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The Association Between Exposure to Greenness and Blood Pressure in Children: Findings from the Seven Northeastern Cities Study in China

34 Pages Posted: 15 May 2019

See all articles by Xiang Xiao

Xiang Xiao

Sun Yat-Sen University (SYSU) - Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment

Bo-Yi Yang

Sun Yat-Sen University (SYSU) - Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment

Li-Wen Hu

Sun Yat-Sen University (SYSU) - Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment

Iana Markevych

Ludwig Maximilian University of Munich (LMU); German Research Center for Environmental Health - Helmholtz Center Munich

Michael S. Bloom

Sun Yat-Sen University (SYSU) - Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment; University at Albany (SUNY)

Shyamali Dharmage

University of Melbourne, School of Population and Global Health, Allergy and Lung Health Unit; Royal Childrens Hospital - Murdoch Childrens Research Institute

Bin Jalaludin

Centre for Air Quality and Health Research and Evaluation; University of New South Wales (UNSW)

Luke D. Knibbs

University of Queensland - School of Public Health

Joachim Rodriguez

Ludwig Maximilian University of Munich (LMU) - University Hospital; German Centre for Lung Research

Lidia Morawska

Queensland University of Technology

Shao Lin

SUNY University at Albany

Marjut Roponen

Sun Yat-Sen University (SYSU) - Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment

Yuming Guo

Monash University - School of Public Health and Preventive Medicine

Steve Hung Lam Yim

The Chinese University of Hong Kong (CUHK) - Department of Geography and Resource Management; The Chinese University of Hong Kong (CUHK) - Institute of Environment, Energy and Sustainability; The Chinese University of Hong Kong (CUHK) - Stanley Ho Big Data Decision Analytics Research Centre

Ari Leskinen

Government of the Republic of Finland - Finnish Meteorological Institute; University of Eastern Finland - Department of Applied Physics

Mika Komppula

Government of the Republic of Finland - Finnish Meteorological Institute

Pasi Jalava

University of Eastern Finland

Hong-Yao Yu

Sun Yat-Sen University (SYSU) - Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment

Mohammed Zeeshan

Sun Yat-Sen University (SYSU) - Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment

Xiao-Wen Zeng

Sun Yat-Sen University (SYSU) - Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment

Guang-Hui Dong

Sun Yat-Sen University (SYSU) - Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment

More...

Abstract

Background: There is scarcity of evidence on the associations between greenness and blood pressure, particularly in children. We aimed to investigate this association among children living in China.

Methods: Our study included 9,354 children (4·3 to 17·8 years of age) participating in the Seven Northeastern Cities Study in China. Greenness around each child's school was estimated by NDVI (Normalized Difference Vegetation Index) and SAVI (Soil-Adjusted Vegetation Index). Particulate matter <1μm (PM1) and nitrogen dioxide (NO2) concentrations were predicted by spatiotemporal models. Associations between greenness and blood pressure were determined by generalized linear mixed-effect models. Mediation by air pollution, physical activity and body mass index was assessed using causal mediation analysis.

Findings: Higher greenness was consistently associated with lower blood pressure. An increase of 0·1 in NDVI corresponded to a reduction in SBP of 0·71 mmHg (95% CI: 0·18, 1·23) and lower odds of hypertension (OR= 0·81, 95% CI: 0·72, 0·92). Stronger associations were observed in children with higher BMI. Ambient PM1 and NO2 mediated 24·2% and 19·6% of the association between greenness and SBP, respectively.

Interpretation: Greater greenness had a beneficial effect on blood pressure among Chinese children, particularly in overweight or obese children. The associations were partially mediated by air pollution. If confirmed in future studies, these results could encourage policy makers to incorporate more greenspace for both aesthetic and health benefits.

Funding Statement: This work was supported by grants 81872582, 91543208, 81673128, and 81703179 from the National Natural Science Foundation of China, grant 2018B030312005 from the Guangdong Provincial Natural Science Foundation Team Project, grants 201807010032 and 201803010054 from the Science and Technology Program of Guangzhou, grant 2016YFC0207000 from the National Key Research and Development Program of China, and grants 2016A030313342, 2017A050501062, and 2018B05052007 from the Guangdong Province Natural Science Foundation

Declaration of Interests: The authors state: "none reported."

Ethics Approval Statement: This study was approved by the Human Studies Committee of Sun Yat-sen University.

Keywords: greenness; blood pressure; childhood hypertension; modification; mediation

Suggested Citation

Xiao, Xiang and Yang, Bo-Yi and Hu, Li-Wen and Markevych, Iana and Bloom, Michael S. and Dharmage, Shyamali and Jalaludin, Bin and Knibbs, Luke D. and Rodriguez, Joachim and Morawska, Lidia and Lin, Shao and Roponen, Marjut and Guo, Yuming and Yim, Steve Hung Lam and Leskinen, Ari and Komppula, Mika and Jalava, Pasi and Yu, Hong-Yao and Zeeshan, Mohammed and Zeng, Xiao-Wen and Dong, Guang-Hui, The Association Between Exposure to Greenness and Blood Pressure in Children: Findings from the Seven Northeastern Cities Study in China (May 10, 2019). Available at SSRN: https://ssrn.com/abstract=3386280 or http://dx.doi.org/10.2139/ssrn.3386280

Xiang Xiao

Sun Yat-Sen University (SYSU) - Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment

China

Bo-Yi Yang

Sun Yat-Sen University (SYSU) - Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment

China

Li-Wen Hu

Sun Yat-Sen University (SYSU) - Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment

China

Iana Markevych

Ludwig Maximilian University of Munich (LMU)

Geschwister-Scholl-Platz 1
Munich, DE Bavaria 80539
Germany

German Research Center for Environmental Health - Helmholtz Center Munich

Institute for Bioinformatics and Systems Biology
Ingolstaedter Landstrasse 1
Neuherberg, 85764
Germany

Michael S. Bloom

Sun Yat-Sen University (SYSU) - Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment

China

University at Albany (SUNY)

1400 Washington Ave
Albany, NY 12222
United States

Shyamali Dharmage

University of Melbourne, School of Population and Global Health, Allergy and Lung Health Unit ( email )

185 Pelham Street
Carlton, Victoria 3053
Australia

Royal Childrens Hospital - Murdoch Childrens Research Institute ( email )

Parkville, Victoria
Australia

Bin Jalaludin

Centre for Air Quality and Health Research and Evaluation

Australia

University of New South Wales (UNSW)

Kensington
High St
Sydney, NSW 2052
Australia

Luke D. Knibbs

University of Queensland - School of Public Health

St Lucia
Brisbane
Australia

Joachim Rodriguez

Ludwig Maximilian University of Munich (LMU) - University Hospital

Munich
Germany

German Centre for Lung Research

Giessen
Germany

Lidia Morawska

Queensland University of Technology

2 George Street
Brisbane, Queensland 4000
Australia

Shao Lin

SUNY University at Albany

1400 Washington Avenue
Building, Room 109
Albany, NY 12222
United States

Marjut Roponen

Sun Yat-Sen University (SYSU) - Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment

China

Yuming Guo

Monash University - School of Public Health and Preventive Medicine

Australia

Steve Hung Lam Yim

The Chinese University of Hong Kong (CUHK) - Department of Geography and Resource Management ( email )

Hong Kong
China

The Chinese University of Hong Kong (CUHK) - Institute of Environment, Energy and Sustainability ( email )

Shatin, N.T., Hong Kong
China

The Chinese University of Hong Kong (CUHK) - Stanley Ho Big Data Decision Analytics Research Centre ( email )

Shatin, N.T., Hong Kong
China

Ari Leskinen

Government of the Republic of Finland - Finnish Meteorological Institute

P.O.Box 503
FIN-00101 Helsinki
Finland

University of Eastern Finland - Department of Applied Physics

PO Box 111
Joensuu, 80100
Finland

Mika Komppula

Government of the Republic of Finland - Finnish Meteorological Institute

P.O.Box 503
FIN-00101 Helsinki
Finland

Pasi Jalava

University of Eastern Finland

PO Box 111
Joensuu, 80100
Finland

Hong-Yao Yu

Sun Yat-Sen University (SYSU) - Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment

China

Mohammed Zeeshan

Sun Yat-Sen University (SYSU) - Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment

China

Xiao-Wen Zeng

Sun Yat-Sen University (SYSU) - Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment

China

Guang-Hui Dong (Contact Author)

Sun Yat-Sen University (SYSU) - Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment ( email )

China

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