新疆农村居民住宅绿地暴露与心血管疾病发病关系前瞻性队列研究

简乐瑶; 马儒林; 郭淑霞; 何佳; 李毓; 丁玉松; 芮东升; 毛羿丹; 何欣; 孙雪莹; 廖晟宇; 郭恒

doi:10.11847/zgggws1140993

新疆农村居民住宅绿地暴露与心血管疾病发病关系前瞻性队列研究

doi: 10.11847/zgggws1140993

简乐瑶^{1, 2},
马儒林^{1, 2},
郭淑霞^{1, 2},
何佳^{1, 2},
李毓^{1, 2},
丁玉松^{1, 2},
芮东升^{1, 2},
毛羿丹¹,
何欣¹,
孙雪莹¹,
廖晟宇¹,
郭恒^{1, 2, ,}

1.
石河子大学医学院预防医学系，石河子 832000
2.
国家卫生健康委中亚高发病防治重点实验室，石河子 832000

基金项目: 重点领域科技攻关计划（2021AB030）；中国医学科学院中央级公益性科研院所基本科研业务费专项资金资助（2020 – PT330 – 003）；石河子大学创新发展项目（CXFZ202005）

详细信息

作者简介:
简乐瑶（1999 – ），硕士在读，研究方向：慢性病流行病学

通信作者:
郭恒，E-mail：guoheng@shzu.edu.cn

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- 文章访问数: 81
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- PDF下载量: 12
- 被引次数: 0
出版历程
- 接收日期: 2022-11-29
- 录用日期: 2023-05-19
- 修回日期: 2023-04-03
- 网络出版日期: 2023-09-06
- 刊出日期: 2023-08-10

Association of exposure to residential green space and cardiovascular disease incidence among rural adult residents in Xinjiang: a prospective cohort study

JIAN Leyao^{1, 2},
MA Rulin^{1, 2},
GUO Shuxia^{1, 2},
HE Jia^{1, 2},
LI Yu^{1, 2},
DING Yusong^{1, 2},
RUI Dongsheng^{1, 2},
MAO Yidan¹,
HE Xin¹,
SUN Xueying¹,
LIAO Shengyu¹,
GUO Heng^{1, 2
, ,}

1.
Department of Public Health, School of Medicine, Shihezi University, Shihezi 832000, China
2.
National Health Commission Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases/First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi 832000, China

More Information

Corresponding author: GUO Heng, E-mail：guoheng@shzu.edu.cn

摘要

摘要: 目的了解新疆农村居民住宅绿地暴露与心血管疾病（CVD）发病的关系，为该人群的CVD一级预防提供理论基础与数据支持。方法采用前瞻性队列研究方法，于2016年9月采用典型抽样的方法在新疆生产建设兵团第三师51团招募12813名 ≥ 18岁农村常住居民进行基线调查，并分别于2019年4月、2020年6月、2021年7月和2022年6月对9659名住址信息完整且基线调查无CVD的居民进行了4次随访调查；采用广义线性混合模型（GLMM）和Cox比例风险回归模型分析新疆农村居民住宅绿地暴露与CVD发病的关系，并采用亚组分析方法分析各分层因素对绿地暴露与CVD发病风险关联的潜在影响。结果截至2022年6月，9659名新疆农村居民中失访655人，失访率为6.78%。最终纳入分析的9004名新疆农村居民共随访49565.76人年，平均随访（5.50 ± 1.09）人年，随访期间CVD发病762例，发病密度为153.73/万人年，CVD累积发病率为8.46%。发生CVD组新疆农村居民的NDVI_{250 m}、NDVI_{500 m}和NDVI_{1 000 m}平均值分别为（0.229 ± 0.068）、（0.265 ± 0.067）和（0.298 ± 0.060），均低于未发生CVD组新疆农村居民NDVI_{250 m}、NDVI_{500 m}和NDVI_{1 000 m}平均值的（0.242 ± 0.063）、（0.278 ± 0.060）和（0.308 ± 0.053），差异均有统计学意义（均P < 0.001）。在调整了性别、年龄、文化程度、婚姻状况、体力活动水平和PM_2.5等混杂因素后，GLMM模型分析结果显示，新疆农村居民NDVI_{250 m}、NDVI_{500 m}和NDVI_{1 000 m}每增加1个四分位数间距的β值分别为 – 0.200、– 0.169和 – 0.200；Cox比例风险回归模型分析结果显示，NDVI_{250 m}、NDVI_{500 m}和NDVI_{1 000 m}每增加1个四分位数间距，新疆农村居民的CVD发病风险可降低14.4%（HR = 0.856，95%CI = 0.798～0.919）、14.3%（HR = 0.857，95%CI = 0.800～0.918）和16.7%（HR = 0.833，95%CI = 0.755～0.896）。在调整了性别、年龄、文化程度、婚姻状况、体力活动水平、PM_2.5中除分层因素外的其他混杂因素后，亚组分析结果显示，住宅绿地暴露对年龄 ≤ 50岁和体力活动水平较高的新疆农村居民具有更强的保护作用，NDVI_{250 m}、NDVI_{500 m}和NDVI_{1 000 m}每增加1个四分位数间距，年龄 ≤ 50岁新疆农村居民的CVD发病风险可降低20.7%（HR = 0.793，95%CI = 0.720～0.874）、20.3%（HR = 0.797，95%CI = 0.726～0.875）和24.1%（HR = 0.759，95%CI = 0.688～0.837）；NDVI_{250 m}每增加1个四分位数间距，体力活动水平较高新疆农村居民的CVD发病风险可降低28.9%（HR = 0.711，95%CI = 0.613～0.825）。结论较高的住宅绿地暴露水平可以降低新疆农村居民CVD的发病风险。
- 心血管疾病（CVD） /
- 发病 /
- 住宅绿地暴露 /
- 关系 /
- 农村居民 /
- 前瞻性队列研究
Abstract: Objective To examine the relationship between exposure to residential green space and the incidence of cardiovascular disease (CVD) among rural residents in Xinjiang Production and Construction Corps (Xinjiang). Methods Totally 12 813 rural residents aged ≥ 18 years and living in local regions at least one year were recruited with typical sampling in Xinjiang for a face-to-face baseline questionnaire survey during September 2016 and 9 659 of them without CVD and with complete residence information at the baseline survey were followed up four times in April 2019, June 2020, July 2021, and June 2022. Generalized linear model (GLMM) and Cox proportional hazards regression model were used to analyze the relationship between exposure to residential green space (measured with normalized difference vegetation index [NDVI] for the region between a participant′s residential location and the center of the residential area) and CVD incidence among the participants. Subgroup analysis was performed to explore potential impact of each stratification factor on the relationship between exposure to residential green space and CVD incidence risk. Results Of the 9 659 cohort participants, 9 004 were followed-up and 655 (6.78%) were lost to follow-up by the end of the study (June 2022). During the follow-up of 49 565.76 person-years (PYs) totally and 5.50 ± 1.09 PYs averagely among the 9 004 participants finally included in the analysis, overall 762 CVD cases were identified; the CVD incidence density was 153.73/10 000 PYs and the CVD cumulative incidence was 8.46%. The mean values of NDVI_{250 m}, NDVI_{500 m}, and NDVI_{1 000 m} were 0.229 ± 0.068, 0.265 ± 0.067, and 0.298 ± 0.060 for the followed-up participants with CVD incidence and 0.242 ± 0.063, 0.278 ± 0.060, and 0.308 ± 0.053 for those without CVD, respectively, with significant differences in the NDVI values between the two groups (all P < 0.001). After adjusting for gender, age, education, marital status, physical activity and particulate matter less than 2.5 microns in aerodynamic diameter (PM_2.5), the results of GLMM model analysis revealed the β coefficients of – 0.200, – 0.169, and – 0.200 for CVD incidence associated with each quartile increase in the values of NDVI_{250 m}, NDVI_{500 m}, and NDVI_{1 000 m}. The results of Cox proportional hazards regression model analysis also showed that each quartile increase in the values of NDVI_{250 m}, NDVI_{500 m}, and NDVI_{1 000 m} was associated with 14.4% (hazard risk [HR] = 0.856, 95% confidence interval [95%CI]: 0.798 – 0.919), 14.3% (HR = 0.857, 95%CI: 0.800 – 0.918), and 16.7% (HR = 0.833, 95%CI: 0.755 – 0.896) reduction in CVD incidence risk. After adjusting for gender, age, education, marital status, physical activity and PM_2.5 (except for when used as a stratifica-tion variable), subgroup analysis results further demonstrated that each quartile increase in the values of NDVI_{250 m}, NDVI_{500 m}, and NDVI_{1 000 m} was associated with much higher reduction of 20.7% (HR = 0.793, 95%CI: 0.720 – 0.874), 20.1% (HR = 0.797, 95%CI: 0.726 – 0.875) and 24.1% (HR = 0.759, 95%CI: 0.688 – 0.837) in CVD incidence risk for the followed participants aged 50 years and younger; and for the followed participants with higher intensity of physical activity, each quartile increase in the values of NDVI_{250 m} was associated with a 28.9% (HR = 0.711, 95%CI: 0.613 – 0.825) reduction in CVD incidence risk. Conclusion Higher exposure to residential green space could be associated with reduced CVD incidence risk among rural residents in Xinjiang.
- cardiovascular disease /
- incidence /
- exposure to residential green space /
- association /
- rural residents /
- prospective cohort study

HTML全文

表 1 新疆不同特征农村居民随访期间CVD发病情况比较

Table 1. CVD incidence by demographics and physical activity among 9 004 adult rural residents in Xinjiang Production and Construction Corps during four follow-ups after a baseline survey, 2016 – 2022

特征		调查人数	CVD发病例数	CVD累积发病率（%）	χ²值	P 值
性别	男性	4607	296	6.43	50.576	< 0.001
	女性	4397	466	10.60
年龄（岁）	≤ 50	7366	416	5.65	414.283	< 0.001
	> 50	1638	346	21.12
文化程度	小学及以下	6181	608	9.84	48.022	< 0.001
	初中及以上	2823	154	5.46
婚姻状况	非在婚	1267	49	3.87	40.197	< 0.001
	在婚	7737	713	9.22
体力活动水平	低	6700	574	8.57	0.367	0.544
	高	2304	188	8.16

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表 2 不同组别新疆农村居民住宅绿地暴露和PM_2.5暴露水平比较（$ \bar{x} $ ± s）

Table 2. CVD-non-CVD disparity in normalized difference vegetation index (NDVI) and PM_2.5 among 9 004 adult rural residents in Xinjiang Production and Construction Corps at baseline survey, 2016（$ \bar{x} $ ± s）

指标	发生CVD组	未发生CVD组	t 值	P 值
NDVI_{250 m}	0.229 ± 0.068	0.242 ± 0.063	5.227	< 0.001
NDVI_{500 m}	0.265 ± 0.067	0.278 ± 0.060	5.009	< 0.001
NDVI_{1 000 m}	0.298 ± 0.060	0.308 ± 0.053	4.225	< 0.001
PM_2.5，（μg/m³）	103.92 ± 0.98	103.86 ± 0.94	– 1.832	0.067

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表 3 新疆农村居民住宅绿地暴露与CVD发病关系的亚组分析

Table 3. Subgroup-specific hazard risks of CVD associated with a quartile increase in NDVI after adjusting other factors among 9 004 adult rural residents followed up during 2016 – 2022 in Xinjiang Production and Construction Corps

因素		NDVI_{250 m}			NDVI_{500 m}			NDVI_{1 000 m}
因素		HR 值	95%CI	P 值 ^a	HR 值	95%CI	P 值 ^a	HR 值	95%CI	P 值 ^a
性别	男性	0.841	0.748～0.945	0.426	0.867	0.776～0.968	0.819	0.825	0.736～0.925	0.984
	女性	0.860	0.786～0.940		0.844	0.773～0.922		0.833	0.759～0.914
年龄（岁）	≤ 50	0.793	0.720～0.874	0.021	0.797	0.726～0.875	0.047	0.759	0.688～0.837	0.029
	> 50	0.936	0.842～1.040		0.937	0.845～1.038		0.928	0.834～1.033
文化程度	小学及以下	0.870	0.805～0.941	0.259	0.851	0.788～0.920	0.565	0.846	0.780～0.919	0.639
	初中及以上	0.797	0.673～0.944		0.882	0.758～1.025		0.792	0.677～0.927
婚姻状况	非在婚	0.688	0.506～0.936	0.302	0.709	0,546～0.922	0.230	0.711	0.534～0.948	0.803
	在婚	0.866	0.805～0.931		0.867	0.808～0.932		0.841	0.781～0.906
体力活动水平	低	0.904	0.833～0.981	0.004	0.869	0.799～0.945	0.259	0.860	0.791～0.935	0.102
	高	0.711	0.613～0.825		0.825	0.728～0.936		0.761	0.660～0.877
注：a 为交互作用的P值。

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新疆农村居民住宅绿地暴露与心血管疾病发病关系前瞻性队列研究

doi: 10.11847/zgggws1140993

作者简介:
简乐瑶（1999 – ），硕士在读，研究方向：慢性病流行病学

通信作者:
郭恒，E-mail：guoheng@shzu.edu.cn

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Association of exposure to residential green space and cardiovascular disease incidence among rural adult residents in Xinjiang: a prospective cohort study

Corresponding author: GUO Heng, E-mail：guoheng@shzu.edu.cn

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留言板

新疆农村居民住宅绿地暴露与心血管疾病发病关系前瞻性队列研究

doi: 10.11847/zgggws1140993

作者简介: 简乐瑶（1999 – ），硕士在读，研究方向：慢性病流行病学

通信作者: 郭恒，E-mail：guoheng@shzu.edu.cn

计量

出版历程

Association of exposure to residential green space and cardiovascular disease incidence among rural adult residents in Xinjiang: a prospective cohort study

Corresponding author: GUO Heng, E-mail：guoheng@shzu.edu.cn

计量

出版历程

目录

作者简介:
简乐瑶（1999 – ），硕士在读，研究方向：慢性病流行病学

通信作者:
郭恒，E-mail：guoheng@shzu.edu.cn