Abstract
Exposure to greenness is increasingly linked to beneficial health outcomes, but the associations between greenness and the disease burden of lower respiratory infections (LRIs) are unclear. We used the normalized difference vegetation index (NDVI) and the leaf area index (LAI) to measure greenness and incidence, death, and disability-adjusted life years (DALYs) due to LRIs to represent the disease burden of LRIs. We applied a generalized linear mixed model to evaluate the association between greenness and LRI disease burden and performed a stratified analysis, after adjusting for covariates. Additionally, we assessed the potential mediating effects of fine particulate matter (PM2.5), ozone (O3), nitrogen dioxide (NO2), and heat on the association between greenness and the disease burden of LRIs. In the adjusted model, one 0.1 unit increase of NDVI and 0.5 increase in LAI were significantly inversely associated with incidence, death, and DALYs due to LRIs, respectively. Greenness was negatively correlated with the disease burden of LRIs across 15–65 age group, both sexes, and low SDI groups. PM2.5, O3, and heat mediated the effects of greenness on the disease burden of LRIs. Greenness was significantly negatively associated with the disease burden of LRIs, possibly by reducing exposure to air pollution and heat.
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Data availability
Publicly available datasets were analyzed in this study. This data can be found here: [dataset1] Global Burden of Disease, 2019. http://ghdx.healthdata.org/gbd-results-tool. [dataset2] Surface PM2.5. Atmospheric Composition Analysis Group, V5.GL.02. https://sites.wustl.edu/acag/datasets. [dataset3] NASA Earth Observations，2022. Vegetation Index. https://neo.gsfc.nasa.gov/. (Accessed Jan. 30, 2022). [dataset4] https://doi.org/10.6084/m9.figshare.12968114. [dataset5] World Bank, 2022. https://databank.worldbank.org/home.aspx.
Abbreviations
- LRIs:
-
Lower respiratory infections
- GBD:
-
Global burden of disease
- DALYs:
-
Disability-adjusted life years
- PM2.5 :
-
Fine particulate matter ≤2.5 μm
- O3 :
-
Ozone
- NO2 :
-
Nitrogen dioxide
- NDVI:
-
Normalized difference vegetation index
- LAI:
-
Leaf area index
- SDI:
-
Socio-demographic Index
- RR:
-
Rate ratio
- CI:
-
Confidence interval
- IQR:
-
Interquartile range
- VIF:
-
Variance inflation factor
- GLMMs:
-
Generalized linear mixed models
- PQL:
-
Penalized quasi-likelihood
- GDP:
-
Gross domestic product
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We would like to thank all of our teachers and students for their assistance with this work.
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The work was supported by the 512 Talent Cultivation Plan of Bengbu Medical College (grant numbers by 51201202 and by 51201307) and the Natural Science Foundation of Anhui Province (grant no. 2108085MH252), China.
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Chengrong Liu: formal analysis, data curation, writing—original draft, and visualization. Chao Liu: investigation and resources. Peiyao Zhang: investigation and resources. Meihui Tian: investigation and resources. Ke Zhao: investigation and resources. Fenfen He: investigation and supervision. Yilin Dong: investigation and resources. Haoyu Liu: investigation and supervision. Wenjia Peng: methodology and writing—review and editing. Xianjie Jia: supervision, project administration, writing—review and editing, and funding acquisition. Ying Yu: conceptualization, writing—review and editing, supervision, and funding acquisition.
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Liu, ., Liu, C., Zhang, P. et al. Association of greenness with the disease burden of lower respiratory infections and mediation effects of air pollution and heat: a global ecological study. Environ Sci Pollut Res 30, 91971–91983 (2023). https://doi.org/10.1007/s11356-023-28816-y
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DOI: https://doi.org/10.1007/s11356-023-28816-y