146.0) higher CRP. Conclusion PM2.5 has the strongest relationship of the individual pollutants examined with maternal blood CRP concentrations. Mixtures incorporating all three pollutants, assessed using the AQHI and WQS index, showed stronger relationships with CRP compared with individual pollutants and illustrate the importance of conducting multipollutant analyses.
Collapse
Affiliation(s)
- Priyanka Gogna
- Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
| | - Michael M. Borghese
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
| | - Paul J. Villeneuve
- School of Mathematics and Statistics, Carleton University, Ottawa, Ontario, Canada
| | | | - Markey Johnson
- Water and Air Quality Bureau, Health Canada, Ottawa, Ontario, Canada
| | - Robin H. Shutt
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
| | - Jillian Ashley-Martin
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
| | | | - Will D. King
- Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
| |
Collapse
|
3
|
Byun G, Kim S, Choi Y, Kim A, Team AC, Lee JT, Bell ML. Long-term exposure to PM 2.5 and mortality in a national cohort in South Korea: effect modification by community deprivation, medical infrastructure, and greenness. BMC Public Health 2024; 24:1266. [PMID: 38720292 PMCID: PMC11080206 DOI: 10.1186/s12889-024-18752-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 04/30/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Long-term exposure to PM2.5 has been linked to increased mortality risk. However, limited studies have examined the potential modifying effect of community-level characteristics on this association, particularly in Asian contexts. This study aimed to estimate the effects of long-term exposure to PM2.5 on mortality in South Korea and to examine whether community-level deprivation, medical infrastructure, and greenness modify these associations. METHODS We conducted a nationwide cohort study using the National Health Insurance Service-National Sample Cohort. A total of 394,701 participants aged 30 years or older in 2006 were followed until 2019. Based on modelled PM2.5 concentrations, 1 to 3-year and 5-year moving averages of PM2.5 concentrations were assigned to each participant at the district level. Time-varying Cox proportional-hazards models were used to estimate the association between PM2.5 and non-accidental, circulatory, and respiratory mortality. We further conducted stratified analysis by community-level deprivation index, medical index, and normalized difference vegetation index to represent greenness. RESULTS PM2.5 exposure, based on 5-year moving averages, was positively associated with non-accidental (Hazard ratio, HR: 1.10, 95% Confidence Interval, CI: 1.01, 1.20, per 10 µg/m3 increase) and circulatory mortality (HR: 1.22, 95% CI: 1.01, 1.47). The 1-year moving average of PM2.5 was associated with respiratory mortality (HR: 1.33, 95% CI: 1.05, 1.67). We observed higher associations between PM2.5 and mortality in communities with higher deprivation and limited medical infrastructure. Communities with higher greenness showed lower risk for circulatory mortality but higher risk for respiratory mortality in association with PM2.5. CONCLUSIONS Our study found mortality effects of long-term PM2.5 exposure and underlined the role of community-level factors in modifying these association. These findings highlight the importance of considering socio-environmental contexts in the design of air quality policies to reduce health disparities and enhance overall public health outcomes.
Collapse
Affiliation(s)
- Garam Byun
- School of the Environment, Yale University, New Haven, CT, 06511, USA
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, 02841, Republic of Korea
| | - Sera Kim
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, 02841, Republic of Korea
| | - Yongsoo Choi
- School of the Environment, Yale University, New Haven, CT, 06511, USA
| | - Ayoung Kim
- Department of Public Health Sciences, Graduate School of Public health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea
| | - AiMS-Create Team
- Ai-Machine learning Statistics Collaborative Research Ensemble for Air pollution, Temperature, and all types of Environmental exposures, Seoul National University and Pusan National University, Seoul, Republic of Korea
| | - Jong-Tae Lee
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, 02841, Republic of Korea.
- School of Health Policy and Management, College of Health Sciences, Korea University, Hana Science Hall, 145, Anam-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea.
| | - Michelle L Bell
- School of the Environment, Yale University, New Haven, CT, 06511, USA
- School of Health Policy and Management, College of Health Sciences, Korea University, Hana Science Hall, 145, Anam-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| |
Collapse
|
4
|
Abstract
Accumulating evidence suggests that living in areas of high surrounding greenness or even brief exposures to areas of high greenery is conducive to cardiovascular health, which may be related to the environmental, social, psychological, and physiological benefits of greenspaces. Recent data from multiple cross-sectional, longitudinal, and cohort studies suggest that living in areas of high surrounding greenness is associated with a lower risk of all-cause and cardiovascular mortality. High levels of neighborhood greenery have been linked also to a decrease in the burden of cardiovascular disease risk factors as reflected by lower rates of hypertension, dyslipidemia, and diabetes. Those who live in greener environments report better mental health and more frequent social interactions, which can benefit cardiovascular health as well. In this narrative review, we discuss evidence linking greenspaces to cardiovascular health as well as the potential mechanisms underlying the beneficial effects of greenspaces, including the impact of vegetation on air, noise and light pollution, ambient temperature, physical activity, mental health, and biodiversity. We review literature on the beneficial effects of acute and chronic exposure to nature on cardiovascular disease risk factors, inflammation and immune function, and we highlight the potential cardiovascular effects of biogenic volatile organic compounds that are emitted by trees and shrubs. We identify current knowledge gaps in this area and underscore the need for additional population studies to understand more clearly and precisely the link between greenness and health. Such understanding is urgently needed to fully redeem the promise of greenspaces in preventing adverse environmental exposures, mitigating the effects of climate change, and creating healthier living environments.
Collapse
Affiliation(s)
- Rachel J Keith
- Christina Lee Brown Envirome Institute (R.J.K., J.L.H., A.B.)
- Department of Medicine (R.J.K., A.B.), University of Louisville
| | - Joy L Hart
- Christina Lee Brown Envirome Institute (R.J.K., J.L.H., A.B.)
- Department of Communication (J.L.H.), University of Louisville
| | - Aruni Bhatnagar
- Christina Lee Brown Envirome Institute (R.J.K., J.L.H., A.B.)
- Department of Medicine (R.J.K., A.B.), University of Louisville
| |
Collapse
|
5
|
Lamichhane DK, Ha E, Hong YC, Lee DW, Park MS, Song S, Kim S, Kim WJ, Bae J, Kim HC. Ambient particulate matter and surrounding greenness in relation to sleep quality among pregnant women: A nationwide cohort study. Heliyon 2024; 10:e26742. [PMID: 38434397 PMCID: PMC10904245 DOI: 10.1016/j.heliyon.2024.e26742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 02/08/2024] [Accepted: 02/19/2024] [Indexed: 03/05/2024] Open
Abstract
Background Particulate air pollution and residential greenness are associated with sleep quality in the general population; however, their influence on maternal sleep quality during pregnancy has not been assessed. Objective This cross-sectional study investigated the individual and interactive effects of exposure to particulate matter (PM) air pollution and residential greenness on sleep quality in pregnant women. Methods Pregnant women (n = 4933) enrolled in the Korean Children's Environmental Health Study with sleep quality information and residential address were included. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). The average concentrations of PM (PM2.5 and PM10) during pregnancy were estimated through land use regression, and residential greenness in a 1000 m buffer area around participants' residences was estimated using the Normalized Difference Vegetation Index (NDVI1000-m). Modified Poisson regression models were used to estimate the associations between PM and NDVI and poor sleep quality (PSQI >5) after controlling for a range of covariates. A four-way mediation analysis was conducted to examine the mediating effects of PM. Results After adjusting for confounders, each 10 μg/m3 increase in PM2.5 and PM10 exposure was associated with a higher risk of poor sleep quality (relative risk [RR]: 1.06; 95% confidence interval [CI]: 1.01, 1.11; and RR: 1.09; 95% CI: 1.06, 1.13, respectively), and each 0.1-unit increase in NDVI1000-m was associated with a lower risk of poor sleep quality (RR: 0.97; 95% CI: 0.95, 0.99). Mediation analysis showed that PM mediated approximately 37%-56% of the association between residential greenness and poor sleep quality. Conclusions This study identified a positive association between residential greenness and sleep quality. Furthermore, these associations are mediated by a reduction in exposure to particulate air pollution and highlight the link between green areas, air pollution control, and human health.
Collapse
Affiliation(s)
- Dirga Kumar Lamichhane
- Department of Occupational and Environmental Medicine, Inha University School of Medicine, Incheon, Republic of Korea
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Eunhee Ha
- Department of Occupational and Environmental Medicine, Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Yun-Chul Hong
- Institute of Environmental Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Dong-Wook Lee
- Department of Occupational and Environmental Medicine, Inha University School of Medicine, Incheon, Republic of Korea
| | - Myung-Sook Park
- Institute of Environmental Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Sanghwan Song
- Environmental Health Research Division, Department of Environmental Health Research, National Institute of Environmental Research, Ministry of Environment, Incheon, Republic of Korea
| | - Suejin Kim
- Environmental Health Research Division, Department of Environmental Health Research, National Institute of Environmental Research, Ministry of Environment, Incheon, Republic of Korea
| | - Woo Jin Kim
- Department of Internal Medicine and Environmental Health Center, Kangwon National University, Chuncheon, Republic of Korea
| | - Jisuk Bae
- Department of Preventive Medicine, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
| | - Hwan-Cheol Kim
- Department of Occupational and Environmental Medicine, Inha University School of Medicine, Incheon, Republic of Korea
| | - Ko-CHENS Study Group
- Department of Occupational and Environmental Medicine, Inha University School of Medicine, Incheon, Republic of Korea
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Occupational and Environmental Medicine, Ewha Womans University School of Medicine, Seoul, Republic of Korea
- Institute of Environmental Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
- Environmental Health Research Division, Department of Environmental Health Research, National Institute of Environmental Research, Ministry of Environment, Incheon, Republic of Korea
- Department of Internal Medicine and Environmental Health Center, Kangwon National University, Chuncheon, Republic of Korea
- Department of Preventive Medicine, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
| |
Collapse
|
6
|
Xu S, Marcon A, Bertelsen RJ, Benediktsdottir B, Brandt J, Engemann K, Frohn LM, Geels C, Gislason T, Heinrich J, Holm M, Janson C, Markevych I, Modig L, Orru H, Schlünssen V, Sigsgaard T, Johannessen A. Long-term exposure to low-level air pollution and greenness and mortality in Northern Europe. The Life-GAP project. ENVIRONMENT INTERNATIONAL 2023; 181:108257. [PMID: 37857189 DOI: 10.1016/j.envint.2023.108257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 09/28/2023] [Accepted: 10/09/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Air pollution has been linked to mortality, but there are few studies examining the association with different exposure time windows spanning across several decades. The evidence for the effects of green space and mortality is contradictory. OBJECTIVE We investigated all-cause mortality in relation to exposure to particulate matter (PM2.5 and PM10), black carbon (BC), nitrogen dioxide (NO2), ozone (O3) and greenness (normalized difference vegetation index - NDVI) across different exposure time windows. METHODS The exposure assessment was based on a combination of the Danish Eulerian Hemispheric Model and the Urban Background Model for the years 1990, 2000 and 2010. The analysis included a complete case dataset with 9,135 participants from the third Respiratory Health in Northern Europe study (RHINE III), aged 40-65 years in 2010, with mortality follow-up to 2021. We performed Cox proportional hazard models, adjusting for potential confounders. RESULTS Altogether, 327 (3.6 %) persons died in the period 2010-2021. Increased exposures in 1990 of PM2.5, PM10, BC and NO2 were associated with increased all-cause mortality hazard ratios of 1.40 (95 % CI1.04-1.87 per 5 μg/m3), 1.33 (95 % CI: 1.02-1.74 per 10 μg/m3), 1.16 (95 % CI: 0.98-1.38 per 0.4 μg/m3) and 1.17 (95 % CI: 0.92-1.50 per 10 μg/m3), respectively. No statistically significant associations were observed between air pollution and mortality in other time windows. O3 showed an inverse association with mortality, while no association was observed between greenness and mortality. Adjusting for NDVI increased the hazard ratios for PM2.5, PM10, BC and NO2 exposures in 1990. We did not find significant interactions between greenness and air pollution metrics. CONCLUSION Long term exposure to even low levels of air pollution is associated with mortality. Opening up for a long latency period, our findings indicate that air pollution exposures over time may be even more harmful than anticipated.
Collapse
Affiliation(s)
- Shanshan Xu
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - Alessandro Marcon
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | | | - Bryndis Benediktsdottir
- Department of Respiratory Medicine and Sleep, Landspitali - the National University Hospital of Iceland, Reykjavik, Iceland
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Kristine Engemann
- Section for Ecoinformatics & Biodiversity, Department of Bioscience, Aarhus University, Aarhus C, Denmark
| | - Lise Marie Frohn
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Camilla Geels
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Thorarinn Gislason
- Department of Respiratory Medicine and Sleep, Landspitali - the National University Hospital of Iceland, Reykjavik, Iceland
| | - Joachim Heinrich
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany; Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Mathias Holm
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Iana Markevych
- Institute of Psychology, Jagiellonian University, Krakow, Poland
| | - Lars Modig
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Sweden
| | - Hans Orru
- Department of Public Health, Institute of Family Medicine and Public Health, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Vivi Schlünssen
- Department of Public Health, Research Unit for Environment Occupation and Health, Danish Ramazzini Center, Aarhus University, Aarhus, Denmark
| | - Torben Sigsgaard
- Department of Public Health, Research Unit for Environment Occupation and Health, Danish Ramazzini Center, Aarhus University, Aarhus, Denmark
| | - Ane Johannessen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| |
Collapse
|
7
|
Johannessen A, Xu S, Abbah AP, Janson C. Greenness exposure: beneficial but multidimensional. Breathe (Sheff) 2023; 19:220221. [PMID: 37645023 PMCID: PMC10461730 DOI: 10.1183/20734735.0221-2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 05/25/2023] [Indexed: 08/31/2023] Open
Abstract
Many studies have shown that greenness has beneficial health effects, particularly on psychological and cardiovascular outcomes. In this narrative review, we provide a synthesis of knowledge regarding greenness exposure and respiratory health. The following outcomes were reviewed: respiratory mortality, lung cancer mortality, lung cancer incidence, respiratory hospitalisations, lung function, COPD, and asthma. We identified 174 articles through a literature search in PubMed, of which 42 were eligible for inclusion in this review. The most common marker for greenness exposure was the normalised difference vegetation index (NDVI), which was used in 29 out of 42 papers. Other markers used were tree canopy cover, landcover/land-use, plant diversity, density of tall trees and subjectively perceived greenness. We found beneficial effects of greenness in most studies regarding respiratory mortality, lung cancer incidence, respiratory hospitalisations and lung function. For lung cancer mortality, asthma and COPD, the effects of greenness were less clear cut. While many aspects of greenness are beneficial, some aspects may be harmful, and greenness may have different health effects in different population subgroups. Future studies of greenness and respiratory diseases should focus on asthma and COPD, on effects in different population subgroups and on disentangling the health effects of the various greenness dimensions.
Collapse
Affiliation(s)
- Ane Johannessen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Shanshan Xu
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Achenyo Peace Abbah
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| |
Collapse
|
8
|
Bianconi A, Longo G, Coa AA, Fiore M, Gori D. Impacts of Urban Green on Cardiovascular and Cerebrovascular Diseases-A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5966. [PMID: 37297570 PMCID: PMC10253108 DOI: 10.3390/ijerph20115966] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023]
Abstract
Cardiovascular diseases (CVDs) are a leading cause of mortality globally. In particular, ischemic heart diseases (IHDs) and cerebrovascular diseases (CBVDs) represent the main drivers of CVD-related deaths. Many literature examples have assessed the association between CVD risk factors and urban greenness. Urban green (UG) may positively affect physical activity, reduce air and noise pollution, and mitigate the heat island effect, which are known risk factors for CVD morbidity. This systematic review aims to assess the effects of urban green spaces on CVD morbidity and mortality. Peer-reviewed research articles with a quantitative association between urban green exposure variables and cardiovascular and cerebrovascular outcomes were included. Meta-analyses were conducted for each outcome evaluated in at least three comparable studies. Most of the included studies' results highlighted an inverse correlation between exposure to UG and CVD outcomes. Gender differences were found in four studies, with a protective effect of UG only statistically significant in men. Three meta-analyses were performed, showing an overall protective effect of UG on CVD mortality (HR (95% CI) = 0.94 (0.91, 0.97)), IHD mortality (HR (95% CI) = 0.96 (0.93, 0.99)), and CBVD mortality (HR (95% CI) = 0.96 (0.94, 0.97)). The results of this systematic review suggest that exposure to UG may represent a protective factor for CVDs.
Collapse
Affiliation(s)
| | | | | | - Matteo Fiore
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy
| | | |
Collapse
|
9
|
Hasegawa K, Tsukahara T, Nomiyama T. Short-term associations of low-level fine particulate matter (PM 2.5) with cardiorespiratory hospitalizations in 139 Japanese cities. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2023; 258:114961. [PMID: 37137261 DOI: 10.1016/j.ecoenv.2023.114961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/09/2023] [Accepted: 04/24/2023] [Indexed: 05/05/2023]
Abstract
There have been few studies in non-western countries on the relationship between low levels of daily fine particulate matter (PM2.5) exposure and morbidity or mortality, and the impact of PM2.5 concentrations below 15 μg/m3, which is the latest World Health Organization Air Quality Guideline (WHO AQG) value for the 24-h mean, is not yet clear. We assessed the associations between low-level PM2.5 exposure and cardiorespiratory admissions in Japan. We collected the daily hospital admission count data, air pollutant data, and meteorological condition data recorded from April 2016 to March 2019 in 139 Japanese cities. City-specific estimates were obtained from conditional logistic regression models in a time-stratified case-crossover design and pooled by random-effect models. We estimated that every 10-μg/m3 increase in the concurrent-day PM2.5 concentration was related to a 0.52% increase in cardiovascular admissions (95% CI: 0.13-0.92%) and a 1.74% increase in respiratory admissions (95% CI: 1.41-2.07%). These values were nearly the same when the datasets were filtered to contain only daily PM2.5 concentrations <15 μg/m3. The exposure-response curves showed approximately sublinear-to-linear curves with no indication of thresholds. These associations with cardiovascular diseases weakened after adjusting for nitrogen dioxide or sulfur dioxide, but associations with respiratory diseases were almost unchanged when additionally adjusted for other pollutants. This study demonstrated that associations between daily PM2.5 and daily cardiorespiratory hospitalizations might persist at low concentrations, including those below the latest WHO AQG value. Our findings suggest that the updated guideline value may still be insufficient from the perspective of public health.
Collapse
Affiliation(s)
- Kohei Hasegawa
- Department of Preventive Medicine and Public Health, School of Medicine, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan.
| | - Teruomi Tsukahara
- Department of Preventive Medicine and Public Health, School of Medicine, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan; Department of Occupational Medicine, School of Medicine, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Tetsuo Nomiyama
- Department of Preventive Medicine and Public Health, School of Medicine, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan; Department of Occupational Medicine, School of Medicine, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| |
Collapse
|
10
|
Poulsen AH, Sørensen M, Hvidtfeldt UA, Ketzel M, Christensen JH, Brandt J, Frohn LM, Khan J, Jensen SS, Lund T, Raaschou-Nielsen O. Air pollution and stroke; effect modification by sociodemographic and environmental factors. A cohort study from Denmark. Int J Hyg Environ Health 2023; 251:114165. [PMID: 37121155 DOI: 10.1016/j.ijheh.2023.114165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 03/03/2023] [Accepted: 03/29/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVES Air pollution increases the risk of stroke, but the literature on identifying susceptible subgroups of populations is scarce and inconsistent. The aim of this study was to investigate if the association between air pollution and risk of stroke differed by sociodemographic factors, financial stress, comorbid conditions, and residential road traffic noise, population density and green space. METHODS We assessed long-term exposure to air pollution with ultrafine particles, PM2.5, elemental carbon and NO2 for a cohort of 1,971,246 Danes aged 50-85 years. During follow-up from 2005 to 2017, we identified 83,211 incident stroke cases. We used Cox proportional hazards model (relative risk) and Aalen additive hazards models (absolute risk) to estimate associations and confidence intervals (CI) between 5-year running means of air pollution at the residence and risk of stroke in population strata. RESULTS All four pollutants were associated with higher risk of stroke. The association between air pollution and stroke was strongest among individuals with comorbidities, with shorter education, lower income and being retired. The results also indicated stronger associations among individuals living in less populated areas, and with low noise levels and more green space around the residence. Estimates of absolute risk seemed better suited to detect such interactions than estimates of relative risk. For example for PM2.5 the hazard ratio for stroke was 1.28 (95%CI: 1.22-1.34) and 1.26 (95%CI: 1.16-1.37) among those with mandatory and medium/long education respectively. The corresponding rate difference estimates per 100,000 person years were 568 (95%CI: 543-594) and 423(95%CI: 390-456) CONCLUSION: The associations between air pollution and risk of stroke was stronger among individuals of lower socioeconomic status or with pre-existing comorbid conditions. Absolute risk estimates were better suited to identify such effect modification.
Collapse
Affiliation(s)
- Aslak Harbo Poulsen
- Work, Environment and Cancer, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark.
| | - Mette Sørensen
- Work, Environment and Cancer, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark; Department of Natural Science and Environment, Roskilde University, Universitetsvej 1, 4000, Roskilde, Denmark
| | - Ulla Arthur Hvidtfeldt
- Work, Environment and Cancer, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Frederiksborgvej 399, 4000, Roskilde, Denmark; Global Centre for Clean Air Research (GCARE), Department of Civil and Environmental Engineering, University of Surrey, Guildford, UK
| | - Jesper H Christensen
- Department of Environmental Science, Aarhus University, Frederiksborgvej 399, 4000, Roskilde, Denmark
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Frederiksborgvej 399, 4000, Roskilde, Denmark; iClimate - interdisciplinary Centre for Climate Change, Aarhus University, Frederiksborgvej 399, 4000, Roskilde, Denmark
| | - Lise Marie Frohn
- Department of Environmental Science, Aarhus University, Frederiksborgvej 399, 4000, Roskilde, Denmark; iClimate - interdisciplinary Centre for Climate Change, Aarhus University, Frederiksborgvej 399, 4000, Roskilde, Denmark
| | - Jibran Khan
- Department of Environmental Science, Aarhus University, Frederiksborgvej 399, 4000, Roskilde, Denmark; Danish Big Data Centre for Environment and Health (BERTHA), Aarhus University, Frederiksborgvej 399, 4000, Roskilde, Denmark
| | - Steen Solvang Jensen
- Department of Environmental Science, Aarhus University, Frederiksborgvej 399, 4000, Roskilde, Denmark
| | - Thomas Lund
- Centre of Social Medicine, University Hospital Bispebjerg-Frederiksberg, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark; Department of Occupational and Social Medicine, Holbaek Hospital & Department of Public Health, University of Copenhagen, Denmark
| | - Ole Raaschou-Nielsen
- Work, Environment and Cancer, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark; Department of Environmental Science, Aarhus University, Frederiksborgvej 399, 4000, Roskilde, Denmark
| |
Collapse
|
11
|
Oak YJ, Park RJ, Lee JT, Byun G. Future air quality and premature mortality in Korea. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 865:161134. [PMID: 36587681 DOI: 10.1016/j.scitotenv.2022.161134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/22/2022] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
We simulate air quality in Korea for the present, the near-term, and the long-term future conditions under the Shared Socioeconomic Pathways (SSP1: most sustainable pathway with strong emissions control, SSP3: most challenging pathway with mild emissions control) using a chemical transport model. Simulated future concentrations of NO2, SO2, and fine particulate matter (PM2.5), show, in general, lower values compared to the present with varying degrees depending on SSP scenarios. Significant reductions in precursor emissions result in a decrease in O3 concentrations under a NOx-limited environment in the long-term future under SSP1. Under SSP3, O3 increases in the future under a VOC-limited regime, driven by increased CH4 levels and biogenic VOC emissions under the warming climate. Concentrations of PM2.5 and its components, including sulfate, nitrate, ammonium, and organic aerosols (OA), generally decrease in the long-term future under both scenarios. However, the contribution of biogenic secondary OA (BSOA) to PM2.5 will increase in the future. Simulated results are used to estimate cardiorespiratory mortality changes with concentration-response factors from epidemiologic studies in Korea based on national health surveys and Korean cohorts, using projected population structures from the SSP database. The cardiorespiratory health burden of long-term exposure to O3, NO2, SO2, and PM2.5 is estimated to be 10,419 (95 % confidence interval: 1271-17,142), 8630 (0-18,713), 3958 (0-9272), and 10,431 (1411-20,643) deaths in 2019. We find that the total cardiorespiratory excess mortality due to air pollutants under SSP1 decreases by 8 % and 95 % in 2045 and 2095, respectively. Under SSP3, excess mortality increases by 80 % in 2045, and decreases by 22 % in 2095, resulting in a substantial difference in the health outcomes depending on the emission scenario. We also find that the BSOA contribution to total PM2.5 will differ by region, emphasizing the potential health impact of BSOA on a local scale in the future.
Collapse
Affiliation(s)
- Yujin J Oak
- School of Earth and Environmental Sciences, Seoul National University, Seoul, South Korea
| | - Rokjin J Park
- School of Earth and Environmental Sciences, Seoul National University, Seoul, South Korea.
| | - Jong-Tae Lee
- School of Health Policy and Management, College of Health Science, Korea University, Seoul, South Korea; Interdisciplinary Program in Precision Public Health, Korea University, Seoul, South Korea
| | - Garam Byun
- Interdisciplinary Program in Precision Public Health, Korea University, Seoul, South Korea
| |
Collapse
|
12
|
Gou A, Tan G, Ding X, Wang J, Jiao Y, Gou C, Tan Q. Spatial association between green space and COPD mortality: a township-level ecological study in Chongqing, China. BMC Pulm Med 2023; 23:89. [PMID: 36932348 PMCID: PMC10024412 DOI: 10.1186/s12890-023-02359-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 02/10/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND There are regional differences in the effect of green space on mortality of Chronic obstructive pulmonary disease (COPD). We conduct an ecological study, using the administrative divisions of Chongqing townships in China as the basic unit, to investigate the association between COPD mortality and green space based on data of 313,013 COPD deaths in Chongqing from 2012 to 2020. Green space is defined by Fractional vegetation cover (FVC), which is further calculated based on the normalised vegetation index (NDVI) from satellite remote sensing imagery maps. METHODS After processing the data, the non-linear relationship between green space and COPD mortality is revealed by generalised additive models; the spatial differences between green space and COPD mortality is described by geographically weighted regression models; and finally, the interpretive power and interaction of each factor on the spatial distribution of COPD mortality is examined by a geographic probe. RESULTS The results show that the FVC local regression coefficients ranged from - 0.0397 to 0.0478, 63.0% of the regions in Chongqing have a positive correlation between green space and COPD mortality while 37.0% of the regions mainly in the northeast and west have a negative correlation. The interpretive power of the FVC factor on the spatial distribution of COPD mortality is 0.08. CONCLUSIONS Green space may be a potential risk factor for increased COPD mortality in some regions of Chongqing. This study is the first to reveal the relationship between COPD mortality and green space in Chongqing at the township scale, providing a basis for public health policy formulation in Chongqing.
Collapse
Affiliation(s)
- Aiping Gou
- College of Ecological Technology and Engineering, Shanghai Institute of Technology, Shanghai, 201418, China
| | - Guanzheng Tan
- College of Ecological Technology and Engineering, Shanghai Institute of Technology, Shanghai, 201418, China
| | - Xianbin Ding
- Institute of Chronic and Non-communicable Disease Control and Prevention, Chongqing Center for Disease Control and Prevention, Chongqing, 400042, China.
| | - Jiangbo Wang
- College of Architecture, Nanjing Tech University, Nanjing, 211816, China.
| | - Yan Jiao
- Institute of Chronic and Non-communicable Disease Control and Prevention, Chongqing Center for Disease Control and Prevention, Chongqing, 400042, China
| | - Chunyan Gou
- Department of Acupuncture, Chongqing Traditional Chinese Medicine Hospital, Chongqing, 400021, China
| | - Qiang Tan
- Institute of Chronic and Non-communicable Disease Control and Prevention, Chongqing Center for Disease Control and Prevention, Chongqing, 400042, China
| |
Collapse
|
13
|
Zhao C, Wang W, Wen H, Huang Z, Wang X, Jiao K, Chen Q, Feng H, Wang Y, Liao J, Ma L. Effects of green spaces on alleviating mortality attributable to PM 2.5 in China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:14402-14412. [PMID: 36153419 DOI: 10.1007/s11356-022-23097-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
Increasing research suggested that green spaces are associated with many health benefits, but evidence for the quantitative relationship between green spaces and mortality attributable to particulate matter with an aerodynamic diameter of 2.5 μm or less (PM2.5) is limited. We collected disease-specific mortality and PM2.5 data for a period of 4 years (2015-2018) along with green space data for an 8-year duration (2010-2017) in 31 provincial-level administrative regions of China. First, this study used the Integrated Exposure-Response model to estimate the mortality of four diseases attributable to PM2.5, including chronic obstructive pulmonary diseases (COPD), lung cancer (LC), ischemic heart disease (IHD), and cerebrovascular disease (CBVD). Then we performed linear regression and mixed-effects model to investigate the counteracting effect of green spaces on death caused by PM2.5 exposure. The differences in impacts among the Eastern, Central, and Western regions were explored using stratified analysis. The most significant results from linear regression analysis indicated that per 100 km2 of green spaces increase, there was a decreased total mortality (10-5) (COPD, LC, IHD, and CBVD) attributable to PM2.5 by - 4.012 [95% confidence interval (CI): - 5.535, - 2.488], while the reduction by mixed-linear regression analysis was - 2.702/105 (95% CI = - 3.645, - 1.759). Of all hysteresis analyses, the effect estimates (β) at lag3 and lag4 were the largest. The effect of green spaces was more advantageous when targeting CBVD and the Eastern region. We found a negative correlation between green space exposure and mortality attributable to PM2.5, which can provide further support for city planners, government personnel, and others to build a healthier city and achieve national health goals.
Collapse
Affiliation(s)
- Chuanyu Zhao
- Department of Preventive Medicine, School of Public Health, Wuhan University, Wuhan, 430071, People's Republic of China
| | - Wanyue Wang
- Department of Preventive Medicine, School of Public Health, Wuhan University, Wuhan, 430071, People's Republic of China
| | - Haoxuan Wen
- Department of Preventive Medicine, School of Public Health, Wuhan University, Wuhan, 430071, People's Republic of China
| | - Zenghui Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, 430071, People's Republic of China
| | - Xiaodie Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, 430071, People's Republic of China
| | - Kuizhuang Jiao
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, 430071, People's Republic of China
| | - Qihao Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, 430071, People's Republic of China
| | - Huan Feng
- Guangzhou Fangzhou Pharmaceutical Company Limited, Guangzhou, 510000, People's Republic of China
| | - Yizhe Wang
- Department of Surveying and Mapping, School of Remote Sensing and Information Engineering, Wuhan University, Wuhan, 430071, People's Republic of China
| | - Jingling Liao
- Department of Nutrition and Food Hygiene, School of Public Health, Medical College, Wuhan University of Science and Technology, Wuhan, 430081, People's Republic of China
| | - Lu Ma
- Department of Biostatistics, School of Public Health, Wuhan University, o. 115 Donghu Avenue, Wuchang district, Wuhan, 430071, People's Republic of China.
| |
Collapse
|
14
|
Donovan GH, Prestemon JP, Gatziolis D, Michael YL, Kaminski AR, Dadvand P. The association between tree planting and mortality: A natural experiment and cost-benefit analysis. ENVIRONMENT INTERNATIONAL 2022; 170:107609. [PMID: 36332494 DOI: 10.1016/j.envint.2022.107609] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/31/2022] [Accepted: 10/29/2022] [Indexed: 06/16/2023]
Abstract
Several recent longitudinal studies have found that exposure to the natural environment is associated with lower non-accidental mortality. However, most of these studies used the normalized difference vegetation index (NDVI) as an exposure metric; and because NDVI might not be sensitive enough to adequately capture changes in urban vegetation, these studies might lack true longitudinal variation in exposure. Therefore, we used a natural experiment to assess the impact of 30 years of tree planting by the nonprofit Friends of Trees on non-accidental, cardiovascular, lower-respiratory, and accidental mortality in Portland, Oregon (mortality data were provided by the Oregon Health Authority). We estimated autoregressive mixed models of Census-tract level mortality rate (deaths per 100,000 population) associated with trees planted, including a tract-level random effect. All models used data from the American Community Survey to control for year, race, education, income, and age. Each tree planted in the preceding 15 years was associated with significant reductions in non-accidental (-0.21, 95 % CI: -0.30, -0.12) and cardiovascular mortality (-0.066, 95 % CI: -0.11, -0.027). Furthermore, the dose-response association between tree planting and non-accidental mortality increased in magnitude as trees aged and grew. Each tree planted in the preceding 1-5 years was associated with a reduction in mortality rate of -0.154 (95 % CI: -0.323, 0.0146), whereas each tree planted in the last 6-10 and 11-15 years was associated with a reduction in mortality rate of -0.262 (95 % CI: -0.413, -0.110) and -0.306 (95 % CI: -0.527, -0.0841) respectively. Using US EPA estimates of a value of a statistical life, we estimated that planting a tree in each of Portland's 140 Census tracts would generate $14.2 million in annual benefits (95 % CI: $8.0 million to $20.4 million). In contrast, the annual cost of maintaining 140 trees would be $2,716-$13,720.
Collapse
Affiliation(s)
| | - Jeffrey P Prestemon
- USDA Forest Service, Southern Research Station, Research Triangle Park, NC, USA
| | | | - Yvonne L Michael
- Drexel University, Dornsife School of Public Health, Philadelphia, PA, USA
| | | | - Payam Dadvand
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| |
Collapse
|
15
|
Feng S, Meng Q, Guo B, Guo Y, Chen G, Pan Y, Zhou J, Xu J, Zeng Q, Wei J, Xu H, Chen L, Zeng C, Zhao X. Joint exposure to air pollution, ambient temperature and residential greenness and their association with metabolic syndrome (MetS): A large population-based study among Chinese adults. ENVIRONMENTAL RESEARCH 2022; 214:113699. [PMID: 35714687 DOI: 10.1016/j.envres.2022.113699] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 06/08/2022] [Accepted: 06/12/2022] [Indexed: 06/15/2023]
Abstract
Previous studies assessing adverse health have traditionally focused on a single environmental exposure, failing to reflect the reality of various exposures present simultaneously. Air pollution, ambient temperature and greenness have been proposed as critical environmental factors associated with metabolic syndrome (MetS). However, evidence exploring their joint relationships with MetS is needed for identifying interactive factors and developing more targeted public health interventions. The baseline data was obtained from China Multi-Ethnic Cohort (CMEC). Environmental data of air pollutants (PM2.5, O3) and NDVI for greenness was calculated from satellites data. Ambient temperature data were obtained from European Center for Medium-Range Weather Forecasts (ECMWF). MetS was classified based on National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) using anthropometric measures and biomarkers. Logistic regression models were utilized to examine the combined relationship of MetS with three-year exposure to air pollutants, temperature and NDVI. Relative excess risk due to interaction (RERI) was calculated to evaluate interaction on an additive scale. We found associations between prevalent MetS and interquartile range (IQR) increases in PM2.5 (OR: 1.38; 95% confidence interval [95% CI]: 1.23, 1.55) and O3 (OR: 1.15; 95% CI: 1.09, 1.22). Additive and multiplicative interactions were observed between air pollutants and temperature exposure. Compared to low-temperature level, the relationship between PM2.5 and MetS attenuated (RERI: 0.22, 95% CI: 0.44, -0.04) at high-temperature level, while the relationship between O3 and MetS enhanced (RERI: 0.05, 95% CI: 0.02, 0.11). At low NDVI 250 m, the association between PM2.5 and MetS was stronger (RERI: 0.13, 95% CI: 0.05, 0.19) with high NDVI 250 m as the reference group. Our findings showed that ambient temperature and residential greenness could affect the relationship between air pollutants and MetS.
Collapse
Affiliation(s)
- Shiyu Feng
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qiong Meng
- Department of Epidemiology and Health Statistics, School of Public Health, Kunming Medical University, China
| | - Bing Guo
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Gongbo Chen
- Guangdong Provincial Engineering Technology Research Center of Environmental and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | | | - Jing Zhou
- Chenghua District Center for Disease Control and Prevention, China
| | - Jingru Xu
- Chongqing Municipal Center for Disease Control and Prevention, China
| | - Qibing Zeng
- School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, China
| | - Jing Wei
- Department of Atmospheric and Oceanic Science, Earth System Science Interdisciplinary Center, University of Maryland, College Park, MD, USA
| | - Huan Xu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lin Chen
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chunmei Zeng
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xing Zhao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China.
| |
Collapse
|
16
|
Zare Sakhvidi MJ, Yang J, Mehrparvar AH, Dzhambov AM, Ebrahimi A, Dadvand P, Jacquemin B. Exposure to greenspace and cancer incidence, prevalence, and mortality: A systematic review and meta-analyses. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 838:156180. [PMID: 35618130 DOI: 10.1016/j.scitotenv.2022.156180] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/11/2022] [Accepted: 05/19/2022] [Indexed: 06/15/2023]
Abstract
We conducted a systematic review and meta-analysis of the available literature on the association between greenspace exposure and all-sites and site-specific cancer incidence, prevalence, and mortality in adults. We searched PubMed, Scopus, and Web of Science for original articles published, without language restriction until September 2021. We assessed the risk of bias in each study and the overall quality of evidence for exposure-outcome pairs that were reported in two or more studies. Out of the 18 included studies, cross-sectional studies were the most common study design (n = 8), and most of the studies were conducted in Europe (n = 8). In terms of risk of bias, the majority of cohorts (four out of six) and case-control studies (three out of four) were of good or very good quality, and cross-sectional studies were mostly (five out of eight) of poor quality. Outcomes (incidence, prevalence, mortality) on different cancer sites were reported: lung cancer (n = 9), prostate cancer (n = 4), breast cancer (n = 4), skin cancer (n = 3), colorectal cancer (n = 2), all-sites cancer (n = 2), brain cancer (n = 1), mouth and throat cancer (n = 1), and esophageal cancer (n = 1). The meta-analyses for the breast, lung, and prostate cancer incidence did not show statistically significant associations (for example for breast cancer: hazard ratio = 0.83; 95% confidence interval: 0.47-1.48). For skin cancer, the available evidence suggests that greenspace could be a potential risk factor. For the other cancers, the evidence was non-conclusive. The overall quality of evidence of all of the exposure-outcome pairs was very low. Given the wide confidence interval of the pooled estimates and very low quality of evidence, the findings should be interpreted with caution. Future large and longitudinal studies are needed to assess the potential association of greenspace exposure with cancers, considering types and quality of greenspace, evaluation of cancer sub-types, and adjustment for a sufficient set of covariates.
Collapse
Affiliation(s)
- Mohammad Javad Zare Sakhvidi
- Occupational Health Department, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran; Univ Rennes, INSERM, EHESP, IRSET (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, F-35000 Rennes, France
| | - Jun Yang
- School of Public Health, Guangzhou Medical University, Guangzhou 511436, China
| | | | - Angel M Dzhambov
- Department of Hygiene, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - AliAsghar Ebrahimi
- Environmental Health Department, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Payam Dadvand
- ISGlobal, Doctor Aiguader 88, 08003 Barcelona, Spain; Universitat Pompeu Fabra (UPF), Doctor Aiguader 88, 08003 Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, 28029 Madrid, Spain
| | - Bénédicte Jacquemin
- Univ Rennes, INSERM, EHESP, IRSET (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, F-35000 Rennes, France.
| |
Collapse
|
17
|
Bereziartua A, Chen J, de Hoogh K, Rodopoulou S, Andersen ZJ, Bellander T, Brandt J, Fecht D, Forastiere F, Gulliver J, Hertel O, Hoffmann B, Arthur Hvidtfeldt U, Verschuren WMM, Jöckel KH, Jørgensen JT, Katsouyanni K, Ketzel M, Hjertager Krog N, Brynedal B, Leander K, Liu S, Ljungman P, Faure E, Magnusson PKE, Nagel G, Pershagen G, Peters A, Raaschou-Nielsen O, Renzi M, Rizzuto D, Samoli E, van der Schouw YT, Schramm S, Severi G, Stafoggia M, Strak M, Sørensen M, Tjønneland A, Weinmayr G, Wolf K, Zitt E, Brunekreef B, Hoek G. Exposure to surrounding greenness and natural-cause and cause-specific mortality in the ELAPSE pooled cohort. ENVIRONMENT INTERNATIONAL 2022; 166:107341. [PMID: 35717714 DOI: 10.1016/j.envint.2022.107341] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/28/2022] [Accepted: 06/08/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The majority of studies have shown higher greenness exposure associated with reduced mortality risks, but few controlled for spatially correlated air pollution and traffic noise exposures. We aim to address this research gap in the ELAPSE pooled cohort. METHODS Mean Normalized Difference Vegetation Index (NDVI) in a 300-m grid cell and 1-km radius were assigned to participants' baseline home addresses as a measure of surrounding greenness exposure. We used Cox proportional hazards models to estimate the association of NDVI exposure with natural-cause and cause-specific mortality, adjusting for a number of potential confounders including socioeconomic status and lifestyle factors at individual and area-levels. We further assessed the associations between greenness exposure and mortality after adjusting for fine particulate matter (PM2.5), nitrogen dioxide (NO2) and road traffic noise. RESULTS The pooled study population comprised 327,388 individuals who experienced 47,179 natural-cause deaths during 6,374,370 person-years of follow-up. The mean NDVI in the pooled cohort was 0.33 (SD 0.1) and 0.34 (SD 0.1) in the 300-m grid and 1-km buffer. In the main fully adjusted model, 0.1 unit increment of NDVI inside 300-m grid was associated with 5% lower risk of natural-cause mortality (Hazard Ratio (HR) 0.95 (95% CI: 0.94, 0.96)). The associations attenuated after adjustment for air pollution [HR (95% CI): 0.97 (0.96, 0.98) adjusted for PM2.5; 0.98 (0.96, 0.99) adjusted for NO2]. Additional adjustment for traffic noise hardly affected the associations. Consistent results were observed for NDVI within 1-km buffer. After adjustment for air pollution, NDVI was inversely associated with diabetes, respiratory and lung cancer mortality, yet with wider 95% confidence intervals. No association with cardiovascular mortality was found. CONCLUSIONS We found a significant inverse association between surrounding greenness and natural-cause mortality, which remained after adjusting for spatially correlated air pollution and traffic noise.
Collapse
Affiliation(s)
- Ainhoa Bereziartua
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
| | - Sophia Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Zorana J Andersen
- Section of Environment and Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden.
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; iClimate - interdisciplinary Center for Climate Change, Aarhus University, Denmark.
| | - Daniela Fecht
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK.
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, Rome, Italy; School of Public Health, Faculty of Medicine, Imperial College London, London, UK.
| | - John Gulliver
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK; Centre for Environmental Health and Sustainability & School of Geography, Geology and the Environment, University of Leicester, Leicester, UK.
| | - Ole Hertel
- Department of Ecoscience, Aarhus University, Roskilde, Denmark.
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Germany.
| | | | - W M Monique Verschuren
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University of Duisburg-Essen, Essen, Germany.
| | - Jeanette T Jørgensen
- Section of Environment and Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Environmental Research Group, School of Public Health, Imperial College London, London, UK.
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Frederiksborgvej 399, DK-4000 Roskilde, Denmark; Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford GU2 7XH, United Kingdom.
| | - Norun Hjertager Krog
- Section of Air Pollution and Noise, Norwegian Institute of Public Health, Norway.
| | - Boel Brynedal
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Shuo Liu
- Section of Environment and Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Petter Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden.
| | - Elodie Faure
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP UMR1018, 94805 Villejuif, France.
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden.
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany; Chair of Epidemiology, Ludwig Maximilians Universität München, Munich, Germany.
| | - Ole Raaschou-Nielsen
- Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Environmental Science, Aarhus University, Frederiksborgvej 399, DK-4000 Roskilde, Denmark.
| | - Matteo Renzi
- Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, Rome, Italy.
| | - Debora Rizzuto
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden.
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
| | - Sara Schramm
- Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, University Hospital Essen, Germany.
| | - Gianluca Severi
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP UMR1018, 94805 Villejuif, France; Department of Statistics, Computer Science and Applications "G. Parenti" (DISIA), University of Florence, Italy.
| | - Massimo Stafoggia
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, Rome, Italy.
| | - Maciej Strak
- Institute for Risk Assessment Sciences, Utrecht University, the Netherlands; National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
| | - Mette Sørensen
- Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Natural Science and Environment, Roskilde University, Roskilde, Denmark.
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark; Diet, Genes and Environment (DGE), Denmark.
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany.
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria; Department of Internal Medicine 3, LKH Feldkirch, Feldkirch, Austria.
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.
| |
Collapse
|
18
|
Mueller W, Milner J, Loh M, Vardoulakis S, Wilkinson P. Exposure to urban greenspace and pathways to respiratory health: An exploratory systematic review. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 829:154447. [PMID: 35283125 DOI: 10.1016/j.scitotenv.2022.154447] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 03/04/2022] [Accepted: 03/06/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND/OBJECTIVE Urban greenspace may have a beneficial or adverse effect on respiratory health. Our objective was to perform an exploratory systematic review to synthesise the evidence and identify the potential causal pathways relating urban greenspace and respiratory health. METHODS We followed PRISMA guidelines on systematic reviews and searched five databases for eligible studies during 2000-2021. We incorporated a broad range of urban greenspace and respiratory health search terms, including both observational and experimental studies. Screening, data extraction, and risk of bias, assessed using the Navigation Guide criteria, were performed independently by two authors. We performed a narrative synthesis and discuss suggested pathways to respiratory health. RESULTS We identified 108 eligible papers (n = 104 observational, n = 4 experimental). The most common greenspace indicators were the overall greenery or vegetation (also known as greenness), green land use/land cover of physical area classes (e.g., parks, forests), and tree canopy cover. A wide range of respiratory health indicators were studied, with asthma prevalence being the most common. Two thirds (n = 195) of the associations in these studies were positive (i.e., beneficial) with health, with 31% (n = 91) statistically significant; only 9% (n = 25) of reported associations were negative (i.e., adverse) with health and statistically significant. The most consistent positive evidence was apparent for respiratory mortality. There were n = 35 (32%) 'probably low' and n = 73 (68%) 'probably high' overall ratings of bias. Hypothesised causal pathways for health benefits included lower air pollution, more physically active populations, and exposure to microbial diversity; suggested mechanisms with poorer health included exposure to pollen and other aeroallergens. CONCLUSION Many studies showed positive association between urban greenspace and respiratory health, especially lower respiratory mortality; this is suggestive, but not conclusive, of causal effects. Results underscore the importance of contextual factors, greenspace metric employed, and the potential bias of subtle selection factors, which should be explored further.
Collapse
Affiliation(s)
- William Mueller
- Institute of Occupational Medicine, Edinburgh, UK; London School of Hygiene & Tropical Medicine, UK.
| | - James Milner
- London School of Hygiene & Tropical Medicine, UK
| | - Miranda Loh
- Institute of Occupational Medicine, Edinburgh, UK
| | - Sotiris Vardoulakis
- National Centre for Epidemiology and Population Health, Australian National University, Australia
| | | |
Collapse
|
19
|
Tian X, Zhang C, Xu B. The Impact of Air Pollution on Residents' Happiness: A Study on the Moderating Effect Based on Pollution Sensitivity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:7536. [PMID: 35742783 PMCID: PMC9224219 DOI: 10.3390/ijerph19127536] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/11/2022] [Accepted: 06/18/2022] [Indexed: 11/18/2022]
Abstract
Promoting people's happiness is a vital goal of public policy, and air pollution, as the focus of public opinion, is an important influencing factor of residents' happiness. Although previous literature has explored the relationship between air pollution and happiness, the impact of pollution sensitivity on the relationship has so far received little attention. This paper uses the 2016 China Labor-force Dynamics Survey database (CLDS) to study the impact of air pollution on personal happiness and dissects the moderating effect of air pollution sensitivity from the stock and incremental perspectives. The results found that (1) there is an inverted U-shaped relationship between air pollution and residents' happiness, such that happiness increases and then decreases with increasing air pollution. The PM10 concentration at the turning point is 119.69 μg/m3, which exceeds the national secondary standard limit (70 μg/m3) by 70.99% and is at the intermediate stage of mild pollution, exceeding the WHO recommended standard (20 μg/m3) by 498.45%, far higher than the international standard recommended level; (2) both air pollution stock sensitivity and incremental sensitivity have a significant positive moderating effect on the relationship between air pollution and happiness, and pollution sensitivity exacerbates the negative effect of air pollution on residents' happiness by shifting the curve turning point to the left and steepening the curve shape; (3) in addition, the effect of air pollution on different groups is significantly heterogeneous, with lower-age and male groups more likely to have lower happiness due to air pollution; the positive moderating effect of pollution sensitivity is more significant in lower-age, female, and higher-income groups. Therefore, in order to enhance residents' happiness, the government should not only improve air quality, but also focus on helping residents establish an appropriate subjective perception of air quality.
Collapse
Affiliation(s)
- Xuan Tian
- School of Economics, Nanjing University of Finance and Economics, Nanjing 210003, China;
| | - Cheng Zhang
- School of Finance, Nanjing University of Finance and Economics, Nanjing 210003, China;
| | - Bing Xu
- Wenzhou Base, National Institution for Finance & Development, Wenzhou Business College, Wenzhou 325015, China
| |
Collapse
|
20
|
Coleman CJ, Yeager RA, Pond ZA, Riggs DW, Bhatnagar A, Arden Pope C. Mortality risk associated with greenness, air pollution, and physical activity in a representative U.S. cohort. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 824:153848. [PMID: 35176374 DOI: 10.1016/j.scitotenv.2022.153848] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 05/04/2023]
Abstract
Several cohort studies suggest greenness is associated with decreased mortality risk. Potential confounding by or interactions between physical activity and air pollution remains unclear. This study evaluates associations of greenness, air pollution, and physical activity with mortality risk and investigates confounding and effect modification across these key risk factors. National Health Interview Survey (NHIS) data covering 1997-2014 were linked to the National Death Index to generate a cohort of 403,748 individuals with 39,528 deaths. Greenness, represented by census-tract Normalized Difference Vegetation Index (NDVI) for the seasonal period of May-October, was averaged over the years 2003-2016. Air pollution was estimated by census-tract level PM2.5 concentrations from 1999 to 2015. Cox Proportional Hazard Models were used to estimate hazard ratios (HR) for differences in greenness, air pollution, and physical activity. Alternative models that evaluated potential confounding and stratified models that evaluated effect modification were examined. Mortality risks were associated with PM2.5 (HR = 1.14, 95% CI: 1.09-1.19 per 10 μg/m3) and physical inactivity (1.49, 1.44-1.54 relative to sufficiently active), but not with greenness (1.01, 0.99-1.03 per IQR). The PM2.5-mortality association was mitigated at high levels of greenness (1.05, 0.91-1.22). There was no strong evidence of confounding between air pollution, physical activity, and greenness. However, stratified analysis suggested effect modification for PM2.5 and NDVI by physical activity. A significant protective greenness-mortality association was observed for only highly active individuals (0.91, 0.86-0.96). Also, relatively high PM2.5-mortality HRs were observed for more physically active individuals (1.25, 1.12-1.40). PM2.5 air pollution and physical inactivity are robustly associated with mortality risk. Greenness may be most beneficial and air pollution relatively harmful to highly active individuals. This analysis provides evidence that, in addition to not smoking, being physically active and living in a clean, green environment contributes to improved health and reduced risk of mortality.
Collapse
Affiliation(s)
- Carver J Coleman
- Department of Economics, Brigham Young University, Provo, UT 84602, United States of America
| | - Ray A Yeager
- Department of Environmental and Occupational Health Sciences, University of Louisville, Louisville, KY 40292, United States of America
| | - Zachari A Pond
- Department of Economics, University of California, Berkeley, Berkeley, CA 94720, United States of America
| | - Daniel W Riggs
- Department of Medicine, University of Louisville, Louisville, KY 40292, United States of America
| | - Aruni Bhatnagar
- Department of Medicine, University of Louisville, Louisville, KY 40292, United States of America
| | - C Arden Pope
- Department of Economics, Brigham Young University, Provo, UT 84602, United States of America.
| |
Collapse
|
21
|
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.
Collapse
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.
| |
Collapse
|
22
|
Liu L, Yan LL, Lv Y, Zhang Y, Li T, Huang C, Kan H, Zhang J, Zeng Y, Shi X, Ji JS. Air pollution, residential greenness, and metabolic dysfunction biomarkers: analyses in the Chinese Longitudinal Healthy Longevity Survey. BMC Public Health 2022; 22:885. [PMID: 35509051 PMCID: PMC9066955 DOI: 10.1186/s12889-022-13126-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 03/31/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We hypothesize higher air pollution and fewer greenness exposures jointly contribute to metabolic syndrome (MetS), as mechanisms on cardiometabolic mortality. METHODS We studied the samples in the Chinese Longitudinal Healthy Longevity Survey. We included 1755 participants in 2012, among which 1073 were followed up in 2014 and 561 in 2017. We used cross-sectional analysis for baseline data and the generalized estimating equations (GEE) model in a longitudinal analysis. We examined the independent and interactive effects of fine particulate matter (PM2.5) and Normalized Difference Vegetation Index (NDVI) on MetS. Adjustment covariates included biomarker measurement year, baseline age, sex, ethnicity, education, marriage, residence, exercise, smoking, alcohol drinking, and GDP per capita. RESULTS At baseline, the average age of participants was 85.6 (SD: 12.2; range: 65-112). Greenness was slightly higher in rural areas than urban areas (NDVI mean: 0.496 vs. 0.444; range: 0.151-0.698 vs. 0.133-0.644). Ambient air pollution was similar between rural and urban areas (PM2.5 mean: 49.0 vs. 49.1; range: 16.2-65.3 vs. 18.3-64.2). Both the cross-sectional and longitudinal analysis showed positive associations of PM2.5 with prevalent abdominal obesity (AO) and MetS, and a negative association of NDVI with prevalent AO. In the longitudinal data, the odds ratio (OR, 95% confidence interval-CI) of PM2.5 (per 10 μg/m3 increase) were 1.19 (1.12, 1.27), 1.16 (1.08, 1.24), and 1.14 (1.07, 1.21) for AO, MetS and reduced high-density lipoprotein cholesterol (HDL-C), respectively. NDVI (per 0.1 unit increase) was associated with lower AO prevalence [OR (95% CI): 0.79 (0.71, 0.88)], but not significantly associated with MetS [OR (95% CI): 0.93 (0.84, 1.04)]. PM2.5 and NDVI had a statistically significant interaction on AO prevalence (pinteraction: 0.025). The association between PM2.5 and MetS, AO, elevated fasting glucose and reduced HDL-C were only significant in rural areas, not in urban areas. The association between NDVI and AO was only significant in areas with low PM2.5, not under high PM2.5. CONCLUSIONS We found air pollution and greenness had independent and interactive effect on MetS components, which may ultimately manifest in pre-mature mortality. These study findings call for green space planning in urban areas and air pollution mitigation in rural areas.
Collapse
Affiliation(s)
- Linxin Liu
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Lijing L Yan
- Global Heath Research Center, Duke Kunshan University, Kunshan, China.,School of Public Health, Wuhan University, Wuhan, China.,Institute for Global Health and Development, Peking University, Beijing, China
| | - Yuebin Lv
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yi Zhang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Tiantian Li
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Cunrui Huang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Haidong Kan
- School of Public Health, Fudan University, Shanghai, China
| | - Junfeng Zhang
- Nicholas School of the Environment and Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Yi Zeng
- Center for Healthy Aging and Development Studies, National School of Development, Peking University, Beijing, China.,Center for the Study of Aging and Human Development, Duke Medical School, Durham, NC, USA
| | - Xiaoming Shi
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China.,Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - John S Ji
- Vanke School of Public Health, Tsinghua University, Beijing, China.
| |
Collapse
|
23
|
Joint associations between neighborhood walkability, greenness, and particulate air pollution on cardiovascular mortality among adults with a history of stroke or acute myocardial infarction. Environ Epidemiol 2022; 6:e200. [PMID: 35434462 PMCID: PMC9005250 DOI: 10.1097/ee9.0000000000000200] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 01/29/2022] [Indexed: 11/26/2022] Open
Abstract
Fine particulate matter (PM2.5) is a known risk factor for cardiovascular disease (CVD). Neighborhood walkability and greenness may also be associated with CVD, but there is limited evidence on their joint or interacting effects with PM2.5.
Collapse
|
24
|
Cai L, Zhuang M, Ren Y. Spatiotemporal characteristics of NO 2, PM 2.5 and O 3 in a coastal region of southeastern China and their removal by green spaces. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2022; 32:1-17. [PMID: 32013546 DOI: 10.1080/09603123.2020.1720620] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/19/2020] [Indexed: 06/10/2023]
Abstract
Understanding the spatio-temporal characteristics of air pollutants is essential to improving air quality. One aspect is the question of whether green spaces can reduce air pollutant concentrations. However, previous studies on this issue have reported mixed results. This study analyzed the spatio-temporal characteristics of NO2, PM2.5 and O3 in Fujian Province, Southeast China in 2015. In order to reduce uncertainties in the conclusions drawn, the effects landscape metrics describing green spaces have on air pollutants have been analyzed using Pearson correlation analysis at six different spatial scales for the four seasons, considering the influence of meteorological conditions. The results show that PM2.5 and O3 are major pollutants whose relative importance varies with the seasons. Significant differences in pollutant concentrations were observed in suburban and urban areas, highlighting the importance of ensuring a reasonable spatial distribution of monitoring stations. Moreover, significant correlations between air pollutants and green space landscape patterns during the four seasons were found, revealing increased air pollutant concentrations with increasing landscape fragmentation and reduced connectivity and aggregation. This probably indicates that interconnected green spaces have the potential to improve air quality. Utilizing green space function regulations can alleviate NO2 and PM2.5 pollution effectively, but it is still difficult to reduce O3 concentrations because green spaces are likely to not only serve as sinks for O3, but can also promote O3 formation.
Collapse
Affiliation(s)
- Longyan Cai
- Key Laboratory of Urban Environment and Health, Fujian Key Laboratory of Watershed Ecology, Institute of Urban Environment, Chinese Academy of Sciences, Xiamen, China
| | - Mazhan Zhuang
- Xiamen Institute of Environmental Science, Xiamen, CN, China
| | - Yin Ren
- Key Laboratory of Urban Environment and Health, Fujian Key Laboratory of Watershed Ecology, Institute of Urban Environment, Chinese Academy of Sciences, Xiamen, China
| |
Collapse
|
25
|
Asri AK, Tsai HJ, Pan WC, Guo YL, Yu CP, Wu CS, Su HJ, Lung SCC, Wu CD, Spengler JD. Exploring the Potential Relationship Between Global Greenness and DALY Loss Due to Depressive Disorders. Front Psychiatry 2022; 13:919892. [PMID: 35836657 PMCID: PMC9273782 DOI: 10.3389/fpsyt.2022.919892] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/07/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Prior studies have shown that greenness can reduce the burden of depressive disorders. However, most were focused on local-scale analyses while limited evaluated globally. We aimed to investigate the association between greenness and the burden of depressive disorders using data from 183 countries worldwide. METHODS We used the normalized difference vegetation index (NDVI) to estimate greenness. Country-level disability-adjusted life year (DALY) loss due to depressive disorders was used to represent depressive disorder burdens. A generalized linear mixed model was applied to assess the relationship between greenness and depressive disorders after controlling for covariates. Stratified analyses were conducted to determine the effects of greenness across several socio-demographic levels. RESULTS The findings showed a significant negative association between greenness and the health burden of depressive disorders with a coefficient of -0.196 (95% CI: -0.356, -0.035) in the DALY changes per interquartile unit increment of NDVI. The stratified analyses suggested beneficial effects of greenness on depressive disorders across sex, various age groups especially for those aged <49 years, with low-income and/or those living in highly urbanized countries. CONCLUSIONS Our study noted that greenness exposure was significant negative association with the burden of depressive disorders. The findings should be viewed as recommendations for relevant authorities in supporting environmental greenness enhancement to reduce the mental burdens.
Collapse
Affiliation(s)
| | - Hui-Ju Tsai
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Wen-Chi Pan
- Institute of Environmental and Occupational Health Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yue Leon Guo
- Department of Environmental and Occupational Medicine, National Taiwan University (NTU) and NTU Hospital, Taipei, Taiwan.,National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Chia-Pin Yu
- School of Forestry and Resource Conservation, National Taiwan University, Taipei, Taiwan
| | - Chi-Shin Wu
- Department of Psychiatry, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - Huey-Jen Su
- Department of Environmental and Occupational Health, National Cheng Kung University, Tainan, Taiwan
| | - Shih-Chun Candice Lung
- Research Center for Environmental Changes, Academia Sinica, Taipei, Taiwan.,Department of Atmospheric Sciences, National Taiwan University, Taipei, Taiwan.,Institute of Environmental Health, School of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chih-Da Wu
- Department of Geomatics, National Cheng Kung University, Tainan, Taiwan.,National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - John D Spengler
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| |
Collapse
|
26
|
Klompmaker JO, Hart JE, James P, Sabath MB, Wu X, Zanobetti A, Dominici F, Laden F. Air pollution and cardiovascular disease hospitalization - Are associations modified by greenness, temperature and humidity? ENVIRONMENT INTERNATIONAL 2021; 156:106715. [PMID: 34218186 PMCID: PMC8380672 DOI: 10.1016/j.envint.2021.106715] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/03/2021] [Accepted: 06/10/2021] [Indexed: 05/19/2023]
Abstract
BACKGROUND Studies have observed associations between long-term air pollution and cardiovascular disease hospitalization. Little is known, however, about effect modification of these associations by greenness, temperature and humidity. METHODS We constructed an open cohort consisting of all fee-for-service Medicare beneficiaries, aged ≥ 65, living in the contiguous US from 2000 through 2016 (~63 million individuals). We assigned annual average PM2.5, NO2 and ozone zip code concentrations. Cox-equivalent Poisson models were used to estimate associations with first cardiovascular disease (CVD), coronary heart disease (CHD) and cerebrovascular disease (CBV) hospitalization. RESULTS PM2.5 and NO2 were both positively associated with CVD, CHD and CBV hospitalization, after adjustment for potential confounders. Associations were substantially stronger at the lower end of the exposure distributions. For CVD hospitalization, the hazard ratio (HR) of PM2.5 was 1.041 (1.038, 1.045) per IQR increase (4.0 µg/m3) in the full study population and 1.327 (1.305, 1.350) per IQR increase for a subgroup with annual exposures always below 10 µg/m3 PM2.5. Ozone was only positively associated with CVD, CHD and CBV hospitalization for the low-exposure subgroup (<40 ppb). Associations of PM2.5 were stronger in areas with higher greenness, lower ozone and Ox, lower summer and winter temperature and lower summer and winter specific humidity. CONCLUSION PM2.5 and NO2 were positively associated with CVD, CHD and CBV hospitalization. Associations were more pronounced at low exposure levels. Associations of PM2.5 were stronger with higher greenness, lower ozone and Ox, lower temperature and lower specific humidity.
Collapse
Affiliation(s)
- Jochem O Klompmaker
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, 655 Huntington Avenue, Boston, MA 02115, United States.
| | - Jaime E Hart
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, 655 Huntington Avenue, Boston, MA 02115, United States; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, 181 Longwood Avenue, Boston, MA 02115, United States
| | - Peter James
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, 655 Huntington Avenue, Boston, MA 02115, United States; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Drive, Boston, MA 02215, United States
| | - M Benjamin Sabath
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, United States
| | - Xiao Wu
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, United States
| | - Antonella Zanobetti
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, 655 Huntington Avenue, Boston, MA 02115, United States
| | - Francesca Dominici
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, United States
| | - Francine Laden
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, 655 Huntington Avenue, Boston, MA 02115, United States; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, 181 Longwood Avenue, Boston, MA 02115, United States; Department of Epidemiology, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, United States
| |
Collapse
|
27
|
Zare Sakhvidi MJ, Yang J, Siemiatycki J, Dadvand P, de Hoogh K, Vienneau D, Goldberg M, Zins M, Lequy E, Jacquemin B. Greenspace exposure and cancer incidence: A 27-year follow-up of the French GAZEL cohort. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 787:147553. [PMID: 33989869 DOI: 10.1016/j.scitotenv.2021.147553] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/22/2021] [Accepted: 04/30/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Greenspace exposure has been suggested to be associated with a range of health outcomes. The available evidence on the association of this exposure with cancer is still very scarce and inconsistent. OBJECTIVES We aimed to study the association between greenspace exposure and all-site and site-specific (prostate, breast, colorectal, bladder, lung, and malignant melanoma of skin) cancer incidence in the GAZEL cohort. METHODS This study was based on over 27 years of follow-up (1989-2016) of 19,408 participants across France. We assessed the residential greenspace exposure within several buffers as well as residential proximity to green spaces (agricultural, urban, and forests) in each follow-up. We used time-dependent Cox models, controlling for time-varying personal and area-level variables, with different lags between exposure and outcome. Additional analysis was conducted according to the urban-rural residence of the participants' over follow-up. RESULTS Over the 294,645 person-years of follow-up, we registered 4075 incident cases of cancer. We found an increase in the risk for all-sites cancer with an inter-quartile range increase of Normalized Difference in Vegetation Index across different buffers (hazard ratio (HR) of 1.08; 95% CI: 1.02, 1.14 for the 100 m buffer). We found a positive association of all-sites cancer with proximity to agricultural lands (HR: 1.03; 95% CI: 1.00, 1.05), and forests (HR:1.04; 95% CI: 1.00, 1.07), but not with urban green spaces. The cancer site-specific analyses suggested a protective role of greenspace for breast, lung, and colorectal cancers (e.g. breast cancer HR at 100 m buffer: 0.82; 95% CI: 0.69, 0.99). Non-significant associations were observed for prostate, bladder, and skin cancer. Stratified analyses based on urban, semi-urban, and rural classification did not suggest any differential pattern. CONCLUSION We identified an increased risk of all-site cancer with increased greenspace and proximity to agricultural lands and forests; whereas potential protective role of greenspace for breast cancer.
Collapse
Affiliation(s)
- Mohammad Javad Zare Sakhvidi
- Univ. Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France
| | - Jun Yang
- Univ. Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France
| | - Jack Siemiatycki
- Centre de recherches du centre hospitalier de l'université de Montréal, Québec, Canada
| | - Payam Dadvand
- ISGlobal, Doctor Aiguader 88, 08003 Barcelona, Spain; Universitat Pompeu Fabra (UPF), Doctor Aiguader 88, 08003 Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, 28029 Madrid, Spain
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Danielle Vienneau
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Marcel Goldberg
- Inserm UMS 11, Villejuif, France; Université de Paris, Paris, France
| | - Marie Zins
- Inserm UMS 11, Villejuif, France; Université de Paris, Paris, France
| | | | - Bénédicte Jacquemin
- Univ. Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France.
| |
Collapse
|
28
|
Son JY, Sabath MB, Lane KJ, Miranda ML, Dominici F, Di Q, Schwartz J, Bell ML. Long-term Exposure to PM2.5 and Mortality for the Older Population: Effect Modification by Residential Greenness. Epidemiology 2021; 32:477-486. [PMID: 33788795 DOI: 10.1097/ede.0000000000001348] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although many studies demonstrated reduced mortality risk with higher greenness, few studies examined the modifying effect of greenness on air pollution-health associations. We evaluated residential greenness as an effect modifier of the association between long-term exposure to fine particles (PM2.5) and mortality. METHODS We used data from all Medicare beneficiaries in North Carolina (NC) and Michigan (MI) (2001-2016). We estimated annual PM2.5 averages using ensemble prediction models. We estimated mortality risk per 1 μg/m3 increase using Cox proportional hazards modeling, controlling for demographics, Medicaid eligibility, and area-level covariates. We investigated health disparities by greenness using the Normalized Difference Vegetation Index with measures of urbanicity and socioeconomic status. RESULTS PM2.5 was positively associated with mortality risk. Hazard ratios (HRs) were 1.12 (95% confidence interval (CI) = 1.12 to 1.13) for NC and 1.01 (95% CI = 1.00 to 1.01) for MI. HRs were higher for rural than urban areas. Within each category of urbanicity, HRs were generally higher in less green areas. For combined disparities, HRs were higher in low greenness or low SES areas, regardless of the other factor. HRs were lowest in high-greenness and high-SES areas for both states. CONCLUSIONS In our study, those in low SES and high-greenness areas had lower associations between PM2.5 and mortality than those in low SES and low greenness areas. Multiple aspects of disparity factors and their interactions may affect health disparities from air pollution exposures. Findings should be considered in light of uncertainties, such as our use of modeled PM2.5 data, and warrant further investigation.
Collapse
Affiliation(s)
- Ji-Young Son
- From the School of the Environment, Yale University, New Haven, CT
| | - M Benjamin Sabath
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Kevin J Lane
- School of Public Health, Boston University, Boston, MA
| | | | - Francesca Dominici
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Qian Di
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Joel Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Michelle L Bell
- From the School of the Environment, Yale University, New Haven, CT
| |
Collapse
|
29
|
Kua KP, Lee S. The influence of residential greenness on mortality in the Asia-Pacific region: a systematic review and meta-analysis. Perspect Public Health 2021; 141:342-353. [PMID: 34120524 DOI: 10.1177/17579139211011496] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS To critically appraise the evidence of the impact of exposure to salutogenic green environment on mortality, which is an important endpoint in epidemiological and clinical studies. METHODS We searched for studies published and indexed in three databases (PubMed, AMED, and CINAHL Plus) from inception until 31 March 2020, complemented with a search of cited literature for articles describing the effects of greenness on mortality in Asia-Pacific region. Eligible articles were screened and data were extracted independently by two reviewers. A random-effects model was utilised to obtain pool hazard ratio (HR) and risk ratio of all-cause mortality outcome. RESULTS The search identified 3239 studies, of which 20 studies reporting 133,363 participants from longitudinal cohort studies and 202 million people from population-based prevalence studies were included in the review. The majority of the studies (60%) were conducted in high-income countries in Asia-Pacific. All participants of the longitudinal cohort studies were aged 60 years or older, whereas the prevalence studies involved people of all age groups. A significant protective association of green environment exposure with all-cause mortality was reported in 18 studies. Pooled results from five studies showed increased level of greenness exposure was associated with a significant decrease in all-cause mortality (pooled HR = 0.97; 95% confidence interval (CI) = 0.93 to 1.02; p < 0.01; I²= 87.8%). Meta-analysis of total number of deaths in different quartiles of green spaces noted decreased risks of mortality with all causes of death with increased surrounding greenness. CONCLUSIONS Some limited evidence suggests that populations exposed to the greener environment have a lower risk of mortality, implying the potential role of greenness in increasing longevity. Further studies with standardised design and outcome reporting should be conducted in low- and middle-income countries and in populations of low socioeconomic status to glean more generalisable and complete evidence for public health policy implications.
Collapse
Affiliation(s)
- K P Kua
- Puchong Health Clinic, Petaling District Health Office, Ministry of Health Malaysia, Petaling, Selangor, Malaysia
| | - Swh Lee
- School of Pharmacy, Monash University, Subang Jaya, Selangor, Malaysia; Asian Centre for Evidence Synthesis in Population, Implementation, and Clinical Outcomes (PICO), Health and Well-Being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University, Subang Jaya, Selangor, Malaysia; Gerontechnology Laboratory, Global Asia in the 21st Century (GA21) Platform, Monash University, Subang Jaya, Selangor, Malaysia; Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Selangor, Malaysia
| |
Collapse
|
30
|
Spatial patterns of lower respiratory tract infections and their association with fine particulate matter. Sci Rep 2021; 11:4866. [PMID: 33649419 PMCID: PMC7921673 DOI: 10.1038/s41598-021-84435-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 02/16/2021] [Indexed: 01/31/2023] Open
Abstract
This study aimed to identify the spatial patterns of lower respiratory tract infections (LRIs) and their association with fine particulate matter (PM2.5). The disability-adjusted life year (DALY) database was used to represent the burden each country experiences as a result of LRIs. PM2.5 data obtained from the Atmosphere Composition Analysis Group was assessed as the source for main exposure. Global Moran's I and Getis-Ord Gi* were applied to identify the spatial patterns and for hotspots analysis of LRIs. A generalized linear mixed model was coupled with a sensitivity test after controlling for covariates to estimate the association between LRIs and PM2.5. Subgroup analyses were performed to determine whether LRIs and PM2.5 are correlated for various ages and geographic regions. A significant spatial auto-correlated pattern was identified for global LRIs with Moran's Index 0.79, and the hotspots of LRIs were clustered in 35 African and 4 Eastern Mediterranean countries. A consistent significant positive association between LRIs and PM2.5 with a coefficient of 0.21 (95% CI 0.06-0.36) was identified. Furthermore, subgroup analysis revealed a significant effect of PM2.5 on LRI for children (0-14 years) and the elderly (≥ 70 years), and this effect was confirmed to be significant in all regions except for those comprised of Eastern Mediterranean countries.
Collapse
|
31
|
Bauwelinck M, Casas L, Nawrot TS, Nemery B, Trabelsi S, Thomas I, Aerts R, Lefebvre W, Vanpoucke C, Van Nieuwenhuyse A, Deboosere P, Vandenheede H. Residing in urban areas with higher green space is associated with lower mortality risk: A census-based cohort study with ten years of follow-up. ENVIRONMENT INTERNATIONAL 2021; 148:106365. [PMID: 33444880 DOI: 10.1016/j.envint.2020.106365] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 11/24/2020] [Accepted: 12/21/2020] [Indexed: 05/04/2023]
Abstract
BACKGROUND Epidemiological studies suggest that residing close to green space reduce mortality rates. We investigated the relationship between long-term exposure to residential green space and non-accidental and cardio-respiratory mortality. METHODS We linked the Belgian 2001 census to population and mortality register follow-up data (2001-2011) among adults aged 30 years and older residing in the five largest urban areas in Belgium (n = 2,185,170 and mean follow-up time 9.4 years). Residential addresses were available at baseline. Exposure to green space was defined as 1) surrounding greenness (2006) [normalized difference vegetation index (NDVI) and modified soil-adjusted vegetation index (MSAVI2)] within buffers of 300 m, 500 m, and 1000 m; 2) surrounding green space (2006) [Urban Atlas (UA) and CORINE Land Cover (CLC)] within buffers of 300 m, 500 m, and 1000 m; and 3) perceived neighborhood green space (2001). Cox proportional hazards models with age as the underlying time scale were used to probe into cause-specific mortality (non-accidental, respiratory, COPD, cardiovascular, ischemic heart disease (IHD), and cerebrovascular). Models were adjusted for several sociodemographic variables (age, sex, marital status, country of birth, education level, employment status, and area mean income). We further adjusted our main models for annual mean (2010) values of ambient air pollution (PM2.5, PM10, NO2 and BC, one at a time), and we additionally explored potential mediation with the aforementioned pollutants. RESULTS Higher degrees of residential green space were associated with lower rates of non-accidental and respiratory mortality. In fully adjusted models, hazard ratios (HR) per interquartile range (IQR) increase in NDVI 500 m buffer (IQR: 0.24) and UA 500 m buffer (IQR: 0.31) were 0.97 (95%CI 0.96-0.98) and 0.99 (95%CI 0.98-0.99) for non-accidental mortality, and 0.95 (95%CI 0.93-0.98) and 0.97 (95%CI 0.96-0.99) for respiratory mortality. For perceived neighborhood green space, HRs were 0.93 (95%CI 0.92-0.94) and 0.94 (95%CI 0.91-0.98) for non-accidental and respiratory mortality, respectively. The observed lower mortality risks associated with residential exposure to green space were largely independent from exposure to ambient air pollutants. CONCLUSION We observed evidence for lower mortality risk in associations with long-term residential exposure to green space in most but not all studied causes of death in a large representative cohort for the five largest urban areas in Belgium. These findings support the importance of the availability of residential green space in urban areas.
Collapse
Affiliation(s)
- Mariska Bauwelinck
- Interface Demography (ID), Department of Sociology, Vrije Universiteit Brussel, Pleinlaan 2, BE-1050 Brussels, Belgium; Research Foundation - Flanders (FWO), Egmontstraat 5, BE-1000 Brussels, Belgium.
| | - Lidia Casas
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Herestraat 49 (706), BE-3000 Leuven, Belgium; Medical Sociology and Health Policy, Department of Epidemiology and Social Medicine, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, BE-2610 Wilrijk, Belgium.
| | - Tim S Nawrot
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Herestraat 49 (706), BE-3000 Leuven, Belgium; Centre for Environmental Sciences, University of Hasselt, Agoralaan D, BE-3590 Diepenbeek, Belgium.
| | - Benoit Nemery
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Herestraat 49 (706), BE-3000 Leuven, Belgium.
| | - Sonia Trabelsi
- Center for Operations Research and Econometrics (CORE) - Universit́e catholique de Louvain, Voie du Roman Pays 34, BE-1348 Louvain-la-Neuve, Belgium.
| | - Isabelle Thomas
- Center for Operations Research and Econometrics (CORE) - Universit́e catholique de Louvain, Voie du Roman Pays 34, BE-1348 Louvain-la-Neuve, Belgium; Fonds de la Recherche Scientifique (FRS-FNRS), Rue d'Egmont 5, BE-1000 Brussels, Belgium.
| | - Raf Aerts
- Centre for Environmental Sciences, University of Hasselt, Agoralaan D, BE-3590 Diepenbeek, Belgium; Risk and Health Impact Assessment Unit, Sciensano, Juliette Wytsmanstraat 14, BE-1050 Brussels, Belgium; Division Ecology, Evolution and Biodiversity Conservation, KU Leuven, Kasteelpark Arenberg 31-2435, BE-3001 Leuven, Belgium; Division Forest, Nature and Landscape, KU Leuven, Celestijnenlaan 200E-2411, BE-3001 Leuven, Belgium.
| | - Wouter Lefebvre
- Vlaamse Instelling voor Technologisch Onderzoek (VITO), Boeretang 200, BE-2400 Mol, Belgium.
| | - Charlotte Vanpoucke
- Belgian Interregional Environment Agency (IRCEL-CELINE), Gaucheretstraat 92-94, BE-1030 Brussel, Belgium.
| | - An Van Nieuwenhuyse
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Herestraat 49 (706), BE-3000 Leuven, Belgium; Risk and Health Impact Assessment Unit, Sciensano, Juliette Wytsmanstraat 14, BE-1050 Brussels, Belgium.
| | - Patrick Deboosere
- Interface Demography (ID), Department of Sociology, Vrije Universiteit Brussel, Pleinlaan 2, BE-1050 Brussels, Belgium.
| | - Hadewijch Vandenheede
- Interface Demography (ID), Department of Sociology, Vrije Universiteit Brussel, Pleinlaan 2, BE-1050 Brussels, Belgium.
| |
Collapse
|
32
|
Verheyen VJ, Remy S, Lambrechts N, Govarts E, Colles A, Poelmans L, Verachtert E, Lefebvre W, Monsieurs P, Vanpoucke C, Nielsen F, Van den Eeden L, Jacquemyn Y, Schoeters G. Residential exposure to air pollution and access to neighborhood greenspace in relation to hair cortisol concentrations during the second and third trimester of pregnancy. Environ Health 2021; 20:11. [PMID: 33573648 PMCID: PMC7879652 DOI: 10.1186/s12940-021-00697-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 02/01/2021] [Indexed: 05/14/2023]
Abstract
BACKGROUND Exposure to air pollution during pregnancy has been associated with adverse pregnancy outcomes in studies worldwide, other studies have described beneficial effects of residential greenspace on pregnancy outcomes. The biological mechanisms that underlie these associations are incompletely understood. A biological stress response, which implies release of cortisol, may underlie associations of air pollution exposure and access to neighborhood greenspaces with health. METHODS We explored residential exposure to air pollution and residential access to neighborhood greenspaces in relation to hair cortisol concentrations of participants in a prospective pregnancy cohort study in Flanders, Belgium. Hair samples were collected at the end of the second pregnancy trimester (n = 133) and shortly after delivery (n = 81). Cortisol concentrations were measured in 3-cm scalp-near hair sections, to reflect second and third pregnancy trimester cortisol secretion. We estimated long-term (3 months before sampling) residential exposure to fine particulate matter (PM2.5), nitrogen dioxide (NO2) and black carbon (BC), assessed residential distance to major roads and residential access to neighborhood greenspaces (NHGS). Associations between residential exposures and hair cortisol concentrations were studied using linear regression models while adjusting for season of sampling. RESULTS Three-month mean residential NO2 and BC concentrations were positively associated with third pregnancy trimester hair cortisol concentrations (p = 0.008 and p = 0.017). Access to a large NHGS (10 ha or more within 800 m from residence) was negatively associated with third trimester hair cortisol concentrations (p = 0.019). Access to a large NHGS significantly moderated the association between residential proximity to major roads and second trimester hair cortisol concentrations (p = 0.021). Residential distance to major roads was negatively associated with second trimester hair cortisol concentrations of participants without access to a large NHGS (p = 0.003). The association was not significant for participants with access to a large NHGS. The moderation tended towards significance in the third pregnancy trimester (p < 0.10). CONCLUSIONS Our findings suggest a positive association between long-term residential exposure to air pollution and biological stress during pregnancy, residential access to neighborhood greenspaces may moderate the association. Further research is needed to confirm our results. TRIAL REGISTRATION The IPANEMA study is registered under number NCT02592005 at clinicaltrials.gov .
Collapse
Affiliation(s)
- Veerle Josefa Verheyen
- Flemish Institute for Technological Research (VITO), Mol, Belgium
- Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Sylvie Remy
- Flemish Institute for Technological Research (VITO), Mol, Belgium
| | | | - Eva Govarts
- Flemish Institute for Technological Research (VITO), Mol, Belgium
| | - Ann Colles
- Flemish Institute for Technological Research (VITO), Mol, Belgium
| | - Lien Poelmans
- Flemish Institute for Technological Research (VITO), Mol, Belgium
| | - Els Verachtert
- Flemish Institute for Technological Research (VITO), Mol, Belgium
| | - Wouter Lefebvre
- Flemish Institute for Technological Research (VITO), Mol, Belgium
| | - Pieter Monsieurs
- Flemish Institute for Technological Research (VITO), Mol, Belgium
| | | | - Flemming Nielsen
- The Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Lena Van den Eeden
- Department of Obstetrics and Gynecology, Antwerp University Hospital, Antwerp, Belgium
- People and Health, Thomas More University College, Lier, Belgium
| | - Yves Jacquemyn
- Department of Obstetrics and Gynecology, Antwerp University Hospital, Antwerp, Belgium
- Global Health Institute, Faculty of Medicine, University of Antwerp, Antwerp, Belgium
- Antwerp Surgical Training, Anatomy and Research Centre, University of Antwerp, Antwerp, Belgium
| | - Greet Schoeters
- Flemish Institute for Technological Research (VITO), Mol, Belgium
- Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
- The Department of Public Health, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
33
|
Kim H, Byun G, Choi Y, Kim S, Kim SY, Lee JT. Effects of long-term exposure to air pollution on all-cause mortality and cause-specific mortality in seven major cities of South Korea: Korean national health and nutritional examination surveys with mortality follow-up. ENVIRONMENTAL RESEARCH 2021; 192:110290. [PMID: 33027629 DOI: 10.1016/j.envres.2020.110290] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/09/2020] [Accepted: 09/24/2020] [Indexed: 06/11/2023]
Abstract
Evidence from cohort studies on the effects of long-term exposure to air pollution on mortality is limited in South Korea, which has high concentration of particles compared to North America, Western Europe, and Japan, and low exposure compared to China. To reduce knowledge gaps between other countries and South Korea, we investigated the association between all-cause, cardiovascular, and respiratory mortality and long-term exposure to PM10 and, as a surrogate for fine particles from local emission sources, SO2 and NO2. Participants comprised 18,220 subjects (97,114.4 person-years) residing in 73 districts of seven major cities of South Korea who were assigned to measurements of fixed-site monitoring stations and followed up. We applied Cox proportional hazard models with time-varying exposure up to three years average of air pollutants. We adjusted for individual and district-level covariates measured at baseline such as age, sex, socioeconomic positions, and health behaviors. We found that hazard ratios of PM10 and SO2 for all-cause mortality leveled off over approximately 5 ppb of SO2 and 35-50 μg/m3 of PM10. Interquartile range increases of PM10 (5.05 μg/m3), SO2 (2.09 ppb), and NO2 (11.41 ppb) were associated with 14.4% (95% CI: -0.4, 31.4), 18.1% (-4.5, 46.0), and 18.9% (-8.7, 54.7) increases in cardiovascular mortality, respectively. We did not find positive associations for respiratory mortality. The increase in cardiovascular mortality varied by sex (for PM10, in females, 27.4% (5.8, 53.5) increase), smoking (in non-smokers, 35.9% (12.7, 64.0) increase), drinking (in drinkers, 24.5% (2.1, 51.8) increase), marital status (in those not married, 23.1% (1.1, 49.9)), employment status (for SO2, in those employed, 79.4% (16.1, 177.3) increase), body mass index (in those ≥23, 47.6% (10.4, 97.3) increase), and community deprivation (for PM10, in less deprived communities, 21.0% (1.3, 44.4) increase). In summary, long-term exposure to air pollution is associated with mortality risk in South Korea. Our results suggest that the health effect of long-term exposure to air pollution may not be equal by sex, health behaviors and socioeconomic positions.
Collapse
Affiliation(s)
- Honghyok Kim
- BK21PLUS Program in "Embodiment: Health-Society Interaction," Department of Public Health Science, Graduate School, Korea University, Seoul, South Korea
| | - Garam Byun
- BK21PLUS Program in "Embodiment: Health-Society Interaction," Department of Public Health Science, Graduate School, Korea University, Seoul, South Korea
| | - Yongsoo Choi
- BK21PLUS Program in "Embodiment: Health-Society Interaction," Department of Public Health Science, Graduate School, Korea University, Seoul, South Korea
| | - Sera Kim
- BK21PLUS Program in "Embodiment: Health-Society Interaction," Department of Public Health Science, Graduate School, Korea University, Seoul, South Korea
| | - Soo-Yeon Kim
- BK21PLUS Program in "Embodiment: Health-Society Interaction," Department of Public Health Science, Graduate School, Korea University, Seoul, South Korea
| | - Jong-Tae Lee
- BK21PLUS Program in "Embodiment: Health-Society Interaction," Department of Public Health Science, Graduate School, Korea University, Seoul, South Korea; School of Health Policy and Management, College of Health Science, Korea University, Seoul, South Korea.
| |
Collapse
|
34
|
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.
Collapse
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
| |
Collapse
|
35
|
Association between Surrounding Greenness and Mortality: An Ecological Study in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124525. [PMID: 32586013 PMCID: PMC7344743 DOI: 10.3390/ijerph17124525] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 06/19/2020] [Accepted: 06/20/2020] [Indexed: 11/16/2022]
Abstract
Exposure to surrounding greenness is associated with reduced mortality in Caucasian populations. Little is known however about the relationship between green vegetation and the risk of death in Asian populations. Therefore, we opted to evaluate the association of greenness with mortality in Taiwan. Death information was retrieved from the Taiwan Death Certificate database between 2006 to 2014 (3287 days). Exposure to green vegetation was based on the normalized difference vegetation index (NDVI) collected by the Moderate Resolution Imagine Spectroradiometer (MODIS). A generalized additive mixed model was utilized to assess the association between NDVI exposure and mortality. A total of 1,173,773 deaths were identified from 2006 to 2014. We found one unit increment on NDVI was associated with a reduced mortality due to all-cause (risk ratio [RR] = 0.901; 95% confidence interval = 0.862-0.941), cardiovascular diseases (RR = 0.892; 95% CI = 0.817-0.975), respiratory diseases (RR = 0.721; 95% CI = 0.632-0.824), and lung cancer (RR = 0.871; 95% CI = 0.735-1.032). Using the green land cover as the alternative green index showed the protective relationship on all-cause mortality. Exposure to surrounding greenness was negatively associated with mortality in Taiwan. Further research is needed to uncover the underlying mechanism.
Collapse
|
36
|
Ji JS, Zhu A, Lv Y, Shi X. Interaction between residential greenness and air pollution mortality: analysis of the Chinese Longitudinal Healthy Longevity Survey. Lancet Planet Health 2020; 4:e107-e115. [PMID: 32220672 PMCID: PMC7232951 DOI: 10.1016/s2542-5196(20)30027-9] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 01/18/2020] [Accepted: 01/22/2020] [Indexed: 05/05/2023]
Abstract
BACKGROUND Both air pollution and green space have been shown to affect health. We aimed to assess whether greenness protects against air pollution-related mortality. METHODS We used data from the 2008 wave of the Chinese Longitudinal Healthy Longevity Survey. We calculated contemporaneous normalised difference vegetation index (NDVI) in the 500 m radius around each participant's residence. Fine particulate matter (PM2·5) concentration was calculated using 3-year average concentrations in 1 km × 1 km grid resolution. We used Cox proportional hazards models to estimate the effects of NDVI, PM2·5, and their interaction on all-cause mortality, adjusted for a range of covariates. FINDINGS The cohort contained 12 873 participants, totalling 47 884 person-years. There were 7426 deaths between 2008 and 2014. The mean contemporaneous NDVI was 0·42 (SD 0·21), and the mean 3-year average PM2·5 was 49·63 μg/m3 (13·72). In the fully adjusted model, the mortality hazard ratio for each 0·1-unit decrease in contemporaneous NDVI was 1·08 (95% CI 1·03-1·13), each 10 μg/m3 increase in PM2·5 was 1·13 (1·09-1·18), and the interaction term was 1·01 (1·00-1·02) with a p value of 0·027. We observed non-linear associations in our stratified analyses: people living in urban areas were more likely to benefit from greenness, and people living in rural areas were more likely to be harmed by air pollution. INTERPRETATION Our study showed some indication of a synergistic effect of greenness and air pollution, suggesting that green space planning and air pollution control can jointly improve public health. FUNDING Bill & Melinda Gates Foundation, National Institutes of Health, National Key R&D Program of China, National Natural Science Foundation of China.
Collapse
Affiliation(s)
- John S Ji
- Environmental Research Center, Duke Kunshan University, Kunshan, Jiangsu, China; Nicholas School of the Environment, Duke University, Durham, NC, USA.
| | - Anna Zhu
- Environmental Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
| | - Yuebin Lv
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaoming Shi
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China; Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China.
| |
Collapse
|