背景:高血压(HBP)和糖尿病(DM)是全球最常见的两种心血管疾病,特别是在社会经济地位较低的个人中。研究已经将住宅绿色与降低HBP和DM的风险联系起来。然而,关于SES是否可以改变住宅绿色与HBP和DM的关联的证据有限。
方法:基于一项针对44,876名成年人的全国代表性横断面研究,我们以1km的空间分辨率生成了归一化植被指数(NDVI),以表征个体的住宅绿色水平。行政分类(城市/农村),夜光指数(NLI),个人收入,和教育水平被用来表征区域城市化和个人SES水平。
结果:我们观察到与城市地区相比,农村地区NDVI与HBP和DM的负相关较弱。例如,以及每四分位数范围(IQR,0.26)住宅NDVI增量为0~5年移动平均线,农村地区HBP的OR为1.04(95CI:0.94,1.15),城市地区HBP的OR为0.85(95CI:0.79,0.93)(P=0.003).随着NLI水平的下降,NDVI与DM患病率呈负相关(P<0.001).此外,在收入较低且受教育程度较低的人群中,居民NDVI与HBP和DM患病率的负相关较弱.
结论:较低的地区城市化程度和个体SES可以减弱住宅绿色与HBP和DM患病率的关联。
BACKGROUND: High blood pressure (HBP) and diabetes mellitus (DM) are two of the most prevalent cardiometabolic disorders globally, especially among individuals with lower socio-economic status (SES). Studies have linked residential greenness to decreased risks of HBP and DM. However, there has been limited evidence on whether SES may modify the associations of residential greenness with HBP and DM.
METHODS: Based on a national representative cross-sectional study among 44,876 adults, we generated the normalized difference vegetation index (NDVI) at 1 km spatial resolution to characterize individuals\' residential greenness level. Administrative classification (urban/rural), nighttime light index (NLI), individual income, and educational levels were used to characterize regional urbanicity and individual SES levels.
RESULTS: We observed weaker inverse associations of NDVI with HBP and DM in rural regions compared to urban regions. For instance, along with per interquartile range (IQR, 0.26) increment in residential NDVI at 0∼5 year moving averages, the ORs of HBP were 1.04 (95%CI: 0.94, 1.15) in rural regions and 0.85 (95%CI: 0.79, 0.93) in urban regions (P = 0.003). Along with the decrease in NLI levels, there were continuously decreasing inverse associations of NDVI with DM prevalence (P for interaction <0.001). In addition, weaker inverse associations of residential NDVI with HBP and DM prevalence were found among individuals with lower income and lower education levels compared to their counterparts.
CONCLUSIONS: Lower regional urbanicity and individual SES could attenuate the associations of residential greenness with odds of HBP and DM prevalence.