Association between greenness and cardiovascular risk factors: Results from a large cohort study in Thailand

Kanawat Paoin; Chanathip Pharino; Arthit Phosri; Kayo Ueda; Xerxes Tesoro Seposo; Matthew Kelly; Sam-Ang Seubsman; Adrian Sleigh

doi:10.1016/j.envres.2023.115215

Association between greenness and cardiovascular risk factors: Results from a large cohort study in Thailand

Environ Res. 2023 Mar 1:220:115215. doi: 10.1016/j.envres.2023.115215. Epub 2023 Jan 4.

Authors

Kanawat Paoin¹, Chanathip Pharino², Arthit Phosri³, Kayo Ueda⁴, Xerxes Tesoro Seposo⁵, Matthew Kelly⁶, Sam-Ang Seubsman⁷, Adrian Sleigh⁶

Affiliations

¹ Department of Environmental Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand. Electronic address: kanawat.p@chula.ac.th.
² Department of Environmental Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand. Electronic address: chanathip.p@chula.ac.th.
³ Department of Environmental Health Sciences, Faculty of Public Health, Mahidol University, Bangkok, Thailand.
⁴ Department of Hygiene, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan; Department of Environmental Engineering, Graduate School of Engineering, Kyoto University, Kyoto, Japan; Graduate School of Global Environmental Sciences, Kyoto University, Kyoto, Japan.
⁵ Department of Hygiene, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan.
⁶ Department of Global Health, Research School of Population Health, Australian National University, Canberra, Australia.
⁷ School of Human Ecology, Sukhothai Thammathirat Open University, Nonthaburi, Thailand.

PMID: 36610535
DOI: 10.1016/j.envres.2023.115215

Abstract

Background: The risk of cardiovascular diseases may be reduced by residing in green environments. However, there are relatively few longitudinal cohort studies, especially in Southeast Asia, that focused on the health benefits of long-term greenness exposure in young adults. The present study examined the association between long-term exposure to residential greenness and self-reported morbidities in participants of the Thai Cohort Study (TCS) in Thailand from 2005 to 2013.

Methods: The self-reported outcomes, including high blood pressure, high blood cholesterol, and diabetes, were reported in 2005, 2009, and 2013, where the study participants provided the exact year of disease occurrence. Greenness was assessed by the satellite-based Normalized Difference Vegetation Index (NDVI) and Enhanced Vegetation Index (EVI), with a spatial resolution of 250 m. Long-term exposure to NDVI and EVI of each participant's sub-district was averaged over the period of person-time. We used Cox proportional hazards models to examine the association between greenness and health outcomes. Associations with self-reported morbidity were measured using hazard ratios (HRs) per interquartile range (IQR) increase in NDVI and EVI.

Results: After adjusting for potential confounders, we observed that an IQR increase in NDVI was associated with lower incidence of high blood pressure (HR = 0.92, 95% CI: 0.89, 0.97) and high blood cholesterol (HR = 0.89, 95%CI: 0.87, 0.92), but not significantly associated with diabetes (HR = 0.93, 95%CI: 0.85, 1.01). EVI was also inversely associated with self-reported high blood pressure (HR = 0.92, 95%CI: 0.88, 0.96), high blood cholesterol (HR = 0.89, 95%CI: 0.87, 0.91), and diabetes (HR = 0.92, 95%CI: 0.85, 0.99).

Conclusions: Long-term exposure to residential greenness was inversely associated with self-reported high blood pressure, high blood cholesterol, and diabetes in participants of TCS. Our study provides evidence that greenness exposure may reduce cardiovascular disease risk factors in adult population.

Keywords: Diabetes; EVI; High blood cholesterol; High blood pressure; NDVI.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

China
Cholesterol
Cohort Studies
Humans
Hypertension*
Longitudinal Studies
Thailand / epidemiology

Substances

Cholesterol