绿地暴露与心血管代谢性疾病的关联研究及PM_(2.5)的中介效应

Association between green space exposure and cardiovascular metabolic disease and the mediating effect of PM_(2.5)

目的描述我国社区自然人群心血管代谢性疾病(cardiovascular metabolic disease,CMD)的流行现状,探讨绿地暴露与CMD的关联及细颗粒物(fine particulate matter,PM_(2.5))的中介效应。方法采用多阶段分层整群抽样方法,选取2017—2019年“京津冀地区生活社区自然人群慢性病队列研究”的社区自然人群(≥18岁),采用归一化植被指数(normalized difference vegetation index,NDVI)和增强植被指数(enhanced vegetation index,EVI)评估人群的绿地暴露水平。采用广义线性混合效应模型进行绿地暴露与CMD的关联性分析,并分析PM_(2.5)在其中的中介效应。结果36429名研究对象中男16095名(44.2%),女20334名(55.8%);年龄18~92岁,平均(51.3±14.7)岁;其中CMD患者18025例,患病率为49.5%;同时患两种及以上CMD患者6232例(17.1%),其中高血压合并糖尿病患病率最高,为2584例(7.1%)。绿地与CMD呈负相关(主模型:NDVI500m,OR=0.951,95%CI:0.908~0.995;EVI500m,OR=0.907,95%CI:0.844~0.975)。PM_(2.5)在NDVI500m、EVI500m与CMD关联的中介效应占比分别为17.300%、22.370%。结论我国社区自然人群CMD患病率较高,较高的绿地暴露水平与自然人群CMD患病风险呈负相关,PM_(2.5)在其中发挥中介效应。增加居民住宅周围绿地可能是预防社区自然人群CMD患病的有效措施。

Objective To characterize the prevalence of cardiovascular metabolic disease(CMD)among natural population in living communities in China,examine the relationship between green space exposure and CMD,and investigate the mediating role of fine particulate matter(PM_(2.5))in the association between green space and CMD.Methods Based on the baseline survey of"the cohort study on chronic disease of community natural population in Beijing-Tianjin-Hebei region",a multi-stage stratified cluster sampling method was employed to recruit community residents aged 18 and above as study subjects.The normalized difference vegetation index(NDVI)and enhanced vegetation index(EVI)were used to assess the exposure level of green space.The generalized linear mixed effect model was used to analyze the correlation between green space exposure and CMD,and to analyze the mediating effect of PM_(2.5).Results Among the 36429 subjects,16095 were males(44.2%),20334 were females(55.8%).The age ranged from 18 to 92 years,and the average age was(51.3±14.7)years.Among them,there were 18025 patients with CMD,and the prevalence rate was 49.5%.There were 6232 patients(17.1%)with two and above kinds of CMD at the same time,and the prevalence of hypertension complicated with diabetes was the highest,accounting for 2584 cases(7.1%).There was a negative correlation between green space and CMD(main model:NDVI500m,OR=0.951,95%CI:0.908-0.995;EVI500m,OR=0.907,95%CI:0.844-0.975).The mediating effect of PM_(2.5)between CMD and NDVI500m and EVI500m was 17.300%and 22.370%,respectively.Conclusions The prevalence rate of CMD is relatively high in the natural population in living communities in China,the higher exposure level of green space is negatively correlated with the risk of CMD in natural population,and PM_(2.5)plays an intermediary effect,which suggests that increasing the green space around residents'houses may be an effective measure to prevent the natural population in the community from getting sick with CMD.