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

IF 11.4 1区综合性期刊 Q1 MULTIDISCIPLINARY SCIENCES

Journal of Advanced Research Pub Date : 2025-05-01 DOI:10.1016/j.jare.2024.05.025

Wenjing Wu , Dan Chen , Xingling Ruan , Gonghua Wu , Xinlei Deng , Wayne Lawrence , Xiao Lin , Zhiqiang Li , Ying Wang , Ziqiang Lin , Shuming Zhu , Xueqing Deng , Qiaoxuan Lin , Chun Hao , Zhicheng Du , Jing Wei , Wangjian Zhang , Yuantao Hao

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引用次数: 0

Abstract

Introduction

Residential greenness may influence COPD mortality, but the causal links, risk trajectories, and mediation pathways between them remain poorly understood.

Objectives

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.

Methods

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.

Results

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.

Conclusions

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.

Abstract Image

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中国南方大型队列中的住宅绿化与慢性阻塞性肺病：潜在的因果联系、风险轨迹和中介途径

住宅绿化可能影响COPD死亡率，但它们之间的因果关系、风险轨迹和中介途径仍然知之甚少。目的：我们旨在全面识别潜在的因果关系，表征住院或出院后风险的动态进展，量化绿化与COPD之间的中介作用。方法本研究于2009年1月1日至2015年12月31日在中国南方地区以社区为基础的队列进行，纳入年龄≥18岁的个体。用归一化植被指数（NDVI）表征被试居住地址周围的绿化程度。我们应用双稳健Cox比例风险模型、多状态模型和多重中介方法，研究潜在的因果关系、基线、COPD住院、因COPD或COPD相关并发症首次再入院和全因死亡之间的风险轨迹，以及绿色暴露与COPD死亡率之间的多重中介途径（颗粒物（PM）、温度、体重指数（BMI）和身体活动）。结果共纳入581785例受试者，其中女性52.52%，平均年龄48.36岁[标准差（SD）： 17.56]。NDVI的每个四分位数范围（IQR: 0.06）增加与COPD死亡风险降低相关，产生0.88的风险比（95% CI: 0.81, 0.96）。此外，我们观察到每IQR (0.04) NDVI的增加与多重转变风险（基线- COPD住院、基线-死亡和再入院-死亡风险）呈负相关，尤其是再入院后全因死亡风险的下降（HR = 0.66 [95% CI: 0.44, 0.99]）。在观察到的绿化与COPD死亡率之间的关联中，我们发现了三个中介因素，即PM、温度和BMI（总间接效应的HR: 0.773 [95% CI: 0.703, 0.851]），其中PM的中介作用最高。结论绿色可能是COPD发病率、预后和死亡率的有利因素。这种保护作用主要归因于PM浓度的降低。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Advanced Research Multidisciplinary-Multidisciplinary

CiteScore

21.60

自引率

0.90%

发文量

280

审稿时长

12 weeks

期刊介绍： Journal of Advanced Research (J. Adv. Res.) is an applied/natural sciences, peer-reviewed journal that focuses on interdisciplinary research. The journal aims to contribute to applied research and knowledge worldwide through the publication of original and high-quality research articles in the fields of Medicine, Pharmaceutical Sciences, Dentistry, Physical Therapy, Veterinary Medicine, and Basic and Biological Sciences. The following abstracting and indexing services cover the Journal of Advanced Research: PubMed/Medline, Essential Science Indicators, Web of Science, Scopus, PubMed Central, PubMed, Science Citation Index Expanded, Directory of Open Access Journals (DOAJ), and INSPEC.