Wan Shiyu, Rojas-Rueda David, Pretty Jules, Roscoe Charlotte, James Peter, Ji John S
Vanke School of Public Health, Tsinghua University, Beijing, China.
Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
SSM Popul Health. 2022 Aug 18;19:101194. doi: 10.1016/j.ssmph.2022.101194. eCollection 2022 Sep.
Exposure to natural greenspace benefits health through direct and indirect pathways: increasing physical activity, improving mental health, relieving social isolation, reducing exposure to extreme temperature, noise, and air pollution. Understanding the etiologic pathway of greenspace and health is needed. Here, we used a large cohort follow-up data from the U.K. Biobank to quantify the magnitude of behavioural factors, psychological factors, biomarkers/physiological measurements, co-morbid diseases, and environmental exposure as potential mediators in the relationship between greenspace and mortality. We estimated hazard ratios (HR) with Cox proportional hazards models, and undertook exploratory mediation analyses to quantify the relative contribution of five types of mediators. Our results indicate greenspace was strongly associated with lower mortality risks [per IQR of public greenspace (HR = 0.90 (95% CI 0.86-0.84)) and domestic gardens (HR = 0.91, (95% CI 0.88-0.94))]. The protective associations were especially pronounced among those with lower individual-level socioeconomic status or living in places with area-level deprivation. Exploratory mediation analysis detected benefits in pathways through reducing air pollution, relieving social isolation and depression, increased physical activity and time spent outdoor, better lung function (FEV1/FVC), and having higher serum vitamin D levels.
增加身体活动、改善心理健康、缓解社会隔离、减少暴露于极端温度、噪音和空气污染中。需要了解绿地与健康之间的病因学途径。在此，我们使用了来自英国生物银行的大规模队列随访数据，以量化行为因素、心理因素、生物标志物/生理测量、共病疾病和环境暴露作为绿地与死亡率之间关系的潜在中介因素的影响程度。我们使用Cox比例风险模型估计风险比（HR），并进行探索性中介分析以量化五种类型中介因素的相对贡献。我们的结果表明，绿地与较低的死亡风险密切相关[公共绿地每增加一个四分位间距（HR = 0.90（95% CI 0.86 - 0.84））和家庭花园（HR = 0.91，（95% CI 0.88 - 0.94））]。这种保护关联在个人社会经济地位较低或生活在地区贫困地区的人群中尤为明显。探索性中介分析发现，通过减少空气污染、缓解社会隔离和抑郁、增加身体活动和户外时间、改善肺功能（FEV1/FVC）以及提高血清维生素D水平等途径可带来益处。
