Associations of residential greenness with incident vascular diseases in middle-aged and older adults: A large prospective cohort study
居住地绿化与中老年人群血管疾病发病率的关系：一项大型前瞻性队列研究

Bolun Cheng $^{a, b, c}$ , Wenming Wei $^{a, b}$ , Shiqiang Cheng $^{a, b}$ , Chuyu Pan $^{a, b}$ , Yan Wen $^{a, b}$ , Feng Zhang $^{a, b, c, *}$
程博伦 $^{a, b, c}$ ，魏文铭 $^{a, b}$ ，程时强 $^{a, b}$ ，潘楚宇 $^{a, b}$ ，温岩 $^{a, b}$ ，张峰 $^{a, b, c, *}$ $^{a}$ NHC Key Laboratory of Environment and Endemic Diseases (Xi'an Jiaotong University), Xi'an 710061, China
$^{a}$ 国家卫生健康委员会地方病防治重点实验室（西安交通大学），西安 710061，中国 $^{b}$ Collaborative Innovation Center of Endemic Disease and Health Promotion for Silk Road Region, School of Public Health, Health Science Center, Xi'an Jiaotong University, 710061, China
$^{b}$ 丝绸之路地区地方病防治与健康促进协同创新中心，西安交通大学公共卫生学院，健康科学中心，710061，中国 $^{c}$ Key Laboratory of Environmental Pollution Monitoring and Disease Control (Guizhou Medical University) & Joint Key Laboratory of Endemic Diseases, Guizhou 561113, China
$^{c}$ 环境污染监测与疾病控制重点实验室（贵州医科大学）& 贵州省地方病联合实验室，中国 561113

ARTICLE INFO 文章信息

Edited by Dr. Renjie Chen.
由陈仁杰博士编辑。

Keywords: 关键词：

Residential greenness  居住区绿化
Chronic vascular diseases
慢性血管疾病
Green space  绿地
Natural environment  自然环境
Domestic garden  家庭花园

Abstract 摘要

The relationship between residential greenness and chronic vascular diseases (VD) remains inconclusive. This study aimed to assess the associations between residential greenness and the incidence of new-onset VD. We analyzed data from a cohort of up to 240,000 participants without prior VD. To investigate the associations between residential greenness and the incidence of VD, we employed Cox proportional hazard models alongside restricted cubic spline regression. Greenness encompassed green space, domestic garden, and natural environment, while VD included eight specific conditions, such as heart failure, sequelae of cerebrovascular disease (CeVD), and peripheral vascular disease (PVD). Participants were stratified according to their exposure levels of residential greenness, with the lowest level serving as the reference group. Over a median follow-up of 10.8 years, more than 30,000 participants developed VD. Green space and natural environment were associated with a decreased VD risk, with green space showing the strongest effect on sequelae of CeVD ( $HR = 0.662, 95 % CI$ : 0.556-0.789), followed by natural environment on PVD (0.738, 0.667-0.815). In contrast, domestic garden was correlated with an increased VD risk, such as sequelae of CeVD (1.252, 1.079-1.453) and PVD (1.141, 1.050-1.239). Furthermore, stratified analyses revealed that the protective associations of residential greenness were particularly pronounced for heart failure among obesity individuals, males, and those who consume alcohol. Our findings suggest that exposure to green space and natural environment was negatively associated with VD risk. These results may underscore the potential role of residential greenness in regulating VD risk.
住宅区绿化与慢性血管疾病（VD）之间的关系尚无定论。本研究旨在评估住宅区绿化与新发 VD 发病率之间的关联。我们分析了来自一个包含高达 24 万名无既往 VD 的队列的数据。为探究住宅区绿化与 VD 发病率之间的关联，我们采用了 Cox 比例风险模型和限制性三次样条回归。绿化包括绿地、家庭花园和自然环境，而 VD 包括八种特定疾病，如心力衰竭、脑血管疾病后遗症（CeVD）和外周血管疾病（PVD）。参与者根据其住宅区绿化的暴露水平进行分层，其中最低水平作为参考组。在 10.8 年的中位随访期间，超过 30,000 名参与者发展为 VD。绿地和自然环境与 VD 风险降低相关，其中绿地对 CeVD 后遗症的影响最强（ $HR = 0.662, 95 % CI$ ：0.556-0.789），其次是自然环境对 PVD 的影响（0.738，0.667-0.815）。相比之下，家庭花园与 VD 风险增加相关，如 CeVD 后遗症（1.252，1.079-1.453）和 PVD（1.141，1.050-1.239）。此外，分层分析表明，住宅绿地的保护性关联在肥胖个体、男性以及饮酒者中尤为明显。我们的研究结果表明，接触绿地和自然环境与 VD 风险呈负相关。这些结果可能强调了住宅绿地在调节 VD 风险方面的潜在作用。

1. Introduction 1. 引言

The vascular system performs a critical role in several physiological processes within the human body, functioning as an essential barrier that actively regulates the molecules transport between bloodstream and brain (Rafii et al., 2016). Structural and functional abnormalities in the vascular system can lead to various vascular diseases (VD) (McGuire, 2016). These conditions significantly impact brain and heart, leading to three primary diseases: cerebrovascular diseases (CeVD), cardiovascular diseases (CVD), and peripheral vascular disease (PVD) (Kannel and McGee, 1985; Tapeinos et al., 2022). VD have emerged as the leading cause of premature mortality and chronic disability worldwide (Roth et al., 2020). Specifically, ischemic heart disease and ischemic stroke
血管系统在人体多种生理过程中发挥着关键作用，作为一道重要屏障，主动调节分子在血液和大脑之间的运输（Rafii 等人，2016 年）。血管系统的结构和功能异常可导致各种血管疾病（VD）（McGuire，2016 年）。这些状况严重影响大脑和心脏，导致三种主要疾病：脑血管疾病（CeVD）、心血管疾病（CVD）和外周血管疾病（PVD）（Kannel 和 McGee，1985 年；Tapeinos 等人，2022 年）。VD 已成为全球过早死亡和慢性残疾的主要原因（Roth 等人，2020 年）。具体来说，缺血性心脏病和缺血性中风
account for approximately

16 %

and

11 %

of global deaths, respectively (Tapeinos et al., 2022). The absolute number of CVD-related deaths continues to rise, particularly in low- and middle-income nations (Roth et al., 2017). Thus, managing VD has been escalated to a global public health priority.
心血管疾病分别约占全球死亡人数的

16 %

和

11 %

（Tapeinos 等人，2022 年）。与心血管疾病相关的死亡绝对数量持续上升，尤其是在低收入和中等收入国家（Roth 等人，2017 年）。因此，管理心血管疾病已被提升为全球公共卫生优先事项。

VD etiology encompasses a range of factors, including individual characteristics, genetic predispositions, and environmental determinants (Joseph et al., 2017). Among these, environmental factors may be more amenable to modification at the population level. Extensive studies have aimed to delineate VD etiology, which were generally attributed to multiple factors, such as hypertension (Williams et al., 2018), diabetes (Strain and Paldánius, 2018), and chronic renal insufficiency (O’Hare et al., 2004). Roughly a half of VD variation could be
VD 病因涵盖多种因素，包括个体特征、遗传易感性以及环境决定因素（Joseph 等人，2017 年）。在这些因素中，环境因素可能更易于在群体水平上进行调整。大量研究旨在阐明 VD 病因，这些研究通常归因于多种因素，例如高血压（Williams 等人，2018 年）、糖尿病（Strain 和 Paldánius，2018 年）以及慢性肾功能不全（O’Hare 等人，2004 年）。大约一半的 VD 变异可以通过

attributed to genetic inheritance (Tada et al., 2022), suggesting that the other half may arise from acquired risk factors such as diet (Bechthold et al., 2019), smoking (Ambrose and Barua, 2004), and overweight conditions (Whitlock et al., 2009). Given the significant burden posed by VD, it is imperative to prioritize the identification of modifiable environmental risk factors and to develop interventions as vital public health initiatives.
归因于遗传因素（Tada 等人，2022 年），表明另一半可能源于获得性风险因素，如饮食（Bechthold 等人，2019 年）、吸烟（Ambrose 和 Barua，2004 年）和超重状况（Whitlock 等人，2009 年）。鉴于 VD 带来的重大负担，必须优先识别可改变的环境风险因素，并将开发干预措施作为重要的公共卫生举措。

Recently, residential greenness has emerged as a novel environmental factor that promotes human health and well-being (Franchini and Mannucci, 2018). Residential greenness encompasses areas with natural vegetation, green infrastructure, parks, street greening, and green public spaces (Holland and DeVille, 2021). Many literature highlighting the benefits of greenness on health, such as decreased chronic disease risk (Jimenez and DeVille, 2021), improved mental health (McCormick, 2017), and reduced mortality (Gascon et al., 2016). However, numerous studies have produced inconsistent findings regarding the relationship between greenness and vascular health; some studies indicates beneficial associations (Crouse et al., 2017; Orioli et al., 2019), while others report no correlation (Zijlema et al., 2019) or even adverse effects (Servadio et al., 2019). Furthermore, few studies have examined the effect of residential greenness on specific VD, especially PVD and CeVD. Thus, it is necessary to conduct comprehensive prospective study exploring the relationship between greenness and VD utilizing large cohorts.
最近，居住区的绿化已成为一个促进人类健康和福祉的新环境因素（Franchini and Mannucci, 2018）。居住区的绿化包括自然植被、绿色基础设施、公园、街道绿化和绿色公共空间（Holland and DeVille, 2021）。许多文献强调了绿化对健康的好处，例如降低慢性病风险（Jimenez and DeVille, 2021）、改善心理健康（McCormick, 2017）和减少死亡率（Gascon et al., 2016）。然而，许多研究在绿化与血管健康之间的关系上得出了不一致的结论；一些研究表明有益的关联（Crouse et al., 2017; Orioli et al., 2019），而另一些报告没有相关性（Zijlema et al., 2019）甚至有害影响（Servadio et al., 2019）。此外，很少有研究考察居住区绿化对特定血管疾病（VD）的影响，尤其是周围血管疾病（PVD）和中风（CeVD）。因此，有必要进行一项全面的前瞻性研究，利用大型队列探索绿化与血管疾病之间的关系。

In this study, we aimed to investigate the association of green space, domestic garden, and natural environment exposure and the risk of eight incident VD (heart failure, atrial fibrillation, chronic ischaemic heart disease, occlusion and stenosis, stroke, transient cerebral ischaemic attacks, sequelae of CeVD, and PVD). We further explored the potential modifying effects of demographics and lifestyle characteristic to identify susceptible populations.
在本研究中，我们旨在探讨绿地、家庭花园和自然环境暴露与八种新发 VD（心力衰竭、心房颤动、慢性缺血性心脏病、闭塞和狭窄、中风、短暂性脑缺血发作、脑卒中后遗症和周围血管疾病）风险之间的关联。我们还进一步探索了人口统计学和生活方式特征的潜在调节作用，以识别易感人群。

2. Research design and methods
2. 研究设计与方法

2.1. Study participants 2.1. 研究参与者

The UK Biobank (UKB) represents a large prospective cohort study involving over 500,000 UK residents between 2006 and 2010, with participant aged 40 to 69 years. Enrolled individuals were invited to participate in a comprehensive baseline assessment conducted at one of 22 centers across England, Wales, and Scotland. This assessment comprised touchscreen questionnaires, face-to-face interviews, and various physical measurements. The collected data have been linked to several resources, including health records. Hospital admission dates and causes were acquired through linkage to Health Episode Statistics records for participants in England and Wales, while data pertaining to death dates and causes were sourced from death certificates accessible via the National Health Service Information Centre for those in England and Wales and the National Health Service Central Register for participants in Scotland. These data linkages enabled the long-term monitoring of health outcomes. This study was performed in compliance with the Declaration of Helsinki and approved by the National Health Service National Research Ethics Service (reference 11/NW/0382). All participants gave informed consent for participation in the UKB. Permission to access and analyze UKB data was approved under project No. 46478. Comprehensive cohort details can be found in related publications (Bycroft et al., 2018). Fig. 1 illustrates the participant selection process and the final sample size.
英国生物样本库（UKB）是一项大型前瞻性队列研究，涉及 2006 年至 2010 年间超过 50 万名英国居民，参与者年龄在 40 至 69 岁之间。入组者被邀请参加在英格兰、威尔士和苏格兰的 22 个中心之一进行的全面基线评估。该评估包括触摸屏问卷、面对面访谈以及各种身体测量。收集的数据已与多个资源链接，包括健康记录。英格兰和威尔士的参与者通过链接到健康事件统计记录获取住院日期和原因，而苏格兰参与者的死亡日期和原因数据则来自可通过国家医疗服务信息中心获取的死亡证明，以及英格兰和威尔士的国家医疗服务中央登记处。这些数据链接实现了对健康结果的长期监测。本研究符合《赫尔辛基宣言》，并经国家医疗服务国家研究伦理服务（参考号 11/NW/0382）批准。所有参与者均签署了知情同意书，同意参与英国生物样本库（UKB）的研究。项目编号 46478 的访问和分析 UKB 数据的权限已获批准。详细的队列信息可参见相关文献（Bycroft 等，2018）。图 1 展示了参与者筛选流程和最终样本量。

2.2. Assessment of VD
2.2. VD 评估

Inpatient hospital records are directly linked to Health Episode Statistics in England and Wales, as well as to the Scottish Morbidity Records in Scotland, thereby facilitating precise identification of the initial recorded diagnosis date. After excluding cases identified at baseline, VD were classified using the International Classification of Diseases, 10th revision (ICD-10) in health-related records, including heart failure,
住院病历直接与英格兰和威尔士的健康事件统计以及苏格兰的疾病发病记录相连，从而能够精确识别初次记录的诊断日期。在排除基线时已确诊的病例后，VD 根据国际疾病分类第十次修订版（ICD-10）在健康相关记录中进行分类，包括心力衰竭，

Fig. 1. Flowchart for participants selection. UKB, UK Biobank.
图 1. 参与者筛选流程图。UKB，英国生物样本库。
atrial fibrillation, chronic ischaemic heart disease, occlusion and stenosis, stroke, transient cerebral ischaemic attacks, sequelae of CeVD, and PVD. The health-related records accessible through the UKB comprise self-reported data, primary care records, hospital admissions data, and death certificate information. During the baseline questionnaire, participants were asked to report all diagnosed conditions, which were then verified through verbal interviews conducted by trained nurses. Primary care data were documented by healthcare professionals at general practices, while hospital admission records were sourced through linkage to Health Episode Statistics and Scottish Morbidity Records. The date of death was obtained from the National Health Service Information Centre and the National Health Service Central Register for Scotland (Rodríguez-Gómez et al., 2022). The earliest recorded date of an outcome was utilized, derived from either self-reports, inpatient hospital data, primary care records, or death certificate data. Detailed information regarding the ICD-10 codes utilized to identify VD cases can be found in Supplementary Table S1.
心房颤动、慢性缺血性心脏病、闭塞和狭窄、中风、短暂性脑缺血发作、脑血管病后遗症和周围血管病。通过 UKB 可获取的健康记录包括自我报告数据、初级保健记录、医院入院数据和死亡证明信息。在基线问卷调查中，要求参与者报告所有已诊断的疾病，然后通过训练有素的护士进行的口头访谈进行核实。初级保健数据由全科医疗保健专业人员记录，而医院入院记录则通过链接到健康事件统计和苏格兰发病率记录获取。死亡日期从英国国家医疗服务体系信息中心和苏格兰国家医疗服务体系中央登记处（Rodríguez-Gómez 等人，2022 年）获得。使用最早记录的结果日期，该日期来自自我报告、住院医院数据、初级保健记录或死亡证明数据。用于识别 VD 病例的 ICD-10 代码的详细信息，请参见补充表 S1。

2.3. Estimation of residential greenness
2.3. 居住区绿化评估

To quantify individual exposure to residential greenness, the proportion of overall greenness within a 300 m buffer of residential address served as the primary indicator. This metric was selected based on its status as the World Health Organization (WHO) recommended measure for greenness exposure (Yang et al., 2025), and its widespread adoption in prior research (Zhang et al., 2022; Zhao et al., 2025). Moreover, a previous study revealed that the associations were similar when the Normalized Difference Vegetation Index (NDVI) and percentage of greenness were used as indicators of greenness exposure at the same time (Bloemsma et al., 2022). The 300 m distance, representing an approximate 5 min walking radius as suggested in UK guidelines (Yang et al., 2025), was deemed appropriate for assessing accessible residential greenness.
为了量化个人住宅环境的绿化暴露程度，住宅地址周围 300 米缓冲区内的整体绿化比例被作为主要指标。该指标的选择基于其作为世界卫生组织（WHO）推荐的绿化暴露测量方法（Yang et al., 2025），以及其在先前研究中的广泛应用（Zhang et al., 2022; Zhao et al., 2025）。此外，一项先前研究表明，当同时使用归一化植被指数（NDVI）和绿化百分比作为绿化暴露指标时，关联性相似（Bloemsma et al., 2022）。300 米的距离，代表英国指南中建议的大约 5 分钟步行范围（Yang et al., 2025），被认为适合评估可及的住宅绿化。

Specifically, green space and domestic garden were derived using land use data from the 2005 Generalized Land Use Database (GLUD) for England, referenced at the 2001 Census Output Areas (COA) level (Hu et al., 2023). The GLUD categorized land use within each Lower Layer Super Output Area (LSOA) into nine types: green space, domestic gardens, water, domestic buildings, nondomestic buildings, railways, roads, paths, and other (primarily hard standing) (Hu et al., 2023). Green space and domestic garden exposure were measured by the percentage of each participant’s residential address underwent 300 m buffers. Natural environment was determined from the 2007 Land Cover Map (LCM) data produced by the Centre for Ecology and Hydrology including green space and blue space (Wheeler et al., 2015). Natural environment exposure was measured by the percentage of the home location buffer at 300 m classed as natural environment. The LCM consists of 23 land cover classes; classes 1-21 were reclassified as natural environment, while classes 22-23, encompassing buildings and gardens, were excluded from this analysis. The definition of natural environment was partially overlapped with green and blue space in this study.
具体而言，绿地和庭院数据来源于 2005 年英格兰广义土地利用数据库（GLUD），参考了 2001 年人口普查输出区（COA）的级别（Hu 等人，2023）。GLUD 将每个下层超级输出区（LSOA）内的土地利用分为九种类型：绿地、庭院、水域、住宅建筑、非住宅建筑、铁路、道路、小径和其他（主要是硬化地面）（Hu 等人，2023）。绿地和庭院的暴露程度通过每个参与者住宅地址 300 米缓冲区内的百分比来衡量。自然环境数据来自英国生态与水文中心（Centre for Ecology and Hydrology）于 2007 年发布的土地覆盖地图（LCM）数据，包括绿地和蓝地（Wheeler 等人，2015）。自然环境的暴露程度通过将 300 米范围内的家庭位置缓冲区归类为自然环境的百分比来衡量。LCM 包含 23 种土地覆盖类型；1-21 类被重新归类为自然环境，而 22-23 类（包括建筑和庭院）则被排除在这项分析之外。这项研究中，自然环境的定义与绿色和蓝色空间的部分重叠。

2.4. Covariates measurements
2.4. 协变量测量

This study examines several covariates, including sociodemographic factors (age, sex, body mass index (BMI)), socioeconomic status (measured by the Townsend deprivation index (TDI)), and lifestyle and behaviors factors (smoking frequency per day, alcohol intake frequency per week, and duration of residence). Basic characteristics such as date of birth and sex were obtained from local NHS Primary Care Trust registries. Trained nurses measured the participants’ height and weight, with BMI calculated as weight (in kilograms) divided by height (in meters squared). Additional sociodemographic factors, including lifestyle and behavioral data, were collected through touchscreen questionnaires during the baseline visit. TDI was derived from participants’ residential postcodes, reflecting the area socioeconomic status; higher
这项研究考察了多个协变量，包括社会人口学因素（年龄、性别、体重指数（BMI））、社会经济地位（通过汤森德剥夺指数（TDI）衡量）以及生活方式和行为因素（每日吸烟频率、每周饮酒频率和居住时长）。出生日期和性别等基本信息从当地 NHS 初级保健信托注册处获取。经过培训的护士测量了参与者的身高和体重，BMI 计算为体重（千克）除以身高（平方米）。在基线访视期间，通过触摸屏问卷收集了其他社会人口学因素，包括生活方式和行为数据。TDI 根据参与者的住宅邮政编码得出，反映了地区社会经济地位；较高的
scores indicate a greater degree of deprivation (Tyrrell et al., 2016).
得分表明了更大的剥夺程度（Tyrrell 等人，2016 年）。

2.5. Statistical analysis
2.5. 统计分析

Continuous variables were expressed as mean

\pm

standard deviation, whereas categorical variables were summarized as frequencies (percentages). Incidence rates (IR) for total VD and each subtype were calculated as the number of new cases divided by the total person-years at risk, expressed per 100,000 person-years. Person-years were calculated for each participant from study entry until the occurrence of the VD event, death from any cause, loss to follow-up, or end of the study period, whichever came first. Cox proportional hazard regression models were employed to estimate the associations between residential greenness and the incident VD, calculating the hazard ratio (HR) and

95 %

confidence interval (CI). Model 1 was adjusted for age and sex, while Model 2 was further adjusted for BMI, TDI, smoking frequency per day, alcohol intake frequency per week, and duration of residence. The tertiles of exposure served as cut-off points, with the first tertile (indicating the lowest exposure) designated as the reference group. To evaluate dose-response relationships between residential greenness and VD risk, restricted cubic spline (RCS) regressions were employed (Desquilbet and Mariotti, 2010). Stratified analyses were performed based on age (less than 65 years and 65 years or above), sex (female and male), BMI (normal (

18.5 - 25 kg / m^{2}

), overweight (

25.0 - 30.0 kg / m^{2}

), and obese (

\geq 30.0 kg / m^{2}

)), smoking statues (ever and never), and alcohol intake (ever and never) at baseline. The statistical methods used in subgroup analysis were aligned with those of the primary analysis. We also performed sensitivity analyses for all VD outcomes. Specifically, we restricted the analyses among those who developed VD outcome after 3 years of follow-up. All statistical analyses were conducted using

R

(version 4.1.0), with a two-sided

P

-value

< 0.05

considered statistically significant. Cox proportional hazard models were constructed using “survival” package, while dose-response relationship analyses were conducted using “rms” package. All figures were created in R employing “forestplot” and “ggplot2” packages.
连续变量以均值±标准差表示，而分类变量以频数（百分比）总结。总 VD 和各亚型的发病率（IR）计算为新发病例数除以暴露总人年数，以每 10 万人年表示。人年数计算从研究入组到 VD 事件发生、任何原因死亡、失访或研究期结束（以先发生者为准）的每个参与者的时间。采用 Cox 比例风险回归模型来估计居住地绿化与 VD 新发事件之间的关联，计算风险比（HR）和①置信区间（CI）。模型 1 调整了年龄和性别，而模型 2 进一步调整了 BMI、TDI、每日吸烟频率、每周饮酒频率和居住时间。暴露的 tertiles 作为截断点，第一 tertile（表示最低暴露）被指定为参考组。为了评估居住区绿化与 VD 风险之间的剂量反应关系，采用了限制性三次样条回归（RCS 回归）（Desquilbet 和 Mariotti，2010）。根据年龄（小于 65 岁和 65 岁及以上）、性别（女性和男性）、BMI（正常（

18.5 - 25 kg / m^{2}

）、超重（

25.0 - 30.0 kg / m^{2}

）和肥胖（

\geq 30.0 kg / m^{2}

））、吸烟状况（曾经和从未）以及基线时的饮酒情况（曾经和从未）进行了分层分析。亚组分析中使用的统计方法与主要分析中的方法一致。我们还对所有 VD 结局进行了敏感性分析。具体而言，我们将分析限制在那些在随访 3 年后出现 VD 结局的人群中。所有统计分析均使用

R

（版本 4.1.0）进行，双侧

P

-值

< 0.05

被认为具有统计学意义。使用“survival”包构建了 Cox 比例风险模型，而剂量反应关系分析则使用“rms”包进行。所有图表均使用 R 语言中的“forestplot”和“ggplot2”包创建。

3. Results 3. 结果

3.1. Characteristics of participants
3.1. 参与者特征

The baseline characteristics of the study participants are summarized in Table 1. Among a total of

236, 059

participants,

3392

incident cases of PVD were recorded during 36,789 person-years of follow-up, with a median follow-up time of 10.8 years. Compared to participants without PVD, those with the disease were more likely to be male (

67.25 % vs

46.38 %

), exhibited a higher BMI (

28.39 kg / m^{2}

vs.

27.10 kg / m^{2}

), and reported a higher smoking frequency (

68.46 %

vs.

33.93 %

). The median estimates of green space, domestic garden, and natural environment among participants with incident PVD were

34.75 %, 31.13 %

, and

25.75 %

, respectively. In contrast, the corresponding median estimates for those without incident PVD were

36.83 %, 31.28 %

, and

28.32 %

. A comparative analysis of baseline characteristics among the study population for other VD is provided in Supplementary Table S2. Due to lots of participants excluded, we compared baseline characteristics of included participants and those excluded due to missing data or pre-existing diseases for each VD. No clinically relevant differences were observed in age for atrial fibrillation (

P = 0.061

, Cohen’s

d = 0.006

) and chronic ischaemic heart disease (

P = 0.140

, Cohen’s

d = 0.005

). Although excluded participants had slightly difference of age, BMI, TDI, or greenness exposure levels (

P < 0.05

) in other diseases, effect size remained small (Cohen’s

d < 0.2

), indicating minimal selection bias (Supplementary Table S3).
研究参与者的基线特征总结于表 1。在总共

236, 059

名参与者中，在 36,789 人年的随访期间记录了

3392

例 PVD 新发病例，中位随访时间为 10.8 年。与没有 PVD 的参与者相比，患有该疾病的参与者更有可能是男性（

67.25 % vs

46.38 %

），表现出更高的 BMI（

28.39 kg / m^{2}

vs.

27.10 kg / m^{2}

），并报告更高的吸烟频率（

68.46 %

vs.

33.93 %

）。新发 PVD 参与者的绿地、家庭花园和自然环境的中位估计值分别为

34.75 %, 31.13 %

和

25.75 %

。相比之下，未发生 PVD 的参与者的相应中位估计值为

36.83 %, 31.28 %

和

28.32 %

。其他 VD 研究人群的基线特征比较分析见补充表 S2。由于许多参与者被排除在外，我们比较了每种 VD 中纳入参与者的基线特征与因缺失数据或既往疾病而被排除的参与者的基线特征。对于房颤（

P = 0.061

，Cohen’s

d = 0.006

）和慢性缺血性心脏病（

P = 0.140

，Cohen’s

d = 0.005

），年龄方面未观察到临床相关差异。尽管排除的参与者在其他疾病中的年龄、BMI、TDI 或绿色暴露水平上存在微小差异（

P < 0.05

），效应量仍然较小（Cohen’s

d < 0.2

），表明选择偏倚最小（补充表 S3）。

Table 2 details the IR for all VD outcomes. Over

5, 676, 185

personyears of follow-up, the overall IR for total VD was 1,878.59 (95 %CI: 1,867.33-1,889.9) per 100,000 person-years. Disease-specific IR varied substantially; chronic ischaemic heart disease had the highest incidence
表 2 详细列出了所有 VD 结局的 IR。在

5, 676, 185

人年的随访期间，总 VD 的总体 IR 为每 10 万人年 1,878.59（95%CI：1,867.33-1,889.9）。疾病特异性 IR 差异很大；慢性缺血性心脏病的发生率最高

- Correspondence to: School of Public Health, Health Science Center, Xi’an Jiaotong University, No. 76 Yan Ta West Road, Xi’an 710061, China.
  通讯地址：西安交通大学公共卫生学院，健康科学中心，中国陕西省西安市雁塔西路 76 号，邮编 710061。
E-mail address: fzhxjtu@mail.xjtu.edu.cn (F. Zhang).
电子邮件地址：fzhxjtu@mail.xjtu.edu.cn（张芳）。

Associations of residential greenness with incident vascular diseases in middle-aged and older adults: A large prospective cohort study 居住地绿化与中老年人群血管疾病发病率的关系：一项大型前瞻性队列研究

ARTICLE INFO 文章信息

Keywords: 关键词：

Abstract 摘要

1. Introduction 1. 引言

2. Research design and methods2. 研究设计与方法

2.1. Study participants 2.1. 研究参与者

2.2. Assessment of VD2.2. VD 评估

2.3. Estimation of residential greenness2.3. 居住区绿化评估

2.4. Covariates measurements2.4. 协变量测量

2.5. Statistical analysis2.5. 统计分析