Peking University Center for Public Health and Epidemic Preparedness & Response, Peking University; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, 100191, China.
Peking University Center for Public Health and Epidemic Preparedness & Response, Peking University; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, 100191, China; Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China.
Environ Int. 2024 Aug;190:108894. doi: 10.1016/j.envint.2024.108894. Epub 2024 Jul 18.
The potential for residential greenness to improve cardiovascular health through both physical and psychological mechanisms is well recognized. However, evidence from rapidly urbanizing developing countries and cohort-based causal inference approaches, remains limited. We aim to examine the effect of residential greenness and time to cardiovascular mortality in South China.
We utilized data from a community-based population survey involving 748,209 participants at baseline from 2009 to 2015, followed up until 2020. Residential greenness exposure was assessed by the annual Normalized Difference Vegetation Index (NDVI) in the 500 m radius of each participant's residence. We used time-varying proportional hazard Cox models coupled with inverse probability weighting to fit marginal structural models and obtain hazard ratios (HRs) for cardiovascular disease (CVD) mortality after adjusting for confounders. Multiple effect modifiers on both additive and multiplicative scales were further explored.
A total of 15,139 CVD-related deaths were identified during a median of 7.9 years of follow-up. A protective effect was found between higher greenness exposure and reduced CVD mortality, with a 9.3 % lower rate of total CVD mortality (HR 0.907, 95 % CI 0.859-0.957) based on a 0.1 increase in annual average NDVI. Demographic (age, marital status) and lifestyle factors (smoking, drinking status) were found to modify the association between residential greenness and CVD mortality (all P interaction values < 0.05 or 95 %CI for RERI excluded the value 0). Notably, this effect was more pronounced among older adults, married, and individuals having healthier lifestyles, indicating a greater benefit from greenness for these subgroups.
Our findings support a causal link between increased residential greenness exposure and a reduced risk of CVD mortality in South China with marked heterogenous effects, which has public health implications for cultivating greener urban environments to mitigate the impact of CVD within the context of rapid urbanization.
人们已经充分认识到，居住环境中的绿色植物通过生理和心理机制改善心血管健康的潜力。然而，来自快速城市化的发展中国家和基于队列的因果推断方法的证据仍然有限。我们旨在研究中国南方居住环境绿色度与心血管死亡率之间的关系。
我们利用了一项基于社区的人群调查的数据，该调查涉及 2009 年至 2015 年期间的 748209 名参与者，随访至 2020 年。居住环境绿色度的暴露情况通过每个参与者住所 500 米半径内的年度归一化差异植被指数（NDVI）进行评估。我们使用时变比例风险 Cox 模型结合逆概率加权来拟合边缘结构模型，并在调整混杂因素后获得心血管疾病（CVD）死亡率的危险比（HR）。进一步探讨了在加性和乘法尺度上的多个效应修饰因子。
在中位 7.9 年的随访期间，共发生了 15139 例与 CVD 相关的死亡。较高的绿色环境暴露与降低 CVD 死亡率之间存在保护作用，总 CVD 死亡率降低了 9.3%（HR0.907，95%CI0.859-0.957），这是基于每年平均 NDVI 增加 0.1 而得出的结果。发现人口统计学（年龄、婚姻状况）和生活方式因素（吸烟、饮酒状况）会改变居住环境绿色度与 CVD 死亡率之间的关联（所有 P 交互值均<0.05 或 95%CI 排除了 RERI 值为 0）。值得注意的是，这种效应在年龄较大、已婚和生活方式更健康的个体中更为明显，这表明对于这些亚组人群，绿色度的益处更大。
我们的研究结果支持了在中国南方，增加居住环境绿色度与降低 CVD 死亡率之间存在因果关系，且这种关系存在明显的异质性，这对在快速城市化背景下培养更绿色的城市环境以减轻 CVD 影响具有公共卫生意义。
