Cardiovascular Epidemiology Research Unit, Beth Israel Deaconess Medical Center, Boston, MA 02215 USA; Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA.
Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA; Department of Forestry and Natural Resources, College of Agriculture, National Chiayi University, Chiayi, Taiwan.
Environ Res. 2014 Aug;133:42-8. doi: 10.1016/j.envres.2014.05.005. Epub 2014 Jun 4.
Residential proximity to green space has been associated with physical and mental health benefits, but whether green space is associated with post-stroke survival has not been studied.
Patients ≥ 21 years of age admitted to the Beth Israel Deaconess Medical Center (BIDMC) between 1999 and 2008 with acute ischemic stroke were identified. Demographics, presenting symptoms, medical history and imaging results were abstracted from medical records at the time of hospitalization for stroke onset. Addresses were linked to average Normalized Difference Vegetation Index, distance to roadways with more than 10,000 cars/day, and US census block group. Deaths were identified through June 2012 using the Social Security Death Index.
There were 929 deaths among 1645 patients with complete data (median follow up: 5 years). In multivariable Cox models adjusted for indicators of medical history, demographic and socioeconomic factors, the hazard ratio for patients living in locations in the highest quartile of green space compared to the lowest quartile was 0.78 (95% Confidence Interval: 0.63-0.97) (p-trend = 0.009). This association remained statistically significant after adjustment for residential proximity to a high traffic road.
Residential proximity to green space is associated with higher survival rates after ischemic stroke in multivariable adjusted models. Further work is necessary to elucidate the underlying mechanisms for this association, and to better understand the exposure-response relationships and susceptibility factors that may contribute to higher mortality in low green space areas.
居住环境与绿地的接近程度与身心健康有益相关，但绿地与中风后存活之间是否存在关联尚未得到研究。
1999 年至 2008 年间，在贝斯以色列女执事医疗中心（BIDMC）住院的年龄≥21 岁的急性缺血性中风患者被确定为研究对象。在发病时，从住院病历中提取人口统计学、发病症状、既往病史和影像学结果。地址与平均归一化植被指数、距每天超过 10000 辆汽车的道路的距离以及美国人口普查块组相关联。截至 2012 年 6 月，通过社会保障死亡指数确定死亡情况。
在具有完整数据的 1645 名患者中，有 929 人死亡（中位随访时间：5 年）。在多变量 Cox 模型中，调整了既往病史、人口统计学和社会经济因素的指标后，与居住在绿地最高四分位区的患者相比，居住在绿地最低四分位区的患者的死亡风险比为 0.78（95%置信区间：0.63-0.97）（p 趋势=0.009）。在调整居住靠近高交通流量道路的因素后，这种相关性仍然具有统计学意义。
在多变量调整模型中，居住环境与绿地的接近程度与缺血性中风后更高的生存率相关。需要进一步的工作来阐明这种关联的潜在机制，并更好地理解可能导致低绿地区域死亡率更高的暴露-反应关系和易感因素。
