Interaction between residential greenness and air pollution mortality: analysis of the Chinese Longitudinal Healthy Longevity Survey

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Summary

Background

Both air pollution and green space have been shown to affect health. We aimed to assess whether greenness protects against air pollution-related mortality.

Methods

We used data from the 2008 wave of the Chinese Longitudinal Healthy Longevity Survey. We calculated contemporaneous normalised difference vegetation index (NDVI) in the 500 m radius around each participant's residence. Fine particulate matter (PM _2·5) concentration was calculated using 3-year average concentrations in 1 km × 1 km grid resolution. We used Cox proportional hazards models to estimate the effects of NDVI, PM _2·5, and their interaction on all-cause mortality, adjusted for a range of covariates.

Findings

The cohort contained 12 873 participants, totalling 47 884 person-years. There were 7426 deaths between 2008 and 2014. The mean contemporaneous NDVI was 0·42 (SD 0·21), and the mean 3-year average PM _2·5 was 49·63 μg/m ³ (13·72). In the fully adjusted model, the mortality hazard ratio for each 0·1-unit decrease in contemporaneous NDVI was 1·08 (95% CI 1·03–1·13), each 10 μg/m ³ increase in PM _2·5 was 1·13 (1·09–1·18), and the interaction term was 1·01 (1·00–1·02) with a p value of 0·027. We observed non-linear associations in our stratified analyses: people living in urban areas were more likely to benefit from greenness, and people living in rural areas were more likely to be harmed by air pollution.

Interpretation

Our study showed some indication of a synergistic effect of greenness and air pollution, suggesting that green space planning and air pollution control can jointly improve public health.

Funding

Bill & Melinda Gates Foundation, National Institutes of Health, National Key R&D Program of China, National Natural Science Foundation of China.

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Most cited references 33

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Exposure to Greenness and Mortality in a Nationwide Prospective Cohort Study of Women

Peter Bai James, Jaime Hart, Rachel Banay … (2016)

Background: Green, natural environments may ameliorate adverse environmental exposures (e.g., air pollution, noise, and extreme heat), increase physical activity and social engagement, and lower stress. Objectives: We aimed to examine the prospective association between residential greenness and mortality. Methods: Using data from the U.S.-based Nurses’ Health Study prospective cohort, we defined cumulative average time-varying seasonal greenness surrounding each participant’s address using satellite imagery [Normalized Difference Vegetation Index (NDVI)]. We followed 108,630 women and observed 8,604 deaths between 2000 and 2008. Results: In models adjusted for mortality risk factors (age, race/ethnicity, smoking, and individual- and area-level socioeconomic status), women living in the highest quintile of cumulative average greenness (accounting for changes in residence during follow-up) in the 250-m area around their home had a 12% lower rate of all-cause nonaccidental mortality [95% confidence interval (CI); 0.82, 0.94] than those in the lowest quintile. The results were consistent for the 1,250-m area, although the relationship was slightly attenuated. These associations were strongest for respiratory and cancer mortality. The findings from a mediation analysis suggested that the association between greenness and mortality may be at least partly mediated by physical activity, particulate matter < 2.5 μm, social engagement, and depression. Conclusions: Higher levels of green vegetation were associated with decreased mortality. Policies to increase vegetation may provide opportunities for physical activity, reduce harmful exposures, increase social engagement, and improve mental health. Planting vegetation may mitigate the effects of climate change; in addition, evidence of an association between vegetation and lower mortality rates suggests it also might be used to improve health. Citation: James P, Hart JE, Banay RF, Laden F. 2016. Exposure to greenness and mortality in a nationwide prospective cohort study of women. Environ Health Perspect 124:1344–1352; http://dx.doi.org/10.1289/ehp.1510363

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Green spaces and mortality: a systematic review and meta-analysis of cohort studies

David Rojas-Rueda, Mark Nieuwenhuijsen, Mireia Gascon … (2019)

Summary Background Green spaces have been proposed to be a health determinant, improving health and wellbeing through different mechanisms. We aimed to systematically review the epidemiological evidence from longitudinal studies that have investigated green spaces and their association with all-cause mortality. We aimed to evaluate this evidence with a meta-analysis, to determine exposure-response functions for future quantitative health impact assessments. Methods We did a systematic review and meta-analysis of cohort studies on green spaces and all-cause mortality. We searched for studies published and indexed in MEDLINE before Aug 20, 2019, which we complemented with an additional search of cited literature. We included studies if their design was longitudinal; the exposure of interest was measured green space; the endpoint of interest was all-cause mortality; they provided a risk estimate (ie, a hazard ratio [HR]) and the corresponding 95% CI for the association between green space exposure and all-cause mortality; and they used normalised difference vegetation index (NDVI) as their green space exposure definition. Two investigators (DR-R and DP-L) independently screened the full-text articles for inclusion. We used a random-effects model to obtain pooled HRs. This study is registered with PROSPERO, CRD42018090315. Findings We identified 9298 studies in MEDLINE and 13 studies that were reported in the literature but not indexed in MEDLINE, of which 9234 (99%) studies were excluded after screening the titles and abstracts and 68 (88%) of 77 remaining studies were excluded after assessment of the full texts. We included nine (12%) studies in our quantitative evaluation, which comprised 8 324 652 individuals from seven countries. Seven (78%) of the nine studies found a significant inverse relationship between an increase in surrounding greenness per 0·1 NDVI in a buffer zone of 500 m or less and the risk of all-cause mortality, but two studies found no association. The pooled HR for all-cause mortality per increment of 0·1 NDVI within a buffer of 500 m or less of a participant's residence was 0·96 (95% CI 0·94–0·97; I2, 95%). Interpretation We found evidence of an inverse association between surrounding greenness and all-cause mortality. Interventions to increase and manage green spaces should therefore be considered as a strategic public health intervention. Funding World Health Organization.

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Role of physical activity in the relationship between urban green space and health.

E A Richardson, J Pearce, R Mitchell … (2013)

Local availability of green space has been associated with a wide range of health benefits. Possible causative mechanisms underpinning the green space and health relationship include the provision of physical activity opportunities, the stress-relieving effects of nature and the facilitation of social contacts. This study sought to investigate whether urban green space was related to individual-level health outcomes, and whether levels of physical activity were likely to be a mediating factor in any relationships found. Cross-sectional analysis of anonymized individual health survey responses. Neighbourhood-level green space availability was linked to 8157 respondents to the New Zealand Health Survey 2006/07 on the basis of their place of residence. Adjusted multilevel models were constructed for four health outcomes which are plausibly related to green space via physical activity: cardiovascular disease; overweight; poor general health; and poor mental health (Short Form 36). The greenest neighbourhoods had the lowest risks of poor mental health [odds ratio (OR) 0.81, 95% confidence interval (CI) 0.66-1.00]. Cardiovascular disease risk was reduced in all neighbourhoods with >15% green space availability (e.g. OR 0.80, 95% CI 0.64-0.99 for those with 33-70% green space), However, a dose-response relationship was not found. Green space availability was not related to overweight or poor general health. Overall, levels of physical activity were higher in greener neighbourhoods, but adjustment for this only slightly attenuated the green space and health relationships. Neighbourhood green space was related to better cardiovascular and mental health in a New Zealand Health Survey, independent of individual risk factors. Although physical activity was higher in greener neighbourhoods, it did not fully explain the green space and health relationship. Copyright © 2013 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

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Author and article information

Contributors

John S Ji

Xiaoming Shi

Journal

Journal ID (nlm-ta): Lancet Planet Health

Journal ID (iso-abbrev): Lancet Planet Health

Title: The Lancet. Planetary Health

Publisher: Elsevier B.V

ISSN (Electronic): 2542-5196

Publication date PMC-release: 25 March 2020

Publication date Collection: March 2020

Publication date (Electronic): 25 March 2020

Volume: 4

Issue: 3

Pages: e107-e115

Affiliations

[a ]Environmental Research Center, Duke Kunshan University, Kunshan, Jiangsu, China

[b ]Nicholas School of the Environment, Duke University, Durham, NC, USA

[c ]National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China

[d ]Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China

Author notes

[* ]Correspondence to:Dr John S Ji, Environmental Research Center, Duke Kunshan University, Kunshan, Jiangsu 215316, China john.ji@ 123456dukekunshan.edu.cn

[** ]Prof Xiaoming Shi, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 102206, China shixm@ 123456chinacdc.cn

Article

Publisher ID: S2542-5196(20)30027-9

DOI: 10.1016/S2542-5196(20)30027-9

PMC ID: 7232951

PubMed ID: 32220672

SO-VID: 7ca59049-3a8e-4565-bcff-2f65486e2580

License:

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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Interaction between residential greenness and air pollution mortality: analysis of the Chinese Longitudinal Healthy Longevity Survey

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Pneumonia, sex, and the environment

Most cited references 33

Exposure to Greenness and Mortality in a Nationwide Prospective Cohort Study of Women

Green spaces and mortality: a systematic review and meta-analysis of cohort studies

Role of physical activity in the relationship between urban green space and health.

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