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

Whanhee Lee; Seulkee Heo; Rory Stewart; Xiao Wu; Kelvin C Fong; Ji-Young Son; Benjamin Sabath; Danielle Braun; Jae Yoon Park; Yong Chul Kim; Jung Pyo Lee; Joel Schwartz; Ho Kim; Francesca Dominici; Michelle L Bell

doi:10.1016/j.envint.2023.107844

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

Environ Int. 2023 Mar:173:107844. doi: 10.1016/j.envint.2023.107844. Epub 2023 Feb 21.

Authors

Whanhee Lee¹, Seulkee Heo², Rory Stewart², Xiao Wu³, Kelvin C Fong², Ji-Young Son², Benjamin Sabath⁴, Danielle Braun⁵, Jae Yoon Park⁶, Yong Chul Kim⁷, Jung Pyo Lee⁸, Joel Schwartz⁹, Ho Kim¹⁰, Francesca Dominici³, Michelle L Bell²

Affiliations

¹ School of Biomedical Convergence Engineering, College of Information and Biomedical Engineering, Pusan National University, Yangsan, Republic of Korea. Electronic address: whanhee.lee@pusan.ac.kr.
² Yale School of the Environment, Yale University, New Haven, CT, USA.
³ Department of Biostatistics, Harvard T H Chan School of Public Health, Boston, MA, USA.
⁴ Faculty of Arts and Sciences Research Computing Department, Harvard University, Boston, MA, USA.
⁵ Department of Biostatistics, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA.
⁶ Department of Internal Medicine, Dongguk University Ilsan Hospital, Republic of Korea; Department of Internal Medicine, Dongguk University College of Medicine, Republic of Korea.
⁷ Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
⁸ Department of Internal Medicine, Seoul National University Boramae Medical Center, Republic of Korea.
⁹ Department of Environmental Health, Harvard T H Chan School of Public Health, Boston, MA, USA.
¹⁰ Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea; Institute for Sustainable Development, Graduate School of Public Health, Seoul National University, Republic of Korea.

PMID: 36841189
DOI: 10.1016/j.envint.2023.107844

Abstract

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.

Keywords: Acute Kidney Injury; Chronic Kidney Disease; Greenness; Kidney disease; Medicare.

Publication types

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

MeSH terms

Acute Kidney Injury* / epidemiology
Aged
Cohort Studies
Humans
Longitudinal Studies
Massachusetts / epidemiology
Medicare
Renal Insufficiency, Chronic* / epidemiology
Renal Insufficiency, Chronic* / etiology
United States / epidemiology