Associations between greenness and kidney disease in Massachusetts: The US Medicare longitudinal cohort study

Whanhee Lee; Seulkee Heo; Rory Stewart; Xiao Wu; Kelvin C. Fong; Ji-Young Son; Benjamin Sabath; Danielle Braun; Jae Yoon Park; Yong Chul Kim; Jung Pyo Lee; Joel Schwartz; Ho Kim; Francesca Dominici; Michelle L. Bell

Environment International (Mar 2023)

Associations between greenness and kidney disease in Massachusetts: The US Medicare longitudinal cohort study

Whanhee Lee,
Seulkee Heo,
Rory Stewart,
Xiao Wu,
Kelvin C. Fong,
Ji-Young Son,
Benjamin Sabath,
Danielle Braun,
Jae Yoon Park,
Yong Chul Kim,
Jung Pyo Lee,
Joel Schwartz,
Ho Kim,
Francesca Dominici,
Michelle L. Bell

Affiliations

Whanhee Lee: School of Biomedical Convergence Engineering, College of Information and Biomedical Engineering, Pusan National University, Yangsan, Republic of Korea; Corresponding author at: School of Biomedical Convergence Engineering, Pusan National University, (Address) #401, ABC bldg., 49 Busandaehak-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do 50612, South Korea.
Seulkee Heo: Yale School of the Environment, Yale University, New Haven, CT, USA
Rory Stewart: Yale School of the Environment, Yale University, New Haven, CT, USA
Xiao Wu: Department of Biostatistics, Harvard T H Chan School of Public Health, Boston, MA, USA
Kelvin C. Fong: Yale School of the Environment, Yale University, New Haven, CT, USA
Ji-Young Son: Yale School of the Environment, Yale University, New Haven, CT, USA
Benjamin Sabath: Faculty of Arts and Sciences Research Computing Department, Harvard University, Boston, MA, USA
Danielle Braun: Department of Biostatistics, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
Jae Yoon Park: Department of Internal Medicine, Dongguk University Ilsan Hospital, Republic of Korea; Department of Internal Medicine, Dongguk University College of Medicine, Republic of Korea
Yong Chul Kim: Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
Jung Pyo Lee: Department of Internal Medicine, Seoul National University Boramae Medical Center, Republic of Korea
Joel Schwartz: Department of Environmental Health, Harvard T H Chan School of Public Health, Boston, MA, USA
Ho Kim: Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea; Institute for Sustainable Development, Graduate School of Public Health, Seoul National University, Republic of Korea
Francesca Dominici: Department of Biostatistics, Harvard T H Chan School of Public Health, Boston, MA, USA
Michelle L. Bell: Yale School of the Environment, Yale University, New Haven, CT, USA

Journal volume & issue: Vol. 173
p. 107844

Abstract

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Background: Recent studies have identified the association of environmental stressors with reduced kidney function and the development of kidney disease. While residential greenness has been linked to many health benefits, the association between residential greenness and the development of kidney disease is not clear. We aimed to investigate the association between residential greenness and the development of kidney disease. Methods: We performed a longitudinal population-based cohort study including all fee-for-service Medicare Part A beneficiaries (aged 65 years or older) in Massachusetts (2000–2016). We assessed greenness with the annual average Enhanced Vegetation Index (EVI) based on residential ZIP codes of beneficiaries. We applied Cox-equivalent Poisson models to estimate the association between EVI and first hospital admission for total kidney disease, chronic kidney disease (CKD), and acute kidney injury (AKI), separately. Results: Data for 1,462,949 beneficiaries who resided in a total of 644 ZIP codes were analyzed. The total person-years of follow-up for total kidney disease, CKD, and AKI were 9.8, 10.9, and 10.8 million person-years, respectively. For a 0.1 increase in annual EVI, the hazard ratios (HRs) were 0.95 (95% CI: 0.93 to 0.97) for the first hospital admission for total kidney disease, and the association was more prominent for AKI (HR: 0.94 with 95% CI: 0.92 to 0.97) than CKD (HR: 0.98 with 95% CI: 0.95–1.01]). The estimated effects of EVI on kidney disease were generally more evident in White beneficiaries and those residing in metropolitan areas compared to the overall population. Conclusions: This study found that higher levels of annual residential greenness were associated with a lower risk of the first hospital admission for kidney diseases. Results are consistent with the hypothesis that higher residential greenness benefits kidney patients.

Published in Environment International

ISSN: 0160-4120 (Print)
Publisher: Elsevier
Country of publisher: United Kingdom
LCC subjects: Geography. Anthropology. Recreation: Environmental sciences
Website: https://www.journals.elsevier.com/environment-international

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