Department of Environmental Health, Harvard T. H. Chan School of Public Health, Landmark Center, 401 Park Drive, Boston, MA 02115, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.
Department of Environmental Health, Harvard T. H. Chan School of Public Health, Landmark Center, 401 Park Drive, Boston, MA 02115, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, 181 Longwood Avenue, Massachusetts 02115, USA.
Environ Pollut. 2022 Nov 1;312:120046. doi: 10.1016/j.envpol.2022.120046. Epub 2022 Aug 29.
Natural environments have been linked to decreased risk of cardiovascular disease (CVD) and respiratory disease (RSD) mortality. However, few cohort studies have looked at associations of natural environments with CVD or RSD hospitalization. The aim of this study was to evaluate these associations in a cohort of U.S. Medicare beneficiaries (∼63 million individuals). Our open cohort included all fee-for-service Medicare beneficiaries (2000-2016), aged ≥65, living in the contiguous U.S. We assessed zip code-level park cover based on the United States Geological Survey Protected Areas Database, average greenness (Normalized Difference Vegetation Index, NDVI), and percent blue space cover based on Landsat satellite images. Cox-equivalent Poisson models were used to estimate associations of the exposures with first CVD and RSD hospitalization in the full cohort and among those living in urban zip codes (≥1000 persons/mile). NDVI was weakly negatively correlated with percent park cover (Spearman ρ = -0.23) and not correlated with percent blue space (Spearman ρ = 0.00). After adjustment for potential confounders, percent park cover was not associated with CVD or RSD hospitalization in the full or urban population. An IQR (0.27) increase in NDVI was negatively associated with CVD (HR: 0.97, 95%CI: 0.96, 0.97), but not with RSD hospitalization (HR: 0.99, 95%CI: 0.98, 1.00). In urban zip codes, an IQR increase in NDVI was positively associated with RSD hospitalization (HR: 1.02, 95%CI: 1.00, 1.03). In stratified analyses, percent park cover was negatively associated with CVD and RSD hospitalization for Medicaid eligible individuals and individuals living in low socioeconomic status neighborhoods in the urban population. We observed no associations of percent blue space cover with CVD or RSD hospitalization. This study suggests that natural environments may benefit cardiorespiratory health; however, benefits may be limited to certain contexts and certain health outcomes.
自然环境与心血管疾病 (CVD) 和呼吸道疾病 (RSD) 死亡率降低有关。然而，很少有队列研究关注自然环境与 CVD 或 RSD 住院的关联。本研究旨在评估美国医疗保险受益人队列中的这些关联（约 6300 万人）。我们的开放性队列包括所有按服务收费的医疗保险受益人（2000-2016 年），年龄≥65 岁，居住在美国大陆。我们根据美国地质调查局保护区域数据库评估了邮政编码级别的公园覆盖率、平均绿化程度（归一化差异植被指数，NDVI）和基于陆地卫星图像的蓝色空间覆盖率百分比。Cox 等效泊松模型用于估计在全队列和居住在城市邮政编码（≥1000 人/英里）中的人群中，这些暴露与首次 CVD 和 RSD 住院的关联。NDVI 与公园覆盖率百分比呈弱负相关（Spearman ρ=-0.23），与蓝色空间覆盖率百分比不相关（Spearman ρ=0.00）。在调整潜在混杂因素后，公园覆盖率百分比与全人群或城市人群的 CVD 或 RSD 住院无关。NDVI 增加一个 IQR（0.27）与 CVD 呈负相关（HR：0.97，95%CI：0.96，0.97），但与 RSD 住院无关（HR：0.99，95%CI：0.98，1.00）。在城市邮政编码中，NDVI 增加一个 IQR 与 RSD 住院呈正相关（HR：1.02，95%CI：1.00，1.03）。在分层分析中，公园覆盖率百分比与城市人群中符合医疗补助条件的个体和居住在社会经济地位较低的街区的个体的 CVD 和 RSD 住院呈负相关。我们没有发现蓝色空间覆盖率百分比与 CVD 或 RSD 住院的关联。本研究表明，自然环境可能有益于心肺健康；然而，益处可能仅限于某些环境和某些健康结果。
