National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands; Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands.
Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands.
Environ Int. 2019 Aug;129:525-537. doi: 10.1016/j.envint.2019.05.040. Epub 2019 May 31.
BACKGROUND: Evidence is emerging that poor mental health is associated with the environmental exposures of surrounding green, air pollution and traffic noise. Most studies have evaluated only associations of single exposures with poor mental health. OBJECTIVES: To evaluate associations of combined exposure to surrounding green, air pollution and traffic noise with poor mental health. METHODS: In this cross-sectional study, we linked data from a Dutch national health survey among 387,195 adults including questions about psychological distress, based on the Kessler 10 scale, to an external database on registered prescriptions of anxiolytics, hypnotics & sedatives and antidepressants. We added data on residential surrounding green in a 300 m and a 1000 m buffer based on the Normalized Difference Vegetation Index (NDVI) and a land-use database (TOP10NL), modeled annual average air pollutant concentrations (including particulate matter (PM, PM), and nitrogen dioxide (NO)) and modeled road- and rail-traffic noise (Lden and Lnight) to the survey. We used logistic regression to analyze associations of surrounding green, air pollution and traffic noise exposure with poor mental health. RESULTS: In single exposure models, surrounding green was inversely associated with poor mental health. Air pollution was positively associated with poor mental health. Road-traffic noise was only positively associated with prescription of anxiolytics, while rail-traffic noise was only positively associated with psychological distress. For prescription of anxiolytics, we found an odds ratio [OR] of 0.88 (95% CI: 0.85, 0.92) per interquartile range [IQR] increase in NDVI within 300 m, an OR of 1.14 (95% CI: 1.10, 1.19) per IQR increase in NO and an OR of 1.07 (95% CI: 1.03, 1.11) per IQR increase in road-traffic noise. In multi exposure analyses, associations with surrounding green and air pollution generally remained but attenuated. Joint odds ratios [JOR], based on the Cumulative Risk Index (CRI) method, of combined exposure to air pollution, traffic noise and decreased surrounding green were higher than the ORs of single exposure models. Associations of environmental exposures with poor mental health differed somewhat by age. CONCLUSIONS: Studies including only one of these three correlated exposures may overestimate the influence of poor mental health attributed to the studied exposure, while underestimating the influence of combined environmental exposures.
背景：有证据表明，心理健康状况不佳与周围绿色环境、空气污染和交通噪音等环境暴露因素有关。大多数研究仅评估了单一暴露因素与心理健康状况不佳之间的关联。
目的：评估周围绿色环境、空气污染和交通噪音的综合暴露与心理健康状况不佳之间的关联。
方法：在这项横断面研究中，我们将荷兰一项针对 387195 名成年人的全国健康调查数据与外部数据库中的焦虑症、催眠药和镇静剂以及抗抑郁药的处方记录相关联，该调查包括基于 Kessler 10 量表的心理困扰问题。我们还将基于归一化植被指数（NDVI）和土地利用数据库（TOP10NL）的 300m 和 1000m 缓冲区的居住环境周围绿色数据、年度平均空气污染物浓度（包括颗粒物（PM、PM）和二氧化氮（NO））以及道路交通噪音（Lden 和 Lnight）模型添加到调查中。我们使用逻辑回归分析周围绿色环境、空气污染和交通噪音暴露与心理健康状况不佳之间的关联。
结果：在单一暴露模型中，周围绿色环境与心理健康状况不佳呈负相关。空气污染与心理健康状况不佳呈正相关。道路交通噪音仅与焦虑症的处方呈正相关，而铁路交通噪音仅与心理困扰呈正相关。对于焦虑症的处方，我们发现周围绿色环境每增加一个四分位距（IQR），NDVI 在 300m 范围内的比值比（OR）为 0.88（95%CI：0.85，0.92），NO 每增加一个 IQR 的 OR 为 1.14（95%CI：1.10，1.19），道路交通噪声每增加一个 IQR 的 OR 为 1.07（95%CI：1.03，1.11）。在多暴露分析中，与周围绿色环境和空气污染的关联仍然存在，但有所减弱。基于累积风险指数（CRI）方法的联合比值比（JOR），空气污染、交通噪声和周围绿色环境综合暴露的联合比值比高于单一暴露模型的 OR。环境暴露与心理健康状况不佳之间的关联在一定程度上因年龄而异。
结论：仅包含这三种相关暴露因素之一的研究可能会高估归因于研究暴露因素的心理健康状况不佳的影响，同时低估综合环境暴露因素的影响。
Environ Health Perspect. 2019-8-8
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