当地空气污染浓度是住宅绿地与小儿哮喘发作之间关联的调节因素还是中介因素？宾夕法尼亚州费城小儿患者的纵向研究。
Is local air pollution concentration a moderator or mediator of the association between residential greenspace and pediatric asthma exacerbations? A longitudinal study of pediatric patients in Philadelphia, Pennsylvania.
作者信息
Yen Yun-Ting, Schinasi Leah H, Sánchez Brisa N, Melly Steven, Moore Kari, Forrest Christopher B, Kenyon Chén C, Kondo Michelle C, De Roos Anneclaire J
机构信息
Department of Population Health Science and Policy, Ichan School of Medicine at Mount Sinai, New York, NY, USA.
Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Nesbitt Hall, 3215 Market St, Philadelphia, PA, USA; Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3600 Market St, Philadelphia, PA, 19104, USA.
出版信息
Int J Hyg Environ Health. 2025 May;266:114546. doi: 10.1016/j.ijheh.2025.114546. Epub 2025 Mar 6.
BACKGROUND
Despite mixed evidence supporting the link between greenspace and asthma exacerbations, several studies suggest a negative association. The mechanisms underlying this relationship are unclear, with air pollution concentrations potentially playing a key role. This study investigated whether air pollution concentrations modify or mediate the relationship between residential greenspace and pediatric asthma exacerbations.
METHODS
Data were drawn from a pediatric asthma cohort at Children's Hospital of Philadelphia (2011-2016), including children aged <18 years. Participants were followed from their initial visit until their first asthma exacerbation. Greenspace (tree canopy, grass/shrub cover) near homes was assessed. Daily air pollution data, including PM, ozone, NO, and SO, were obtained from the US Environmental Protection Agency. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated, adjusting for individual and neighborhood characteristics. Effect modification by air pollution concentrations was tested, and causal mediation analyses were conducted.
RESULTS
On days with high SO concentrations, children living near the highest quartile of tree canopy coverage had a 14% lower incidence of asthma exacerbations compared to those in the lowest quartile (HR = 0.86, 95% CI = 0.74, 0.98). Conversely, on days with low SO concentrations, tree canopy coverage was associated with a nonsignificant 12% higher incidence (HR = 1.12, 95% CI = 0.97, 1.28). Similar patterns were observed for NO, but no interactions were found for PM or ozone. Mediation analyses indicated no significant mediation by air pollution.
CONCLUSION
In urban areas with high SO or NO levels, greenspace near homes may support children with asthma by mitigating air pollution's impact, suggesting greenspace-based urban strategies.
背景
尽管关于绿地与哮喘发作之间联系的证据不一，但多项研究表明存在负相关。这种关系背后的机制尚不清楚，空气污染浓度可能起着关键作用。本研究调查了空气污染浓度是否会改变或介导居住绿地与儿童哮喘发作之间的关系。
方法
数据来自费城儿童医院的一个儿童哮喘队列（2011 - 2016年），包括18岁以下的儿童。参与者从首次就诊开始随访，直至首次哮喘发作。评估了家庭附近的绿地（树冠层、草地/灌木覆盖）。每日空气污染数据，包括颗粒物、臭氧、一氧化氮和二氧化硫，来自美国环境保护局。估计了风险比（HRs）和95%置信区间（CIs），并对个体和社区特征进行了调整。测试了空气污染浓度的效应修正，并进行了因果中介分析。
结果
在二氧化硫浓度高的日子里，居住在树冠覆盖率最高四分位数附近的儿童哮喘发作发生率比最低四分位数的儿童低14%（HR = 0.86，95% CI = 0.74，0.98）。相反，在二氧化硫浓度低的日子里，树冠覆盖率与发生率升高12%无显著关联（HR = 1.12，95% CI = 0.97，1.28）。一氧化氮也观察到类似模式，但颗粒物或臭氧未发现相互作用。中介分析表明空气污染无显著中介作用。
结论
在二氧化硫或一氧化氮水平高的城市地区，家庭附近的绿地可能通过减轻空气污染的影响来支持哮喘儿童，这表明基于绿地的城市策略。
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