Journal of Shandong University (Health Sciences) ›› 2022, Vol. 60 ›› Issue (8): 115-119.doi: 10.6040/j.issn.1671-7554.0.2022.0339

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Causal association between green space and cancer incidence

WU Xinying1,2, FENG Yiping1,2, CHANG Kaifeng3, JIA Xianjie4, XUE Fuzhong1,2   

  1. 1. Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China;
    2. Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan 250002, Shandong, China;
    3. Infectious Disease Control Department, Pingyi Center for Disease Control and Prevention, Linyi 273300, Shandong, China;
    4. Department of Epidemiology and Health Statistics, School of Public Health, Bengbu Medical College, Bengbu 233000, Anhui, China
  • Published:2022-07-27

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Abstract: Objective To investigate the causal association between green space and cancer incidence. Methods Based on the Health Care Big Data Platform of Shandong Province, resident electronic health records, cancer surveillance data and electronic medical record data of Pingyi County were linked to construct a cancer incidence cohort. Green space exposure was assessed using normalized difference vegetation index(NDVI)derived from satellite remote sensing data. Outcome was defined as the diagnosis of cancer. The association between NDVI and cancer incidence was explored using generalized linear mixed model(GLMM). Negative control exposure based on time-series studies(NCE-TS)method was used to estimate the causal association. Results A total of 917,450 subjects were included in this study, and 9,157 cancer cases were reported during 2012 and 2015, with a cumulative incidence rate of 9.98‰. GLMM results showed that every 0.01 increase in NDVI was associated with a 26.42% reduction in all-sites cancer(OR=0.7358, 95%CI: 0.6417~0.8298). NCE-TS analysis showed that the causal absolute risk of all-sites cancer among population living in high-level NDVI areas was reduced by 2.651%(95%CI: -2.745%~-2.564%), compared with the low-level NDVI areas. And the absolute risk of lung cancer, stomach cancer, esophageal cancer, liver cancer, colorectal cancer, breast cancer and cervical cancer was reduced by 0.147%~0.718%. Conclusion There is a protective causal association between green space and cancer. As an important ecological environment element, green space should arouse attention in the primary prevention of cancer.

Key words: Green space, Cancer, Negative control exposure, Causal association, Incidence

CLC Number: 

  • R181.3
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