Meng Xia, Zhang Lina, Chan Ka Hung, Lv Jun, Lam Hubert, Liu Cong, Chen Renjie, Kartsonaki Christiana, Wright Neil, Du Huaidong, Yang Ling, Chen Yiping, Sun Dianjianyi, Pei Pei, Yu Canqing, Kan Haidong, Chen Zhengming, Li Liming
School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai 200032, China.
School of Public Health, Zhejiang Chinese Medical University, Hangzhou 310053, China.
Eco Environ Health. 2025 Apr 24;4(2):100148. doi: 10.1016/j.eehl.2025.100148. eCollection 2025 Jun.
Prospective evidence on the relationship of greenness with cardiovascular disease (CVD) incidence is limited in low- and middle-income countries. In 512,691 participants of the China Kadoorie Biobank cohort across 10 regions in China, we calculated the levels of greenness exposure based on satellite-retrieved Normalized Difference Vegetation Index (NDVI) data. Annual maximum NDVI (NDVI) values were estimated within 500 m and 1000 m buffers around the locations for the participants during the follow-up periods. Record linkages to healthcare databases provided incidence data of total CVD, ischemic heart disease and stroke during 2005-2017. Time-varying Cox proportional hazards regression was used to assess the associations between greenness exposure and CVD incidence. After 5.08 million person-years of follow-up, 148,032 incident CVD events were recorded. The overall average level of NDVI was 0.543 for all participants. We observed significant inverse associations of greenness with the incidence of CVD and its subtypes. Specifically, the hazard ratio for total CVD incidence was 0.976 (95% confidence interval: 0.958, 0.994) per 0.1 increase in NDVI within a 500 m buffer. As the 5 rural regions have achieved the WHO recommended greenness goal values, we compared the greenness levels in the 5 urban regions with the WHO's goal for greenness and found that, on average, 3.81% of total CVD incidence might be averted if the recommended greenness values could be achieved. Exposure to a higher level of greenness was associated with a lower risk of CVD incidence in Chinese adults.
在低收入和中等收入国家，关于绿地与心血管疾病（CVD）发病率之间关系的前瞻性证据有限。在中国卡多里生物银行队列研究涉及的中国10个地区的512,691名参与者中，我们基于卫星反演的归一化植被指数（NDVI）数据计算了绿地暴露水平。在随访期间，估计参与者所在位置周围500米和1000米缓冲区内的年度最大NDVI值。与医疗数据库的记录链接提供了2005年至2017年期间CVD、缺血性心脏病和中风的发病数据。采用时变Cox比例风险回归来评估绿地暴露与CVD发病率之间的关联。经过508万人年的随访，记录了148,032例CVD发病事件。所有参与者的NDVI总体平均水平为0.543。我们观察到绿地与CVD及其亚型的发病率之间存在显著的负相关。具体而言，在500米缓冲区内，NDVI每增加0.1，CVD总发病率的风险比为0.976（95%置信区间：0.958, 0.994）。由于5个农村地区已达到世界卫生组织建议的绿地目标值，我们将5个城市地区的绿地水平与世界卫生组织的绿地目标进行了比较，发现如果能够实现建议的绿地值，平均而言，可能避免3.81%的CVD总发病率。在中国成年人中，接触更高水平的绿地与较低的CVD发病风险相关。
