Lee Whanhee, Heo Seulkee, Stewart Rory, Wu Xiao, Fong Kelvin C, Son Ji-Young, Sabath Benjamin, Braun Danielle, Park Jae Yoon, Kim Yong Chul, Lee Jung Pyo, Schwartz Joel, Kim Ho, Dominici Francesca, Bell Michelle L
School of Biomedical Convergence Engineering, College of Information and Biomedical Engineering, Pusan National University, Yangsan, Republic of Korea.
Yale School of the Environment, Yale University, New Haven, CT, USA.
Environ Int. 2023 Mar;173:107844. doi: 10.1016/j.envint.2023.107844. Epub 2023 Feb 21.
Recent studies have identified the association of environmental stressors with reduced kidney function and the development of kidney disease. While residential greenness has been linked to many health benefits, the association between residential greenness and the development of kidney disease is not clear. We aimed to investigate the association between residential greenness and the development of kidney disease.
We performed a longitudinal population-based cohort study including all fee-for-service Medicare Part A beneficiaries (aged 65 years or older) in Massachusetts (2000-2016). We assessed greenness with the annual average Enhanced Vegetation Index (EVI) based on residential ZIP codes of beneficiaries. We applied Cox-equivalent Poisson models to estimate the association between EVI and first hospital admission for total kidney disease, chronic kidney disease (CKD), and acute kidney injury (AKI), separately.
Data for 1,462,949 beneficiaries who resided in a total of 644 ZIP codes were analyzed. The total person-years of follow-up for total kidney disease, CKD, and AKI were 9.8, 10.9, and 10.8 million person-years, respectively. For a 0.1 increase in annual EVI, the hazard ratios (HRs) were 0.95 (95% CI: 0.93 to 0.97) for the first hospital admission for total kidney disease, and the association was more prominent for AKI (HR: 0.94 with 95% CI: 0.92 to 0.97) than CKD (HR: 0.98 with 95% CI: 0.95-1.01]). The estimated effects of EVI on kidney disease were generally more evident in White beneficiaries and those residing in metropolitan areas compared to the overall population.
This study found that higher levels of annual residential greenness were associated with a lower risk of the first hospital admission for kidney diseases. Results are consistent with the hypothesis that higher residential greenness benefits kidney patients.
近期研究已确定环境应激源与肾功能下降及肾病发展之间的关联。虽然居住环境绿化已被证明与诸多健康益处相关，但居住环境绿化与肾病发展之间的关联尚不清楚。我们旨在研究居住环境绿化与肾病发展之间的关联。
我们开展了一项基于人群的纵向队列研究，纳入了马萨诸塞州所有按服务收费的医疗保险A部分受益人（年龄在65岁及以上）（2000 - 2016年）。我们根据受益人的居住邮政编码，使用年度平均增强植被指数（EVI）评估绿化程度。我们分别应用Cox等效泊松模型来估计EVI与肾病、慢性肾病（CKD）和急性肾损伤（AKI）首次住院之间的关联。
分析了居住在总共644个邮政编码区域的1,462,949名受益人的数据。肾病、CKD和AKI的总随访人年数分别为980万、1090万和1080万人年。年度EVI每增加0.1，肾病首次住院的风险比（HR）为0.95（95%CI：0.93至0.97），且该关联在AKI中比在CKD中更显著（HR：0.94，95%CI：0.92至0.97），而CKD的HR为0.98（95%CI：0.95 - 1.01）。与总体人群相比，EVI对肾病的估计影响在白人受益人和居住在大都市地区的人群中通常更明显。
本研究发现，年度居住绿化程度较高与肾病首次住院风险较低相关。结果与较高的居住绿化对肾病患者有益的假设一致。
