Abstract：
Diabetic retinopathy (DR) is a leading cause of vision impairment and blindness among diabetics. We aimed to explore whether long-term exposure to residential greenness was beneficial to DR.
We used data from a large-scale, cross-sectional screening survey conducted in 129 cities of 27 provincial regions of China from 2018 to 2021 among patients with diabetes. We measured residential greenness exposure as the 3-year average of annual maximum Normalized Difference Vegetation Index (NDVI) at a spatial resolution of 250 m. DR was assessed by ophthalmologists based on fundus photographs. The primary outcome was DR, and secondary outcome included DR severity status (i.e., nonproliferative and proliferative), hallmarks of retinal lesions and macular oedema.
A total of 484,380 adult participants with diabetes were included in the current analysis, and 15.7% of them were diagnosed with DR. NDVI was inversely and linearly associated with DR prevalence, and an increment of 0.1 NDVI was associated with a 10% (9%-10%) decrease in DR prevalence. Significant and inverse associations were further found for nonproliferative and proliferative DR, hallmarks of lesions and macular oedema. The association between greenness and DR was stronger among participants who were older, obese, lived in the south, had longer duration of diabetes or did not take antidiabetic medications.
This large-scale nationwide study provides the first-hand epidemiological evidence on the associations of residential greenness with DR. Our findings highlight the importance of residential greenness in alleviating DR risk especially in an era of aging and urbanization.
We used data from a large-scale, cross-sectional screening survey conducted in 129 cities of 27 provincial regions of China from 2018 to 2021 among patients with diabetes. We measured residential greenness exposure as the 3-year average of annual maximum Normalized Difference Vegetation Index (NDVI) at a spatial resolution of 250 m. DR was assessed by ophthalmologists based on fundus photographs. The primary outcome was DR, and secondary outcome included DR severity status (i.e., nonproliferative and proliferative), hallmarks of retinal lesions and macular oedema.
A total of 484,380 adult participants with diabetes were included in the current analysis, and 15.7% of them were diagnosed with DR. NDVI was inversely and linearly associated with DR prevalence, and an increment of 0.1 NDVI was associated with a 10% (9%-10%) decrease in DR prevalence. Significant and inverse associations were further found for nonproliferative and proliferative DR, hallmarks of lesions and macular oedema. The association between greenness and DR was stronger among participants who were older, obese, lived in the south, had longer duration of diabetes or did not take antidiabetic medications.
This large-scale nationwide study provides the first-hand epidemiological evidence on the associations of residential greenness with DR. Our findings highlight the importance of residential greenness in alleviating DR risk especially in an era of aging and urbanization.
摘要：
目的：糖尿病视网膜病变（DR）是糖尿病患者视力障碍和失明的主要原因。我们的目的是探讨长期暴露于住宅绿色是否对DR有益。
方法：我们使用了来自大规模，2018年至2021年在中国27个省级地区的129个城市进行的糖尿病患者的横断面筛查调查。我们以250m的空间分辨率测量了住宅的绿色暴露量，即年度最大归一化植被指数（NDVI）的3年平均值。眼科医生根据眼底照片评估了DR。主要结果是DR，和次要结果包括DR严重程度状态(即，非增殖和增殖)，视网膜病变和黄斑水肿的标志。
结果：共有484,380名患有糖尿病的成年参与者被纳入当前分析，15.7%的患者被诊断为DR。NDVI与DR患病率呈负相关和线性相关，NDVI增加0.1与DR患病率下降10%(9%-10%)相关.进一步发现非增殖性和增殖性DR的显着和逆相关，病变和黄斑水肿的标志。在年龄较大的参与者中，绿色与DR之间的关联更强，肥胖，住在南方,糖尿病持续时间较长或未服用抗糖尿病药物。
结论：这项大规模的全国性研究提供了有关住宅绿色与DR关联的第一手流行病学证据。我们的发现强调了住宅绿色在减轻DR风险方面的重要性，尤其是在老龄化和城市化时代。
方法：我们使用了来自大规模，2018年至2021年在中国27个省级地区的129个城市进行的糖尿病患者的横断面筛查调查。我们以250m的空间分辨率测量了住宅的绿色暴露量，即年度最大归一化植被指数（NDVI）的3年平均值。眼科医生根据眼底照片评估了DR。主要结果是DR，和次要结果包括DR严重程度状态(即，非增殖和增殖)，视网膜病变和黄斑水肿的标志。
结果：共有484,380名患有糖尿病的成年参与者被纳入当前分析，15.7%的患者被诊断为DR。NDVI与DR患病率呈负相关和线性相关，NDVI增加0.1与DR患病率下降10%(9%-10%)相关.进一步发现非增殖性和增殖性DR的显着和逆相关，病变和黄斑水肿的标志。在年龄较大的参与者中，绿色与DR之间的关联更强，肥胖，住在南方,糖尿病持续时间较长或未服用抗糖尿病药物。
结论：这项大规模的全国性研究提供了有关住宅绿色与DR关联的第一手流行病学证据。我们的发现强调了住宅绿色在减轻DR风险方面的重要性，尤其是在老龄化和城市化时代。
