Associations between greenness and kidney disease in Massachusetts: The US Medicare longitudinal cohort study

Environment International · 2023 · 11 citations

• Medicine
• Internal medicine
• Environmental health

BACKGROUND: Recent studies have identified the association of environmental stressors with reduced kidney function and the development of kidney disease. While residential greenness has been linked to many health benefits, the association between residential greenness and the development of kidney disease is not clear. We aimed to investigate the association between residential greenness and the development of kidney disease. METHODS: We performed a longitudinal population-based cohort study including all fee-for-service Medicare Part A beneficiaries (aged 65 years or older) in Massachusetts (2000-2016). We assessed greenness with the annual average Enhanced Vegetation Index (EVI) based on residential ZIP codes of beneficiaries. We applied Cox-equivalent Poisson models to estimate the association between EVI and first hospital admission for total kidney disease, chronic kidney disease (CKD), and acute kidney injury (AKI), separately. RESULTS: Data for 1,462,949 beneficiaries who resided in a total of 644 ZIP codes were analyzed. The total person-years of follow-up for total kidney disease, CKD, and AKI were 9.8, 10.9, and 10.8 million person-years, respectively. For a 0.1 increase in annual EVI, the hazard ratios (HRs) were 0.95 (95% CI: 0.93 to 0.97) for the first hospital admission for total kidney disease, and the association was more prominent for AKI (HR: 0.94 with 95% CI: 0.92 to 0.97) than CKD (HR: 0.98 with 95% CI: 0.95-1.01]). The estimated effects of EVI on kidney disease were generally more evident in White beneficiaries and those residing in metropolitan areas compared to the overall population. CONCLUSIONS: This study found that higher levels of annual residential greenness were associated with a lower risk of the first hospital admission for kidney diseases. Results are consistent with the hypothesis that higher residential greenness benefits kidney patients.

The roles of residential greenness in the association between air pollution and health: a systematic review

Environmental Research Letters · 2021 · 49 citations

• Environmental science
• Environmental health
• Medicine

While a growing body of literature suggests beneficial impacts of greenness on several health outcomes, relatively few studies have examined greenness as an effect modifier to impacts of air pollution on health outcomes, and results from the existing studies are inconclusive. We performed a comprehensive, systematic review of previous literature on greenness as a potential effect modifier for associations between particulate matter air pollution and health. After initial screening of 7814 studies, we identified 20 eligible studies. We summarized findings on study characteristics based on several criteria: health outcome, air pollution exposure, source of air pollution data, study location, study period, and median year of the study period. We evaluated characteristics of effect modification by greenness on air pollution and health associations based on the number of greenness metrics applied, type of greenness metric (e.g. normalized difference vegetation index, land use), data source for greenness, and spatial resolution and buffer size. We also summarized evidence for effect modification by greenness based on strength and direction of evidence for each study and overall evidence of effect modification by greenness by several study characteristics. Our systematic review showed that only a limited number of studies have been conducted on greenness as an effect modifier for air pollution-health associations. We found differences in several study characteristics such as greenness assessment (e.g. greenness metrics applied, spatial resolution, and data sources) across studies. Collectively, the studies provide suggestive evidence for the hypothesis that areas with high greenness have lower impacts of air pollution on health, although some studies reported inconsistent findings. The findings from our review provide valuable knowledge on how greenness affects associations between air pollution and health and could help identify critical areas for future study.

Reductions in mortality resulting from reduced air pollution levels due to COVID-19 mitigation measures

The Science of The Total Environment · 2020 · 73 citations

• Environmental science
• Environmental health
• Environmental protection