Association of Residential Greenness Exposures on Disability: Findings from the Cohort Study on Global AGEing and Adult Health (SAGE) in China

Zhiqing Chen; Yan Shi; Yanfei Guo; Siwen Yu; Qijiong Zhu; Shangfeng Yang; Yuan Zheng; Yayi Li; Yixiang Huang; Wan Peng; Guanhao He; Jianxiong Hu; Xiaomei Dong; Fan Wu; Wenjun Ma; Tao Liu

doi:10.1016/j.envres.2024.120358

Association of Residential Greenness Exposures on Disability: Findings from the Cohort Study on Global AGEing and Adult Health (SAGE) in China

Environ Res. 2024 Nov 12:120358. doi: 10.1016/j.envres.2024.120358. Online ahead of print.

Authors

Zhiqing Chen¹, Yan Shi², Yanfei Guo², Siwen Yu³, Qijiong Zhu³, Shangfeng Yang³, Yuan Zheng³, Yayi Li³, Yixiang Huang³, Wan Peng³, Guanhao He³, Jianxiong Hu³, Xiaomei Dong⁴, Fan Wu⁵, Wenjun Ma⁶, Tao Liu⁷

Affiliations

¹ Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, 510632, China; China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou, 510632, China; Key Laboratory of Viral Pathogenesis & Infection Prevention and Control (Jinan University), Ministry of Education, Guangzhou, 510632, China.
² Shanghai Municipal Centre for Disease Control and Prevention, Shanghai, 200336, China.
³ Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, 510632, China; China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou, 510632, China.
⁴ Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, 510632, China.
⁵ Shanghai Medical College, Fudan University, Shanghai, 200032, China. Electronic address: wufan@shmu.edu.cn.
⁶ Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, 510632, China; China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou, 510632, China; Key Laboratory of Viral Pathogenesis & Infection Prevention and Control (Jinan University), Ministry of Education, Guangzhou, 510632, China. Electronic address: mawj@gdiph.org.cn.
⁷ Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, 510632, China; China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou, 510632, China; Key Laboratory of Viral Pathogenesis & Infection Prevention and Control (Jinan University), Ministry of Education, Guangzhou, 510632, China. Electronic address: gztt_2002@163.com.

PMID: 39542158
DOI: 10.1016/j.envres.2024.120358

Abstract

Background: With the accelerating population ageing globally, disability has become a major public concern. Residential greenness may be one of the influencing factors of disability, but epidemiological evidence in the associations of residential greenness exposures with disability is limited. We aimed to investigate the associations of residential greenness exposures with the risk of disability in the elderly.

Methods: Data of 8,408 residents were obtained from the World Health Organization Study on Global AGEing and Adult Health (WHO SAGE) implemented in China during 2007-2018. Participants were matched to the Normalized Difference Vegetation Index (NDVI) and Enhanced Vegetation Index (EVI) at their residential address. Disability was measured by the 12-item Chinese version of the World Health Organization Disability Assessment Schedule (WHODAS 2.0). The associations were examined using a generalized linear mixed model with stratified analyses by the covariates.

Results: We observed significantly negative associations of greenness exposures with the summary WHODAS score [NDVI_500m: -0.290, 95% Confidence Intervals (95%CI): -0.510, -0.070; EVI_500m: -0.453, 95%CI: -0.757, -0.149], and with the score of cognition (EVI_500m: -0.472, 95%CI: -0.881, -0.063), mobility (NDVI_500m: -0.632, 95%CI: -0.965, -0.299; EVI_500m: -0.739, 95%CI: -1.199, -0.280), and participation (NDVI_500m: -0.388, 95%CI: -0.651, -0.125; EVI_500m: -0.530, 95%CI: -0.893, -0.166). People living alone had a more pronounced association in cognition (NDVI_500m: -1.546, 95%CI: -2.471, -0.621). The associations with summary WHODAS score were stronger among participants living in rural areas (NDVI_500m: -0.420, -0.683, 95%CI: -0.157), having less education level (NDVI_500m: β= -0.618, 95%CI: -0.982, -0.253), and living in northern China (NDVI_500m: β= -0.381, 95%CI: -0.776, 0.013).

Conclusions: Residential greenness may reduce the onset and worsening of disability, particularly for domains of cognition, mobility, and social participation. Because of its stronger influence among people with low socioeconomic status, increasing greenness levels in areas with lower socioeconomic status may promote health equity.

Keywords: Cohort study; Disability; Enhanced Vegetation Index; Normalized Difference Vegetation Index; Residential greenness.