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Joint associations between neighborhood walkability, greenness, and particulate air pollution on cardiovascular mortality among adults with a history of stroke or acute myocardial infarction
Fine particulate matter (PM(2.5)) is a known risk factor for cardiovascular disease (CVD). Neighborhood walkability and greenness may also be associated with CVD, but there is limited evidence on their joint or interacting effects with PM(2.5). METHODS: Cox proportional hazard models were used to es...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9005250/ https://www.ncbi.nlm.nih.gov/pubmed/35434462 http://dx.doi.org/10.1097/EE9.0000000000000200 |
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author | Liao, Noelle S. Van Den Eeden, Stephen K. Sidney, Stephen Deosaransingh, Kamala Schwartz, Joel Uong, Stephen P. Alexeeff, Stacey E. |
author_facet | Liao, Noelle S. Van Den Eeden, Stephen K. Sidney, Stephen Deosaransingh, Kamala Schwartz, Joel Uong, Stephen P. Alexeeff, Stacey E. |
author_sort | Liao, Noelle S. |
collection | PubMed |
description | Fine particulate matter (PM(2.5)) is a known risk factor for cardiovascular disease (CVD). Neighborhood walkability and greenness may also be associated with CVD, but there is limited evidence on their joint or interacting effects with PM(2.5). METHODS: Cox proportional hazard models were used to estimate the risk of CVD mortality among adults with a history of acute myocardial infarction and/or stroke living in Northern California. We assessed the independent and joint effects of walkability, greenness (Normalized Differentiated Vegetation Index [NDVI]), and PM(2.5) at residential addresses, controlling for age, sex, race/ethnicity, comorbidities, BMI, smoking, revascularization, medications, and socioeconomic status. RESULTS: Greenness had a nonlinear association with CVD mortality (P = 0.038), with notably protective effects (HR = 0.87 [95% confidence interval {CI} = 0.78, 0.97]) at higher greenness levels (NDVI ≥ 0.3) and moderate attenuation after adjusting for PM(2.5) (HR = 0.92 [95% CI = 0.82, 1.03]) per 0.1 increase in NDVI. Walkability had no independent effect on CVD mortality. PM(2.5) had a strong independent effect in models adjusted for greenness and walkability (HR = 1.20 [95% CI = 1.08, 1.33)) per 10 μg/m(3) increase in PM(2.5). There was an interaction between walkability and PM(2.5) (P = 0.037), where PM(2.5) had slightly stronger associations in more walkable than less walkable neighborhoods (HR = 1.23 [95% CI = 1.06, 1.42] vs. 1.17 [95% CI = 1.04, 1.32]) per 10 μg/m(3) increase in PM(2.5). Greenness had no interaction with PM(2.5) (P = 0.768) nor walkability (P = 0.385). CONCLUSIONS: High greenness may be protective of CVD mortality among adults with CVD history. PM(2.5) associated CVD mortality risk varies slightly by level of neighborhood walkability, though these small differences may not be clinically meaningful. |
format | Online Article Text |
id | pubmed-9005250 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-90052502022-04-14 Joint associations between neighborhood walkability, greenness, and particulate air pollution on cardiovascular mortality among adults with a history of stroke or acute myocardial infarction Liao, Noelle S. Van Den Eeden, Stephen K. Sidney, Stephen Deosaransingh, Kamala Schwartz, Joel Uong, Stephen P. Alexeeff, Stacey E. Environ Epidemiol Original Research Article Fine particulate matter (PM(2.5)) is a known risk factor for cardiovascular disease (CVD). Neighborhood walkability and greenness may also be associated with CVD, but there is limited evidence on their joint or interacting effects with PM(2.5). METHODS: Cox proportional hazard models were used to estimate the risk of CVD mortality among adults with a history of acute myocardial infarction and/or stroke living in Northern California. We assessed the independent and joint effects of walkability, greenness (Normalized Differentiated Vegetation Index [NDVI]), and PM(2.5) at residential addresses, controlling for age, sex, race/ethnicity, comorbidities, BMI, smoking, revascularization, medications, and socioeconomic status. RESULTS: Greenness had a nonlinear association with CVD mortality (P = 0.038), with notably protective effects (HR = 0.87 [95% confidence interval {CI} = 0.78, 0.97]) at higher greenness levels (NDVI ≥ 0.3) and moderate attenuation after adjusting for PM(2.5) (HR = 0.92 [95% CI = 0.82, 1.03]) per 0.1 increase in NDVI. Walkability had no independent effect on CVD mortality. PM(2.5) had a strong independent effect in models adjusted for greenness and walkability (HR = 1.20 [95% CI = 1.08, 1.33)) per 10 μg/m(3) increase in PM(2.5). There was an interaction between walkability and PM(2.5) (P = 0.037), where PM(2.5) had slightly stronger associations in more walkable than less walkable neighborhoods (HR = 1.23 [95% CI = 1.06, 1.42] vs. 1.17 [95% CI = 1.04, 1.32]) per 10 μg/m(3) increase in PM(2.5). Greenness had no interaction with PM(2.5) (P = 0.768) nor walkability (P = 0.385). CONCLUSIONS: High greenness may be protective of CVD mortality among adults with CVD history. PM(2.5) associated CVD mortality risk varies slightly by level of neighborhood walkability, though these small differences may not be clinically meaningful. Lippincott Williams & Wilkins 2022-02-18 /pmc/articles/PMC9005250/ /pubmed/35434462 http://dx.doi.org/10.1097/EE9.0000000000000200 Text en Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The Environmental Epidemiology. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. |
spellingShingle | Original Research Article Liao, Noelle S. Van Den Eeden, Stephen K. Sidney, Stephen Deosaransingh, Kamala Schwartz, Joel Uong, Stephen P. Alexeeff, Stacey E. Joint associations between neighborhood walkability, greenness, and particulate air pollution on cardiovascular mortality among adults with a history of stroke or acute myocardial infarction |
title | Joint associations between neighborhood walkability, greenness, and particulate air pollution on cardiovascular mortality among adults with a history of stroke or acute myocardial infarction |
title_full | Joint associations between neighborhood walkability, greenness, and particulate air pollution on cardiovascular mortality among adults with a history of stroke or acute myocardial infarction |
title_fullStr | Joint associations between neighborhood walkability, greenness, and particulate air pollution on cardiovascular mortality among adults with a history of stroke or acute myocardial infarction |
title_full_unstemmed | Joint associations between neighborhood walkability, greenness, and particulate air pollution on cardiovascular mortality among adults with a history of stroke or acute myocardial infarction |
title_short | Joint associations between neighborhood walkability, greenness, and particulate air pollution on cardiovascular mortality among adults with a history of stroke or acute myocardial infarction |
title_sort | joint associations between neighborhood walkability, greenness, and particulate air pollution on cardiovascular mortality among adults with a history of stroke or acute myocardial infarction |
topic | Original Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9005250/ https://www.ncbi.nlm.nih.gov/pubmed/35434462 http://dx.doi.org/10.1097/EE9.0000000000000200 |
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