Impact of residential greenness on myocardial infarction in population with diabetes : A sex-dependent association?
Journal article
Ponjoan, Anna, Blanch, Jordi, Alves-Cabratosa, Lia, Martí-Lluch, Ruth, Comas-Cufí, Marc, Cirach, Marta, Nieuwenhuijsen, Mark, Garcia-Gil, María and Ramos, Rafel. (2022). Impact of residential greenness on myocardial infarction in population with diabetes : A sex-dependent association? Environmental Research. 205(1), p. Article 112449. https://doi.org/10.1016/j.envres.2021.112449
Authors | Ponjoan, Anna, Blanch, Jordi, Alves-Cabratosa, Lia, Martí-Lluch, Ruth, Comas-Cufí, Marc, Cirach, Marta, Nieuwenhuijsen, Mark, Garcia-Gil, María and Ramos, Rafel |
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Abstract | Living in urban areas with abundant greenness might provide health benefits in general population. Literature suggests that sex/gender plays a role in the association between greenness and health outcomes. But the impact of greenness in populations with moderate to high cardiovascular risk, such as persons with diabetes, is still unknown. Our aim was to evaluate the relationship between urban greenness and myocardial infarction incidence in persons with type 2 diabetes in Barcelona (Catalonia, Spain), and seek potential gender/sex differences in this association. This retrospective cohort study is based on data from the System for the Development of Research in Primary Care (SIDIAP database). We used Cox models to estimate if a 0.01 increase in Normalized Difference Vegetation Index (NDVI) at census tract level was associated to reduced risk of developing a myocardial infarction. Models were adjusted by demographic and clinical characteristics at individual level, and by environmental and socioeconomic variables at census tract level. Amongst 41,463 persons with diabetes and 154,803.85 person-years of follow-up, we observed 449 incident cases of acute myocardial infarction. For each 0.01 increment in NDVI the risk of developing a myocardial infarction decreased by 6% (Hazard Ratio, HR = 0.94; 95%CI, 0.89–0.99) in the population with diabetes. When stratifying by sex, we observed a significant association only in men (HR = 0.91; 95%CI, 0.86–0.97). People with diabetes living in urban greener areas might benefit from reduced cardiovascular risk, specially men. We observed sex/gender disparities, which could be related to different exposures and activities performed in green spaces between men and women. Further studies are needed to confirm sex/gender disparities between greenness exposure and cardiovascular outcomes. Our findings contribute to improve the health of people with diabetes who should be recommended to spent time and exercise in green areas. |
Keywords | cardiovascular diseases; green space; street-level greenery; men; women |
Year | 2022 |
Journal | Environmental Research |
Journal citation | 205 (1), p. Article 112449 |
Publisher | Elsevier Inc. |
ISSN | 0013-9351 |
Digital Object Identifier (DOI) | https://doi.org/10.1016/j.envres.2021.112449 |
PubMed ID | 34883080 |
Scopus EID | 2-s2.0-85121246975 |
Open access | Published as ‘gold’ (paid) open access |
Page range | 1-7 |
Funder | Agency for Management of University and Research Grants (AGAUR), Generalitat de Catalunya |
Institute of Health Carlos III | |
Spanish Ministry of Economy and Competitiveness | |
Publisher's version | License File Access Level Open |
Output status | Published |
Publication dates | |
Online | 06 Dec 2021 |
Publication process dates | |
Accepted | 24 Nov 2021 |
Deposited | 18 Oct 2023 |
Grant ID | RedIAPP RD16/0007/0004 |
2017 SGR 1146 |
https://acuresearchbank.acu.edu.au/item/8zw41/impact-of-residential-greenness-on-myocardial-infarction-in-population-with-diabetes-a-sex-dependent-association
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Publisher's version
OA_Ponjoan_2022_Impact_of_residential_greenness_on_myocardial.pdf | |
License: CC BY 4.0 | |
File access level: Open |
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