Greenness around schools associated with lower risk of hypertension among children: Findings from the Seven Northeastern Cities Study in China

Xiang Xiao; Bo-Yi Yang; Li-Wen Hu; Iana Markevych; Michael S Bloom; Shyamali C Dharmage; Bin Jalaludin; Luke D Knibbs; Joachim Heinrich; Lidia Morawska; Shao Lin; Marjut Roponen; Yuming Guo; Steve Hung Lam Yim; Ari Leskinen; Mika Komppula; Pasi Jalava; Hong-Yao Yu; Mohammed Zeeshan; Xiao-Wen Zeng; Guang-Hui Dong

doi:10.1016/j.envpol.2019.113422

Greenness around schools associated with lower risk of hypertension among children: Findings from the Seven Northeastern Cities Study in China

Environ Pollut. 2020 Jan:256:113422. doi: 10.1016/j.envpol.2019.113422. Epub 2019 Oct 18.

Authors

Xiang Xiao¹, Bo-Yi Yang¹, Li-Wen Hu¹, Iana Markevych², Michael S Bloom³, Shyamali C Dharmage⁴, Bin Jalaludin⁵, Luke D Knibbs⁶, Joachim Heinrich⁷, Lidia Morawska⁸, Shao Lin⁹, Marjut Roponen¹⁰, Yuming Guo¹¹, Steve Hung Lam Yim¹², Ari Leskinen¹³, Mika Komppula¹⁴, Pasi Jalava¹⁰, Hong-Yao Yu¹, Mohammed Zeeshan¹, Xiao-Wen Zeng¹, Guang-Hui Dong¹⁵

Affiliations

¹ Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China.
² Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstraße 1, 80336, Munich, Germany; Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.
³ Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China; Departments of Environmental Health Sciences & Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY, 12144, USA.
⁴ Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, 3004, Australia; Murdoch Children Research Institute, Melbourne, VIC, 3010, Australia.
⁵ Centre for Air Quality and Health Research and Evaluation, Glebe, NSW, 2037, Australia; IIngham Institute for Applied Medial Research, University of New South Wales, Sydney, 2170, Australia.
⁶ School of Public Health, The University of Queensland, Herston, Queensland, 4006, Australia.
⁷ Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstraße 1, 80336, Munich, Germany; Comprehensive Pneumology Center Munich, German Center for Lung Research, Ziemssenstraße 1, 80336, Munich, Germany.
⁸ International Laboratory for Air Quality and Health, Queensland University of Technology (QUT), GPO Box 2434, Brisbane, Queensland, 4001, Australia.
⁹ Departments of Environmental Health Sciences & Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY, 12144, USA.
¹⁰ Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, FI, 70211, Finland.
¹¹ Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia.
¹² Department of Geography and Resource Management, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong, China; Stanley Ho Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong, China.
¹³ Finnish Meteorological Institute, Kuopio, 70211, Finland; Department of Applied Physics, University of Eastern Finland, Kuopio, 70211, Finland.
¹⁴ Finnish Meteorological Institute, Kuopio, 70211, Finland.
¹⁵ Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China. Electronic address: donggh5@mail.sysu.edu.cn.

PMID: 31672364
DOI: 10.1016/j.envpol.2019.113422

Abstract

Evidence suggests that residential greenness may be protective of high blood pressure, but there is scarcity of evidence on the associations between greenness around schools and blood pressure among children. We aimed to investigate this association in China. Our study included 9354 children from 62 schools in the Seven Northeastern Cities Study. Greenness around each child's school was measured by NDVI (Normalized Difference Vegetation Index) and SAVI (Soil-Adjusted Vegetation Index). Particulate matter ≤ 1 μm (PM₁) concentrations were estimated by spatiotemporal models and nitrogen dioxide (NO₂) concentrations were collected from air monitoring stations. Associations between greenness and blood pressure were determined by generalized linear and logistic mixed-effect models. Mediation by air pollution was assessed using mediation analysis. Higher greenness was consistently associated with lower blood pressure. An increase of 0.1 in NDVI corresponded to a reduction in SBP of 1.39 mmHg (95% CI: 1.86, -0.93) and lower odds of hypertension (OR = 0.76, 95% CI: 0.69, 0.82). Stronger associations were observed in children with higher BMI. Ambient PM₁ and NO₂ mediated 33.0% and 10.9% of the association between greenness and SBP, respectively. In summary, greater greenness near schools had a beneficial effect on blood pressure, particularly in overweight or obese children in China. The associations might be partially mediated by air pollution. These results might have implications for policy makers to incorporate more green space for both aesthetic and health benefits.

Keywords: Blood pressure; Greenness; Hypertension; Mediation; Modification.

MeSH terms

Air Pollution / analysis
Air Pollution / statistics & numerical data
Blood Pressure
Child
China / epidemiology
Cities
Environmental Exposure / statistics & numerical data*
Female
Humans
Hypertension / epidemiology*
Male
Nitrogen Dioxide / analysis
Obesity
Particulate Matter / analysis
Risk
Schools
Sustainable Development*

Substances

Particulate Matter
Nitrogen Dioxide