Residential greenness and chronic obstructive pulmonary disease in a large cohort in southern China: Potential causal links, risk trajectories, and mediation pathways

[Display omitted] •Residential greenness may protect against COPD mortality.•Residential greenness may protect against mortality after COPD or COPD-related readmission.•Higher nighttime light levels amplified the observed protective impacts of greenness.•Greenness may primarily protect against COPD...

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Vydané v:	Journal of advanced research Ročník 71; s. 355 - 367
Hlavní autori:	Wu, Wenjing, Chen, Dan, Ruan, Xingling, Wu, Gonghua, Deng, Xinlei, Lawrence, Wayne, Lin, Xiao, Li, Zhiqiang, Wang, Ying, Lin, Ziqiang, Zhu, Shuming, Deng, Xueqing, Lin, Qiaoxuan, Hao, Chun, Du, Zhicheng, Wei, Jing, Zhang, Wangjian, Hao, Yuantao
Médium:	Journal Article
Jazyk:	English
Vydavateľské údaje:	Egypt Elsevier B.V 01.05.2025 Elsevier
Predmet:	Adult Aged Body Mass Index Causal Inference China - epidemiology Chronic Obstructive Pulmonary Disease Cohort Studies Female Green Space Hospitalization - statistics & numerical data Humans Male Mediation Analyses Middle Aged Original Manuscript Particulate Matter - analysis Prognoses Proportional Hazards Models Pulmonary Disease, Chronic Obstructive - epidemiology Pulmonary Disease, Chronic Obstructive - etiology Pulmonary Disease, Chronic Obstructive - mortality Residence Characteristics - statistics & numerical data Risk Factors China Causal Inference Chronic Obstructive Pulmonary Disease Mediation Analyses Prognoses Green Space
ISSN:	2090-1232, 2090-1224, 2090-1224
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Shrnutí:	[Display omitted] •Residential greenness may protect against COPD mortality.•Residential greenness may protect against mortality after COPD or COPD-related readmission.•Higher nighttime light levels amplified the observed protective impacts of greenness.•Greenness may primarily protect against COPD mortality by reducing particulate matter exposure. Residential greenness may influence COPD mortality, but the causal links, risk trajectories, and mediation pathways between them remain poorly understood. We aim to comprehensively identify the potential causal links, characterize the dynamic progression of hospitalization or posthospital risk, and quantify mediation effects between greenness and COPD. This study was conducted using a community-based cohort enrolling individuals aged ≥ 18 years in southern China from January 1, 2009 to December 31, 2015. Greenness was characterized by normalized difference vegetation index (NDVI) around participants’ residential addresses. We applied doubly robust Cox proportional hazards model, multi-state model, and multiple mediation method, to investigate the potential causal links, risk trajectories among baseline, COPD hospitalization, first readmission due to COPD or COPD-related complications, and all-cause death, as well as the multiple mediation pathways (particulate matter [PM], temperature, body mass index [BMI] and physical activity) connecting greenness exposure to COPD mortality. Our final analysis included 581,785 participants (52.52% female; average age: 48.36 [Standard Deviation (SD): 17.56]). Each interquartile range (IQR: 0.06) increase in NDVI was associated with a reduced COPD mortality risk, yielding a hazard ratio (HR) of 0.88 (95 % CI: 0.81, 0.96). Furthermore, we observed per IQR (0.04) increase in NDVI was inversely associated with the risk of multiple transitions (baseline − COPD hospitalization, baseline − death, and readmission − death risks), especially a declined risk of all-cause death after readmission (HR = 0.66 [95 %CI: 0.44, 0.99]). Within the observed association between greenness and COPD mortality, three mediators were identified, namely PM, temperature, and BMI (HR for the total indirect effect: 0.773 [95 % CI: 0.703, 0.851]), with PM showing the highest mediating effect. Our findings revealed greenness may be a beneficial factor for COPD morbidity, prognosis, and mortality. This protective effect is primarily attributed to the reduction in PM concentration.
Bibliografia:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 The authors contributed equally to this work.
ISSN:	2090-1232 2090-1224 2090-1224
DOI:	10.1016/j.jare.2024.05.025