TY - JOUR
T1 - Global greenness in relation to reducing the burden of cardiovascular diseases
T2 - ischemic heart disease and stroke
AU - Asri, Aji Kusumaning
AU - Yu, Chia Pin
AU - Pan, Wen Chi
AU - Guo, Yue Leon
AU - Su, Huey Jen
AU - Lung, Shih Chun Candice
AU - Wu, Chih Da
AU - Spengler, John D.
N1 - Publisher Copyright:
© 2020 The Author(s). Published by IOP Publishing Ltd.
PY - 2020/12
Y1 - 2020/12
N2 - This ecological study aimed to identify the association between greenness and cardiovascular diseases in terms of ischemic heart disease (IHD) and stroke in 183 countries worldwide. The country-level disability-adjusted life year (DALY) database provided by the WHO was used to represent the health burden due to IHD and stroke for the study countries. Normalized Difference Vegetation Index (NDVI - MOD13A3) was assessed to estimate the greenness in each country. After considering potential covariates, the generalized linear mixed model penalized quasi-likelihood coupled with a sensitivity test was applied to identify the greenness in relation to DALY loss due to IHD and stroke. Stratified analysis was then conducted to determine the effects of greenness among the different levels of gender, age, and economic status. A consistently significant negative association was found between greenness and both IHD and stroke; the NDVI coefficients of the main model were -11.245 (95% CI: -16.770, -5.720) and -4.387 (95% CI:-7.926, -0.085), respectively, in the DALY changes based on the increase of NDVI from 0 to 1. The stratified analysis recognized these effects in both females and males. Negative associations between greenness and IHD as well as stroke were also found in various age groups and were confirmed as significant in low and middle-income countries.
AB - This ecological study aimed to identify the association between greenness and cardiovascular diseases in terms of ischemic heart disease (IHD) and stroke in 183 countries worldwide. The country-level disability-adjusted life year (DALY) database provided by the WHO was used to represent the health burden due to IHD and stroke for the study countries. Normalized Difference Vegetation Index (NDVI - MOD13A3) was assessed to estimate the greenness in each country. After considering potential covariates, the generalized linear mixed model penalized quasi-likelihood coupled with a sensitivity test was applied to identify the greenness in relation to DALY loss due to IHD and stroke. Stratified analysis was then conducted to determine the effects of greenness among the different levels of gender, age, and economic status. A consistently significant negative association was found between greenness and both IHD and stroke; the NDVI coefficients of the main model were -11.245 (95% CI: -16.770, -5.720) and -4.387 (95% CI:-7.926, -0.085), respectively, in the DALY changes based on the increase of NDVI from 0 to 1. The stratified analysis recognized these effects in both females and males. Negative associations between greenness and IHD as well as stroke were also found in various age groups and were confirmed as significant in low and middle-income countries.
KW - cardiovascular diseases
KW - greenness
KW - ischemic heart disease (IHD)
KW - normalized difference vegetation index (NDVI)
KW - stroke
UR - http://www.scopus.com/inward/record.url?scp=85096940102&partnerID=8YFLogxK
U2 - 10.1088/1748-9326/abbbaf
DO - 10.1088/1748-9326/abbbaf
M3 - Article
AN - SCOPUS:85096940102
SN - 1748-9318
VL - 15
JO - Environmental Research Letters
JF - Environmental Research Letters
IS - 12
M1 - 124003
ER -