The effect of residential greenness on cardiovascular mortality from a large cohort in South China: An in-depth analysis of effect modification by multiple demographic and lifestyle characteristics

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 o...

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Vydané v:Environment international Ročník 190; s. 108894
Hlavní autori: Wang, Xiaowen, Zhang, Yuqin, Tarik, Benmarhnia, Zhang, Kai, Lin, Shao, Deng, Xinlei, Gu, Haogao, Wu, Wenjing, Lin, Xiao, Du, Zhicheng, Wang, Ying, Qu, Yanji, Lin, Ziqiang, Zhang, Man, Sun, Yongqing, Dong, Guang-hui, Wei, Yongyue, Zhang, Wangjian, Hao, Yuantao
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: Netherlands Elsevier Ltd 01.08.2024
Elsevier
Predmet:
Adult
Aged
Cardiovascular disease
cardiovascular diseases
Cardiovascular Diseases - mortality
Causal inference
China
China - epidemiology
Cohort
Cohort Studies
environment
Female
Greenness
Humans
Life Sciences
Life Style
lifestyle
Lifestyles Interaction
Male
marital status
Middle Aged
mortality
normalized difference vegetation index
probability
Proportional Hazards Models
protective effect
public health
Residence Characteristics
Risk Factors
risk reduction
surveys
urbanization
China
Causal inference
Cardiovascular disease
Greenness
Cohort
Lifestyles Interaction
ISSN:0160-4120, 1873-6750, 1873-6750
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Shrnutí: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.
Bibliografia:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
ISSN:0160-4120
1873-6750
1873-6750
DOI:10.1016/j.envint.2024.108894