Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan 2nd Road, Guangzhou 510080, Guangdong, China.
Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangdong Provincial Engineering Technology Research Center of Environmental and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, 74 Zhongshan 2nd Road, Yuexiu District, Guangzhou 510080, China.
Environ Int. 2020 Sep;142:105859. doi: 10.1016/j.envint.2020.105859. Epub 2020 Jun 25.
Proximity to greenness has shown protective effects on coronary heart diseases by limiting exposure to environmental hazards, encouraging physical activity, and reducing mental stress. However, no studies have previously evaluated the impacts of greenness on congenital heart defects (CHDs). We examined the association between maternal residential greenness and the risks of CHDs.
We conducted a case-control study (8042 children with major CHDs and 6887 controls without malformations) in 21 cities in Southern China, 2004 - 2016. CHDs cases were diagnosed and verified by obstetrician, pediatrician, or pediatric cardiologists, within one year. We estimated maternal residential greenness using satellite-derived normalized difference vegetation index (NDVI) in zones of 500 meters (m) and 1000 m surrounding participants' residences. Logistic regression models were used to assess NDVI-CHD relationships adjusting for confounders.
Interquartile range NDVI increases within 500 m or 1000 m were associated with odds ratios (OR) of 0.95 (95% confidence interval (CI): 0.92, 0.98) and 0.94 (95%CI: 0.91, 0.97) for total CHDs respectively. Air pollutants mediated 52.1% of the association. We also identified a protective threshold at 0.21 NDVI on CHD. Similar protective effects from greenness were found in most CHDs subtypes. The protective associations were stronger for fall, urban or permanent residents, higher household income maternal age ≤35 years of age, and high maternal education (ORs: ranged from 0.85 to 0.96).
Our findings suggest a beneficial effect of maternal residential greenness on CHDs. Further studies are needed to confirm our findings, which will help to refine preventive health and urban design strategies.
绿色环境与冠心病的保护作用有关，其可以减少环境危害、鼓励身体活动、减轻精神压力。然而，目前还没有研究评估绿色环境对先天性心脏病（CHD）的影响。本研究旨在评估母亲居住地绿化与 CHD 风险之间的关联。
本研究是一项在中国南方 21 个城市进行的病例对照研究（8042 例患有重大 CHD 的儿童和 6887 例无畸形的对照），时间范围为 2004 年至 2016 年。CHD 病例由妇产科医生、儿科医生或儿科心脏病专家在一年内确诊和验证。我们使用卫星衍生的归一化差异植被指数（NDVI）评估母亲居住地周围 500 米和 1000 米范围内的区域绿化情况。使用逻辑回归模型调整混杂因素后评估 NDVI 与 CHD 的关系。
500 米或 1000 米内的四分位间距 NDVI 增加与总 CHD 的比值比（OR）为 0.95（95%置信区间（CI）：0.92，0.98）和 0.94（95%CI：0.91，0.97）相关。空气污染物解释了该关联的 52.1%。我们还发现了一个 0.21 的 NDVI 与 CHD 相关的保护阈值。绿化对大多数 CHD 亚型也有类似的保护作用。对于秋季、城市或永久性居民、高收入家庭、母亲年龄≤35 岁和高母亲教育的个体（OR 范围为 0.85 至 0.96），这种保护关联更强。
本研究结果表明母亲居住地绿化对 CHD 有益。需要进一步的研究来证实我们的发现，这将有助于完善预防保健和城市设计策略。
