TY - JOUR
T1 - Associations of greenness surrounding schools with blood pressure and hypertension
T2 - A nationwide cross-sectional study of 61,229 children and adolescents in China
AU - Luo, Ya Na
AU - Yang, Bo Yi
AU - Zou, Zhiyong
AU - Markevych, Iana
AU - Browning, Matthew H.E.M.
AU - Heinrich, Joachim
AU - Bao, Wen Wen
AU - Guo, Yuming
AU - Hu, Li Wen
AU - Chen, Gongbo
AU - Ma, Jun
AU - Ma, Yinghua
AU - Chen, Ya Jun
AU - Dong, Guang Hui
N1 - Funding Information:
This study was supported by National Natural Science Foundation of China (No. 81972992 ; No. 81673139 ; No. 91543208 ; No. 81803196 ; No. 81673128 ; No. 81872582 ), the special research grant for non-profit public service of the Ministry of Health of China (No. 201202010 ) and the Fundamental Research Funds for the Central Universities ( 20ykzd10 ). Iana Markevych is supported from the “NeuroSmog: Determining the impact of air pollution on the developing brain” (Nr. POIR.04.04.00–1763/18-00) which is implemented as part of the TEAM-NET programme of the Foundation for Polish Science, co-financed from EU resources, obtained from the European Regional Development Fund under the Smart Growth Operational Programme. The authors acknowledge the cooperation of participants in this study who have been very generous with their time and assistance. We are grateful to Luo JY, Zhang X, Luo CY, Wang H, Zhao HP, Pang DH for conducting in filed work.
Publisher Copyright:
© 2021
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2022/3
Y1 - 2022/3
N2 - Background: Greenness exposure may lower blood pressure. However, few studies of this relationship have been conducted with children and adolescents, especially in low and middle-income countries. Objectives: To evaluate associations between greenness around schools and blood pressure among children and adolescents across China. Methods: We recruited 61,229 Chinese citizens aged 6–18 years from 94 schools in a nationwide cross-sectional study in seven Chinese provinces/province-level municipalities. Participants' blood pressures and hypertension were assessed with standardized protocols. Greenness levels within 500 m and 1,000 m of each school were estimated with three satellite-based indices: vegetation continuous fields (VCF), normalized difference vegetation index (NDVI), and soil adjusted vegetation index (SAVI). Generalized linear mixed models were used to evaluate associations between greenness and blood pressure, greenness and prevalent hypertension, using coefficient and odds ratio respectively. Stratified analyses and mediation analyses were also performed. Results: One interquartile range increase in greenness was associated with a 17%–20% reduced prevalence of hypertension for all measures of greenness (odds ratios for VCF500m = 20% (95% CI:18%, 23%); for NDVI500m = 17% (95% CI:13%, 21%); and for SAVI500m = 17% (95% CI: 13%, 20%). Increases in greenness were also associated with reductions in systolic blood pressure (0.48–0.58 mmHg) and diastolic blood pressure (0.26–0.52 mmHg). Older participants, boys, and urban dwellers showed stronger associations than their counterparts. No evidence of mediation was observed for air pollution (i.e., NO2 and PM2.5) and body mass index. Conclusion: Higher greenness around schools may lower blood pressure levels and prevalent hypertension among Chinese children and adolescents, particularly in older subjects, boys, and those living in urban districts. Further studies, preferably longitudinal, are needed to examine causality.
AB - Background: Greenness exposure may lower blood pressure. However, few studies of this relationship have been conducted with children and adolescents, especially in low and middle-income countries. Objectives: To evaluate associations between greenness around schools and blood pressure among children and adolescents across China. Methods: We recruited 61,229 Chinese citizens aged 6–18 years from 94 schools in a nationwide cross-sectional study in seven Chinese provinces/province-level municipalities. Participants' blood pressures and hypertension were assessed with standardized protocols. Greenness levels within 500 m and 1,000 m of each school were estimated with three satellite-based indices: vegetation continuous fields (VCF), normalized difference vegetation index (NDVI), and soil adjusted vegetation index (SAVI). Generalized linear mixed models were used to evaluate associations between greenness and blood pressure, greenness and prevalent hypertension, using coefficient and odds ratio respectively. Stratified analyses and mediation analyses were also performed. Results: One interquartile range increase in greenness was associated with a 17%–20% reduced prevalence of hypertension for all measures of greenness (odds ratios for VCF500m = 20% (95% CI:18%, 23%); for NDVI500m = 17% (95% CI:13%, 21%); and for SAVI500m = 17% (95% CI: 13%, 20%). Increases in greenness were also associated with reductions in systolic blood pressure (0.48–0.58 mmHg) and diastolic blood pressure (0.26–0.52 mmHg). Older participants, boys, and urban dwellers showed stronger associations than their counterparts. No evidence of mediation was observed for air pollution (i.e., NO2 and PM2.5) and body mass index. Conclusion: Higher greenness around schools may lower blood pressure levels and prevalent hypertension among Chinese children and adolescents, particularly in older subjects, boys, and those living in urban districts. Further studies, preferably longitudinal, are needed to examine causality.
KW - Blood pressure
KW - Cardiovascular health
KW - Epidemiology
KW - Green space
KW - Pediatrics
UR - http://www.scopus.com/inward/record.url?scp=85114687293&partnerID=8YFLogxK
U2 - 10.1016/j.envres.2021.112004
DO - 10.1016/j.envres.2021.112004
M3 - Article
C2 - 34499893
AN - SCOPUS:85114687293
SN - 0013-9351
VL - 204
JO - Environmental Research
JF - Environmental Research
M1 - 112004
ER -