Luque-García Leire, García-Baquero Gonzalo, Lertxundi Aitana, Al-Delaimy Wael K, Yang Tiffany C, Delgado-Saborit Juana Maria, Guxens Mònica, McEachan Rosemary R C, Vrijheid Martine, Estarlich Marisa, Nieuwenhuijsen Mark, Ibarluzea Jesús
Department of Preventive Medicine and Public Health, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), 48940 Leioa, Spain; Biogipuzkoa Health Research Institute, Environmental Epidemiology and Child Development Group, Paseo Doctor Begiristain s/n, 20014 Donostia- San Sebastian, Spain; Osakidetza Basque Health Service, Goierri Alto-Urola Integrated Health Organisation, Zumarraga Hospital, 20700 Zumarraga, Spain.
Biogipuzkoa Health Research Institute, Environmental Epidemiology and Child Development Group, Paseo Doctor Begiristain s/n, 20014 Donostia- San Sebastian, Spain; CEADIR. Faculty of Biology, University of Salamanca, Avda Licenciado Méndez Nieto s/n, 37007 Salamanca, Spain.
Sci Total Environ. 2025 Mar 15;969:178907. doi: 10.1016/j.scitotenv.2025.178907. Epub 2025 Feb 24.
Epidemiological studies suggest that exposure to greenness may protect children attention-deficit/hyperactivity disorder (ADHD) diagnosis. However, evidence to date is limited while no previous research has independently investigated exposure to prenatal greenness.
We conducted a nested case-control study with data from Born in Bradford (BiB) and INfancia y Medio Ambiente (INMA) birth cohorts to investigate the association between exposure to various types of residential greenness and ADHD diagnosis, considering both pregnancy and early childhood exposure periods independently. PM was tested as a potential mediator of the association.
Children with ADHD were identified based on a confirmed medical diagnosis. Pregnancy and early childhood exposure to residential greenness were estimated through Normalized Difference Vegetation Index (NDVI) within 300-m, urban green space and natural green space percentages within 300-m, and the linear distance to the closest green space in meters. We performed a conditional logistic regression to analyze the association between the included greenness metrics and ADHD.
We found no statistically significant associations between any of the pregnancy and early childhood greenness metrics and ADHD diagnosis in the BiB cohort. Further analysis on the INMA cohort found that higher urban green space percentage slightly increased the risk of ADHD diagnosis during both pregnancy (total effects: OR 1.04, 95 % CI 1.01 to 1.07, p = 0.012; direct effects: OR 1.06, 95 % CI 1.03 to 1.10, p < 0.001) and early childhood (total effects: OR 1.03, 95 % CI 1.00 to 1.07, p = 0.042; direct effects: OR 1.04, 95 % CI 1.00 to 1.07, p = 0.033). However, these associations were not supported by the sensitivity analyses.
This study found both null and inconsistent associations between the included greenness metrics and ADHD. Further research is warranted to elucidate the potential role of exposure to different types of greenness in ADHD diagnosis.
流行病学研究表明，接触绿色环境可能有助于预防儿童注意力缺陷多动障碍（ADHD）的诊断。然而，迄今为止的证据有限，且此前尚无研究单独调查产前接触绿色环境的情况。
我们利用来自布拉德福德出生队列（BiB）和婴儿与环境队列（INMA）的数据进行了一项巢式病例对照研究，以独立考虑孕期和幼儿期暴露阶段，研究不同类型居住绿色环境暴露与ADHD诊断之间的关联。将颗粒物（PM）作为该关联的潜在中介因素进行检验。
根据确诊的医学诊断确定患有ADHD的儿童。通过300米范围内的归一化植被指数（NDVI）、300米范围内城市绿地和自然绿地的百分比以及到最近绿地的直线距离（以米为单位）来估算孕期和幼儿期的居住绿色环境暴露情况。我们进行了条件逻辑回归分析，以分析纳入的绿色环境指标与ADHD之间的关联。
我们发现，在BiB队列中，孕期和幼儿期的任何绿色环境指标与ADHD诊断之间均无统计学显著关联。对INMA队列的进一步分析发现，较高的城市绿地百分比在孕期（总效应：比值比1.04，95%置信区间1.01至1.07，p = 0.012；直接效应：比值比1.06，95%置信区间1.03至1.10，p < 0.001）和幼儿期（总效应：比值比1.03，95%置信区间1.00至1.07，p = 0.042；直接效应：比值比1.04，95%置信区间1.00至1.07，p = 0.033）均略微增加了ADHD诊断风险。然而，敏感性分析不支持这些关联。
本研究发现纳入的绿色环境指标与ADHD之间既无关联，结果也不一致。有必要进一步开展研究，以阐明接触不同类型绿色环境在ADHD诊断中的潜在作用。
