Iyer Hari S, James Peter, Valeri Linda, Hart Jaime E, Pernar Claire H, Mucci Lorelei A, Holmes Michelle D, Laden Francine, Rebbeck Timothy R
Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
Environ Epidemiol. 2020 Apr 9;4(2):e091. doi: 10.1097/EE9.0000000000000091. eCollection 2020 Apr.
Growing evidence suggests that neighborhood contextual environment could influence risk factors and, therefore, incidence of lethal prostate cancer. We studied the association between neighborhood greenness and lethal prostate cancer incidence and assessed mediation by vigorous physical activity.
A total of 47,958 participants were followed in the Health Professionals Follow-up Study from 1986 to 2014. Neighborhood greenness exposure was estimated using normalized difference vegetation index (NDVI) with 1 km resolution, assigned to home or work addresses at start of follow-up. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) were estimated using sequentially adjusted Cox models with individual and contextual prostate cancer risk factors as covariates. Analyses were compared among those whose addresses were constant over follow-up and stratified by population density and address type.
We observed 898 cases over 1,054,743 person-years. An interquartile range increase in NDVI was associated with 5% lower rate of lethal prostate cancer (aHR = 0.95, 95% CI = 0.88, 1.03), with stronger associations in nonmovers (aHR = 0.92, 95% CI = 0.85, 1.01). Inverse associations were observed among men in high (aHR = 0.90, 95% CI = 0.82, 0.99) but not low (aHR = 1.11, 95% CI = 0.95, 1.29, = 0.086) population density areas, and those reporting from work (aHR = 0.87, 95% CI = 0.75, 1.01) but not home (aHR = 1.04, 95% CI = 0.91, 1.17, = 0.10) addresses. There was no evidence of mediation by vigorous physical activity.
We report inverse associations between neighborhood greenness and lethal prostate cancer when restricting to nonmovers and in high population density areas. Replication could confirm findings and clarify mechanisms.
越来越多的证据表明，邻里环境可能会影响危险因素，进而影响致命性前列腺癌的发病率。我们研究了邻里绿化与致命性前列腺癌发病率之间的关联，并评估了剧烈体育活动的中介作用。
在1986年至2014年的卫生专业人员随访研究中，共对47958名参与者进行了随访。使用分辨率为1千米的归一化植被指数（NDVI）估算邻里绿化暴露情况，并在随访开始时将其分配到家庭或工作地址。使用以个体和环境前列腺癌危险因素作为协变量的逐步调整Cox模型估算调整后的风险比（aHRs）和95%置信区间（CIs）。在随访期间地址不变的人群中进行分析，并按人口密度和地址类型进行分层。
在1054743人年的随访中，我们观察到898例病例。NDVI的四分位数间距增加与致命性前列腺癌发病率降低5%相关（aHR = 0.95，95%CI = 0.88，1.03），在地址不变的人群中关联更强（aHR = 0.92，95%CI = 0.85，1.01）。在人口密度高的地区（aHR = 0.90，95%CI = 0.82，0.99）而非低人口密度地区（aHR = 1.11，95%CI = 0.95，1.29，P = 0.086）以及报告工作地址（aHR = 0.87，95%CI = 0.75，1.01）而非家庭地址（aHR = 1.04，95%CI = 0.91，1.17，P = 0.10）的男性中观察到负相关。没有证据表明剧烈体育活动起到中介作用。
当仅限于地址不变的人群和高人口密度地区时，我们报告了邻里绿化与致命性前列腺癌之间的负相关。重复研究可以证实这些发现并阐明其机制。
