社区绿地与高血压患病风险关联研究

Study on the association between residential greenspace and risk of hypertension

目的 评估社区绿地与成年人高血压及高血压前期患病风险的关联。方法 采用多阶段分层随机抽样,在安徽省蚌埠市某区抽取成年人,通过问卷调查和健康体检获取社会人口学特征和血压水平。计算参与者家庭所在250 m缓冲区的归一化植被指数(normalized difference vegetation index,NDVI)、优化土壤调节植被指数(optimized soil adjusted vegetation index,OSAVI)。应用广义线性混合效应模型探讨社区绿地与居民高血压前期、高血压患病风险的关联,以及关联的差异性。采用中介分析评估体质量指数(body mass index,BMI)、PM2.5的中介作用。结果 最终纳入成年人2 940人,处于高血压前期955例,患病率总体达32.48%,高血压1 414例,患病率总体达48.10%。按照植被暴露水平四分位数分组,调整协变量后,与家庭处于NDVI250、OSAVI250Q1(最低)组居民相比,处于Q4(最高)组居民高血压前期和高血压患病风险更低;以正常血压组作为对照组发现,社区绿地对高血压患病的影响高于其对高血压前期患病的影响。中介分析显示,BMI介导了NDVI250与高血压前期和高血压患病风险负向关联的13.36%(95%CI:4.00%~41.00%)和16.92%(95%CI:3.90%~40.00%),未观察到PM2.5在社区绿地和高血压前期以及高血压之间的关系的中介作用。结论 家庭处于较高的植被水平周围可能与较低的高血压及高血压前期患病风险相关,BMI可能是中介因素之一。

Objective To evaluate the association of residential greenspace with hypertension and pre-hypertension in adult residents.Methods Using multi-stage stratified random sampling,adults were selected from a district in Bengbu,Anhui Province,whose socio-demographic characteristics and blood pressure levels were obtained through questionnaire interview and physical examination.Residential greenness exposure was assessed using the normalized difference vegetation index(NDVI)and optimized soil-adjusted vegetation index(OSAVI)within a 250m buffer around the participants’residences.Generalized linear mixed-effects model was used to evaluate the association between residential greenspace and hypertension/pre-hypertension,as well as the variability of the association.Mediation analysis was used to evaluate the mediation effect of body mass index(BMI)and PM 2.5.Results Of the 2940 adults included,955 were pre-hypertensive,with an overall prevalence of 32.48%,and 1414 had hypertension,with an overall prevalence of 48.10%.After adjusting for covariates,residents in the fourth quartile of greenness exposure(the highest exposure)had a lower risk of pre-hypertension and hypertension compared with those in the first quartile of NDVI 250 and OSAVI 250(the lowest greenness exposure).Taking the normal blood pressure group as the reference group,the impact of residential greenspace on hypertension was larger than that on pre-hypertension.Mediation analysis showed that BMI mediated 13.36%(95%CI:4.00%-41.00%)and 16.92%(95%CI:3.90%-40.00%)of the negative association between NDVI 250 and the risks of pre-hypertension,and between NDVI 250 and hypertension,respectively;while no mediating role of PM 2.5 was observed in the association between neighborhood greenspace and pre-hypertension/hypertension.Conclusions Higher level of neighborhood greenness may be associated with reduced risk of hypertension and pre-hypertension,in which BMI may be a mediating factor.