Urban greenness and mortality in Canada's largest cities: a national cohort study
Urban greenness and mortality in Canada's largest cities: a national cohort study
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DOI：
10.1016/s2542-5196(17)30118-3
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发表时间：
2017-10-01
影响因子：
25.7
通讯作者：
Villeneuve, Paul J.
中科院分区：
文献类型：
--
作者：
Crouse, Dan L.;Pinault, Lauren;Villeneuve, Paul J.
背景已发表的研究结果表明，暴露在绿地中并与绿地互动与改善心理健康有关，并具有认知、生理和社会益处，但很少有研究研究它们对死亡风险的潜在影响。因此，我们在加拿大开展了一项全国性的研究，以检验城市绿化与特定原因死亡率之间的关系。方法我们使用了一项大型队列研究(2001年加拿大人口普查健康与环境队列[2001 CanCHEC])的数据，该研究包括30个城市的约130万成年人(年龄=19岁)、非移民、加拿大城市居民，他们对2001年加拿大统计局强制进行的长期人口普查做出了回应。加拿大统计局已经将这一群体与加拿大死亡率数据库和2011年前的年度所得税申报联系在一起。我们用NASA的Aqua卫星的中分辨率成像光谱仪的图像测量了绿度。在11年的跟踪调查中(2001年至2011年)，我们指定了参与者住宅250米和500米范围内每年从遥感归一化差异植被指数(NDVI)获得的绿色暴露估计值。我们使用COX比例风险模型来估计居住环境绿化(作为一个连续变量)和死亡率之间的关系。我们估计了危险比(HR)和相应的每IQR(0.15)NDVI增加95%的CI，调整了个人(例如，教育和收入)和背景协变量，包括暴露于细颗粒物、臭氧和二氧化氮。我们还考虑了选定的个人协变量(年龄、性别、家庭收入充分率五分位数、最高教育水平和婚姻状况)的影响修正。结果发现，我们的队列包括大约126.5万名基线个人，他们贡献了11523770人年。我们显示，随着参与者住所周围绿色化的增加，所有死因的死亡风险显着降低了8%-12%。在完全校正的分析中，所有死因的风险显著降低(非意外死亡比0.915，95%CI 0.905-0.924；心血管合并糖尿病0.911，0.895-0.928；心血管0.911，0.894-0.928；缺血性心脏病0.904，0.882-0.927；脑血管0.942，0.902-0.983；呼吸系统0.899，0.869-0.930)。男性比女性(HR 0.880，95%CI 0.868-0.893 vs 0.955，0.941-0.969)以及收入较高(最高五分之一0.812，0.791-0.834 vs最低五分之一0.991，0.972-1.011)和受教育程度更高(学历或以上分别为0.816，0.791-0.842vs未完成高中学业)的个人更具保护作用。0.950-0.978)。解释说，在加拿大城市居民中，住宅绿色度的增加与死于几种常见死因的风险降低有关。我们确定了不平等的证据，无论是在接触绿色风险和死亡风险方面，还是通过生活在大致相似环境中的个人的社会经济地位，以及在获得卫生保健和其他社会服务的合理相似方面。这些发现支持制定与创建更绿色、更健康的城市相关的政策。版权所有(C)作者(S)。爱思唯尔有限公司出版。
Background Findings from published studies suggest that exposure to and interactions with green spaces are associated with improved psychological wellbeing and have cognitive, physiological, and social benefits, but few studies have examined their potential effect on the risk of mortality. We therefore undertook a national study in Canada to examine associations between urban greenness and cause-specific mortality.Methods We used data from a large cohort study (the 2001 Canadian Census Health and Environment Cohort [2001 CanCHEC]), which consisted of approximately 1.3 million adult (aged >= 19 years), non-immigrant, urban Canadians in 30 cities who responded to the mandatory 2001 Statistics Canada long-form census. The cohort has been linked by Statistics Canada to the Canadian mortality database and to annual income tax filings through 2011. We measured greenness with images from the moderate-resolution imaging spectroradiometer from NASA's Aqua satellite. We assigned estimates of exposure to greenness derived from remotely sensed Normalized Difference Vegetation Index (NDVI) within both 250 m and 500 m of participants' residences for each year during 11 years of follow-up (between 2001 and 2011). We used Cox proportional hazards models to estimate associations between residential greenness (as a continuous variable) and mortality. We estimated hazard ratios (HRs) and corresponding 95% CIs per IQR (0.15) increase in NDVI adjusted for personal (eg, education and income) and contextual covariates, including exposures to fine particulate matter, ozone, and nitrogen dioxide. We also considered effect modification by selected personal covariates (age, sex, household income adequacy quintiles, highest level of education, and marital status).Findings Our cohort consisted of approximately 1 265 000 individuals at baseline who contributed 11 523 770 person-years. We showed significant decreased risks of mortality in the range of 8-12% from all causes of death examined with increased greenness around participants' residence. In the fully adjusted analyses, the risk was significantly decreased for all causes of death (non-accidental HR 0.915, 95% CI 0.905-0.924; cardiovascular plus diabetes 0.911, 0.895-0.928; cardiovascular 0.911, 0.894-0.928; ischaemic heart disease 0.904, 0.882-0.927; cerebrovascular 0.942, 0.902-0.983; and respiratory 0.899, 0.869-0.930). Greenness associations were more protective among men than women (HR 0.880, 95% CI 0.868-0.893 vs 0.955, 0.941-0.969), and among individuals with higher incomes (highest quintile 0.812, 0.791-0.834 vs lowest quintile 0.991, 0.972-1.011) and more education (degree or more 0.816, 0.791-0.842 vs did not complete high school 0.964, 0.950-0.978).Interpretation Increased amounts of residential greenness were associated with reduced risks of dying from several common causes of death among urban Canadians. We identified evidence of inequalities, both in terms of exposures to greenness and mortality risks, by personal socioeconomic status among individuals living in generally similar environments, and with reasonably similar access to health care and other social services. The findings support the development of policies related to creating greener and healthier cities. Copyright (C) The Author(s). Published by Elsevier Ltd.