Zhang Lina, Shi Shuyan, Wu Shenpeng, Yang Ying, Xu Jihong, Zhang Ya, Wang Qiaomei, Shen Haiping, Zhang Yiping, Yan Donghai, Peng Zuoqi, Liu Cong, Wang Weidong, Jiang Yixuan, Shi Su, Chen Renjie, Kan Haidong, He Yuan, Meng Xia, Ma Xu
School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai 200032, China.
National Research Institute for Family Planning, Beijing 100081, China.
Innovation (Camb). 2022 Apr 9;3(3):100241. doi: 10.1016/j.xinn.2022.100241. eCollection 2022 May 10.
Exposure to greenness may lead to a wide range of beneficial health outcomes. However, the effects of greenness on preterm birth (PTB) are inconsistent, and limited studies have focused on the subcategories of PTB. A total of 3,751,672 singleton births from a national birth cohort in mainland China were included in this study. Greenness was estimated using the satellite-based Normalized Difference Vegetation Index (NDVI) and Enhanced Vegetation Index with 500-m and 1,000-m buffers around participants' addresses. The subcategories of PTB (20-36 weeks) included extremely PTB (EPTB, 20-27 weeks), very PTB (VPTB, 28-31 week), and moderate-to-late PTB (MPTB, 32-36 weeks). Gestational age (GA) was included as another birth outcome. We used logistic regression models and multiple linear regression models to analyze these associations throughout the entire pregnancy. We found inverse associations between greenness and PTB and positive associations between greenness and GA. Specifically, an increase of 0.1 NDVI exposure within a 500-m buffer throughout the entire pregnancy was significantly associated with decreases in PTB (odds ratio [OR], 0.930; 95% confidence interval [CI], 0.927-0.932), EPTB (OR, 0.820; 95% CI, 0.801-0.839), VPTB (OR, 0.913; 95% CI, 0.908-0.919), MPTB (OR, 0.934; 95% CI, 0.931-0.936), and an increase in GA (β = 0.050; 95% CI, 0.049-0.051 weeks). These results suggest the potential protective effects of greenness on PTB and its subcategories: MPTB, VPTB, and EPTB in China.
接触绿色环境可能会带来一系列有益的健康结果。然而，绿色环境对早产（PTB）的影响并不一致，且针对早产亚型的研究有限。本研究纳入了中国大陆一个全国性出生队列中的3751672例单胎分娩。利用基于卫星的归一化植被指数（NDVI）和增强植被指数，以参与者住址周围500米和1000米的缓冲区来估算绿色环境。早产（20 - 36周）的亚型包括极早早产（EPTB，20 - 27周）、非常早产（VPTB，28 - 31周）以及中度至晚期早产（MPTB，32 - 36周）。孕周（GA）被纳入作为另一项出生结局。我们使用逻辑回归模型和多元线性回归模型来分析整个孕期的这些关联。我们发现绿色环境与早产之间呈负相关，与孕周呈正相关。具体而言，在整个孕期，500米缓冲区内NDVI暴露增加0.1与早产（优势比[OR]，0.930；95%置信区间[CI]，0.927 - 0.932）、极早早产（OR，0.820；95% CI，0.801 - 0.839）、非常早产（OR，0.913；95% CI，0.908 - 0.919）、中度至晚期早产（OR，0.934；95% CI，0.931 - 0.936）的减少以及孕周增加（β = 0.050；95% CI，0.049 - 0.051周）显著相关。这些结果表明绿色环境对中国早产及其亚型（中度至晚期早产、非常早产和极早早产）具有潜在的保护作用。
