Associations of combined exposures to ambient temperature, air pollution, and green space with hypertension in rural areas of Anhui Province, China: A cross-sectional study

Li, Guoao; Zhang, Hanshuang; Hu, Maorong; He, Jiaxue; Yang, Wenqiang; Zhao, Huanhuan; Zhu, Zhenyu; Zhu, Junjie; Huang, Fen

doi:10.1016/j.envres.2021.112370

Cited by 27 publications

(17 citation statements)

References 52 publications

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“…Under this condition, we used county/district level exposure information to reflect the exposure of an individual. Although the same method was applied in prior studies [56,57], measurement errors existed to some extent. However, we used satellite data with a high-resolution and national-level representative sample to enhance the reliability and generalizability of our findings.…”

Section: Discussionmentioning

confidence: 99%

The effects of greenness exposure on hypertension incidence among Chinese oldest-old: a prospective cohort study

Zhou

Chen

et al. 2022

Environ Health

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Background Although the oldest-old (those aged over 80 years) are vulnerable to environmental factors and have the highest prevalence of hypertension, studies focusing on greenness exposure and the development of hypertension among them are insufficient. The aim of this study was to explore the association between residential greenness and hypertension in the oldest-old population. Methods This cohort study included data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). The oldest-old were free of hypertension at baseline (2008), and hypertension events were assessed by follow-up surveys in 2011, 2014, and 2018. The one-year averages of the normalized difference vegetation index (NDVI) and enhanced vegetation index (EVI) at 500-m buffer before the interview year of incident hypertension or last censoring interview were collected at the level of 652 residential units (district or county). The linear or nonlinear association between greenness and hypertension incidence was analyzed using the Cox proportional hazards model with penalized splines. The linear links between greenness and hypertension incidence were determined using the Cox proportional hazards model included a random effect term. Results Among 5253 participants, the incidence rate of hypertension was 7.25 (95% confidence interval [CI]: 6.83–7.67) per 100 person-years. We found a nonlinear association between greenness exposure and hypertension risk, and the exposure-response curve showed that 1 change point existed. We examined the linear effect of greenness on hypertension by categorizing the NDVI/EVI into low and high-level exposure areas according to the change point. We found more notable protective effects of each 0.1-unit increase in greenness on hypertension incidence for participants living in the high-level greenness areas (hazard ratio (HR) = 0.60; 95% CI: 0.53–0.70 for NDVI; HR = 0.46; 95% CI: 0.37–0.57 for EVI). In contrast, no significant influence of greenness exposure on hypertension risk was found for participants living in the low-level greenness areas (HR = 0.77; 95% CI: 0.38–1.55 for NDVI; HR = 0.73; 95% CI: 0.33–1.63 for EVI). Conclusions Greenness exposure is nonlinearly associated with hypertension risk among the oldest-old, presenting its relationship in an inverse “U-shaped” curve. Greenness is a protective factor that decreases the risk of hypertension.

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Section: Discussionmentioning

confidence: 99%

The effects of greenness exposure on hypertension incidence among Chinese oldest-old: a prospective cohort study

Zhou

Chen

et al. 2022

Environ Health

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“…Descriptive statistics for individual and community characteristics were first calculated. As we acknowledged that environmental factors were correlated with each other, as indicated in the study by Li et al ( 54 ), before estimating the models, we examined correlations among environmental measures and found a high correlation between average monthly temperature and annual precipitation ( r = 0.77). To avoid underestimation of their effects, we dichotomized temperature and precipitation measures following the use of these variables in the study by Zeng et al ( 52 ).…”

Section: Methodsmentioning

confidence: 99%

Green Space, Air Pollution, Weather, and Cognitive Function in Middle and Old Age in China

Zhang

Luo

Zhang

et al. 2022

Front. Public Health

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Prior research has shown that environmental hazards, such as limited green space, air pollution, and harmful weather, have the strong adverse impact on older adults' cognitive function; however, most of the studies were conducted in developed countries and limited to cross-sectional analyses. China has the largest aging population in the world so the research evidence from it can offer an insight to the study in other developing countries facing similar issues and inform future public health policy and disease control. This study examined the long-term impact of environmental factors, namely, green space coverage, air pollution, and weather conditions on cognitive function using a nationally representative sample consisting of adults aged 45 years and older selected from the China Health and Retirement Longitudinal Study (CHARLS 2011–2018), the China City Statistical Yearbook, and other sources. Multilevel growth curve models were utilized for analysis and the mediator effects of physical activity and social engagement on the relationship between environmental factors and cognitive function were examined. Findings of this study showed that after controlling for sociodemographic characteristics, annual precipitation of 80 cm or more, living in areas with July temperature of 28°C or higher, urban community, and green space coverage were positively associated with cognition score at the baseline and lower precipitation, urban community, and greater green space coverage were associated with slower cognitive decline over a 7-year period. The impact of gross domestic product (GDP) seemed to take into effect more and more over time. These effects did not substantially change after weekly total hours of physical activities and levels of social engagement were added. More research on the mechanisms of the effect of environmental factors on cognition is needed such as the subgroup analyses and/or with more aspects of environmental measures.

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“…Meanwhile, subgroup analysis was conducted to identify which groups were vulnerable to the independent of greenness/PM 2.5 exposures and the combined effect of them, herein, the analyses were strati ed by gender, and individual socioeconomic status residence (education, pension and marital status). P values for difference were identi ed by adding a product term between greenness/PM 2.5 and modi er in the models [29]. Finally, we using subset that excluding participants only be interviewed for one time to identify how the selection of samples changed the estimated association.…”

Section: Main Modelmentioning

confidence: 99%

“…It should note that the health in uence attributed to these environmental factors did not appear an independent effect of one another [20,[24][25][26][27]. This is a considerable aspect since these factors are highly correlated, such as, in theory, areas with heavy air pollution, general with a lower density of vegetation coverage, that can offset the bene t of greenness [23,28,29]. In turn, greenness can eliminate hazardous materials exposure (i.e., mitigate the exposures to noise, heat, air pollution et al) and change the response to air pollution [18] have been well documented.…”

Section: Introductionmentioning

confidence: 99%

Air pollution, residential greenness and medical expenditure in older adults

Zhou

Wang

et al. 2022

Preprint

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Background: Environmental factors have been thought of as potential determinants for human health and would plausibly affect health expenditures. However, little is known about the association between air pollution, greenness, and their combined effect on medical expenditures, let alone, related evidence in older adults is rarely. Method: We used data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Medical expenditures were defined as out-of-pocket medical expenditures in the 12 months preceding the survey. A two-year average of PM2.5 concentrations prior to medical expenditures was collected as PM2.5 exposures. Greenness exposure was contemporaneous with PM2.5 and evaluated by residential units’ NDVI value in 250 m buffer. The two-part models were performed to assess the independent influences of PM2.5, greenness, and its combined influence. The first model was a logistic regression model based on the whole sample, called the participation models. Then a log-transformed linear regression model was fitted using samples with nonzero medical expenditures, named intensity models. Result: We found that each 10-µg/m3 increment in PM2.5 increased the odds of incurring any costs (coefficient=0.80, P <0.001) according to the participation models. PM2.5 was associated with an increase in expenditure based on intensity models (coefficient=0.08, P <0.001). Each 0.1-unit increase in greenness decreased the odds of incurring any costs in the participation models (coefficient=-0.77, P <0.05). The risk of increasing medical expenditures attributed to PM2.5was higher in areas with a low level of greenness (coefficient=0.16, P <0.001). While greenness did not present a protective effect for increasing costs in the low level of PM2.5 (coefficient=0.21, P <0.05), increasing greenness could reduce costs in the high and medium level of PM2.5. Uneducated participants and others without pensions were vulnerable to the combined effect. Conclusion: Air pollution is a potential source of medical expenditures; in comparison, expanding greenspace is associated with these societal costs saved. Suppose the combined impact of greenness and PM2.5 was to be replicated in a future study, which would improve the utility of current evidence.

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Associations of combined exposures to ambient temperature, air pollution, and green space with hypertension in rural areas of Anhui Province, China: A cross-sectional study

Cited by 27 publications

References 52 publications

The effects of greenness exposure on hypertension incidence among Chinese oldest-old: a prospective cohort study

The effects of greenness exposure on hypertension incidence among Chinese oldest-old: a prospective cohort study

Green Space, Air Pollution, Weather, and Cognitive Function in Middle and Old Age in China

Air pollution, residential greenness and medical expenditure in older adults

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