Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Canada.
Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Canada.
Sci Total Environ. 2021 Jun 1;771:145422. doi: 10.1016/j.scitotenv.2021.145422. Epub 2021 Jan 26.
Living closer to greenness were thought to benefit various health outcomes. We aimed to assess the association between residential greenness and mortality among patients undergoing multidrug resistant tuberculosis (MDR-TB) treatment.
We enrolled all local MDR-TB patients reported in Zhejiang, China from 2009 to 2017 and followed them throughout the treatment. We calculated the contemporaneous normalized difference vegetation index (NDVI) in the 250 and 500 m radius around patient's residence. Cox proportional hazards regression models with time-varying NDVI were used to assess the impact of greenness exposure on all-cause mortality during MDR-TB treatment, adjusting for potential individual and contextual covariates.
We ascertained 1,621 active MDR-TB cases, which contributed 3036 person-years at risk with an average follow-up of 684 days (s.d. 149 days) per patient. Among them, there were 163 deaths during follow-up, representing a crude mortality rate of 537 deaths per 10,000 person-years. Patients exposed to the second quintile (Q2) of greenness within the 500 m buffer had around 64% reduced mortality risk over the lowest quintile of greenness with hazard ratio (HR) = 0.364 (95% CI: 0.109-1.22). In lower nighttime light (NTL) areas, the hazard ratios (HR) per quintile increase in NDVI within the 500 m buffer were Q2: 0.35 (95% CI: 0.10-1.18), Q3: 0.24 (95% CI: 0.09-0.66), Q4: 0.26 (95% CI: 0.10-0.69), and Q5: 0.26 (95% CI: 0.10-0.71) relevant to the lowest quintile Q1, with a trend of p-value ≤0.01. Patients who were female, younger (<60 years), resided in urban areas, or had high PM (i.e. particles with diagram ≤2.5 μm) exposure were more likely to benefit from greenness exposure. Associations were neither observed with NDVI in the 250 m buffer nor for patients living in higher NTL areas. There was a non-linear exposure-response relationship between greenness and deaths with p-value ≤0.05.
Increasing greenness exposure along with medical treatment reduces all-cause mortality among patients living in lower NTL areas.
人们认为，居住在绿化环境中更有益于各种健康结果。我们旨在评估住宅绿化与接受耐多药肺结核（MDR-TB）治疗的患者死亡率之间的关系。
我们纳入了 2009 年至 2017 年期间在中国浙江报告的所有本地 MDR-TB 患者，并在整个治疗过程中对其进行了随访。我们计算了患者居住地周围 250 和 500 米半径内的同期归一化差异植被指数（NDVI）。使用时变 NDVI 的 Cox 比例风险回归模型，调整潜在的个体和背景协变量，评估绿色暴露对 MDR-TB 治疗期间全因死亡率的影响。
我们确定了 1621 例活动性 MDR-TB 病例，每个病例的风险暴露期为 3036 人年，平均随访 684 天（每个患者的标准差为 149 天）。其中，随访期间有 163 例死亡，粗死亡率为每 10000 人年 537 例。与最低 NDVI 五分位组相比，暴露于 500 米缓冲区内第二五分位组（Q2）的患者死亡率风险降低了约 64%，风险比（HR）=0.364（95%CI：0.109-1.22）。在低夜间光照（NTL）区域，500 米缓冲区内 NDVI 五分位组的 HR 分别为 Q2：0.35（95%CI：0.10-1.18）、Q3：0.24（95%CI：0.09-0.66）、Q4：0.26（95%CI：0.10-0.69）和 Q5：0.26（95%CI：0.10-0.71），与最低五分位组 Q1 相比呈下降趋势，p 值≤0.01。女性、年龄较小（＜60 岁）、居住在城区或 PM（即直径≤2.5μm 的颗粒）暴露水平较高的患者更有可能受益于绿色暴露。在 250 米缓冲区的 NDVI 或居住在较高 NTL 区域的患者中均未观察到与 NDVI 相关的关联。绿色与死亡之间存在非线性暴露-反应关系，p 值≤0.05。
在接受医疗治疗的同时增加绿色环境暴露可降低居住在低 NTL 区域的患者的全因死亡率。
