Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland.
Environ Int. 2017 Nov;108:176-184. doi: 10.1016/j.envint.2017.08.012. Epub 2017 Aug 31.
Green space may improve health by enabling physical activity and recovery from stress or by decreased pollution levels. We investigated the association between residential green (greenness or green space) and mortality in adults using the Swiss National Cohort (SNC) by mutually considering air pollution and transportation noise exposure. To reflect residential green at the address level, two different metrics were derived: normalised difference vegetation index (NDVI) for greenness, and high resolution land use classification data to identify green spaces (LU-green). We used stratified Cox proportional hazard models (stratified by sex) to study the association between exposure and all natural cause mortality, respiratory and cardiovascular disease (CVD), including ischemic heart disease, stroke and hypertension related mortality. Models were adjusted for civil status, job position, education, neighbourhood socio-economic position (SEP), geographic region, area type, altitude, air pollution (PM), and transportation noise. From the nation-wide SNC, 4.2 million adults were included providing 7.8years of follow-up and respectively 363,553, 85,314 and 232,322 natural cause, respiratory and CVD deaths. Hazard ratios (and 95%-confidence intervals) for NDVI [and LU-green] per interquartile range within 500m of residence were highly comparable: 0.94 (0.93-0.95) [0.94 (0.93-0.95)] for natural causes; 0.92 (0.91-0.94) [0.92 (0.90-0.95)] for respiratory; and 0.95 (0.94-0.96) [0.96 (0.95-0.98)] for CVD mortality. Protective effects were stronger in younger individuals and in women and, for most outcomes, in urban (vs. rural) and in the highest (vs. lowest) SEP quartile. Estimates remained virtually unchanged after incremental adjustment for air pollution and transportation noise, and mediation by these environmental factors was found to be small. We found consistent evidence that residential green reduced the risk of mortality independently from other environmental exposures. This suggests the protective effect goes beyond the absence of pollution sources. Environmental public health measures should not only aim at reducing pollutant exposure, but additionally maintain existing and increase residential green in areas where lacking.
绿色空间可以通过促进身体活动和缓解压力，或者通过降低污染水平来改善健康。我们通过瑞士国家队列（SNC）相互考虑空气污染和交通噪声暴露，研究了居住绿色（绿化或绿色空间）与成年人死亡率之间的关系。为了反映地址层面的居住绿色，我们得出了两个不同的指标：归一化差异植被指数（NDVI）用于绿化，以及高分辨率土地利用分类数据用于识别绿色空间（LU-green）。我们使用分层 Cox 比例风险模型（按性别分层）来研究暴露与所有自然原因死亡率、呼吸和心血管疾病（CVD）之间的关系，包括缺血性心脏病、中风和与高血压相关的死亡率。模型调整了婚姻状况、工作职位、教育程度、邻里社会经济地位（SEP）、地理区域、区域类型、海拔、空气污染（PM）和交通噪声。从全国性的 SNC 中，我们纳入了 420 万成年人，提供了 7.8 年的随访，分别有 363553、85314 和 232322 人死于自然原因、呼吸和 CVD。居住在 500 米范围内，每个四分位间距的 NDVI[和 LU-green]的危险比（95%置信区间）非常相似：自然原因的 0.94（0.93-0.95）[0.94（0.93-0.95）]；呼吸的 0.92（0.91-0.94）[0.92（0.90-0.95）]；CVD 死亡率的 0.95（0.94-0.96）[0.96（0.95-0.98）]。在年轻个体和女性中，保护作用更强，对于大多数结果，在城市（与农村相比）和最高（与最低）SEP 四分位中更强。在逐步调整空气污染和交通噪声后，估计值几乎没有变化，并且发现这些环境因素的中介作用很小。我们发现一致的证据表明，居住绿色独立于其他环境暴露因素降低了死亡率风险。这表明保护作用超出了没有污染源的范围。环境公共卫生措施不仅应旨在减少污染物暴露，还应在缺乏的地区维持和增加现有的居住绿色。
