Combined effect of heatwaves and residential greenness on the risk of stroke among Chinese adults: A national cohort study
Heatwaves have been associated with an increased risk of stroke, while residential greenness may offer protective benefits. This prospective cohort study examined 22,702 participants aged 35 years or older, with no prior history of cardiovascular disease (CVD), from the China Hypertension Survey (CH...
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Elsevier
2025-07-01
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| Series: | Ecotoxicology and Environmental Safety |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S014765132500692X |
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| author | Nuerguli Tuerdi Xue Cao Haosu Tang Yujie Zhang Congyi Zheng Xin Wang Chenye Chang Yixin Tian Xue Yu Xuyan Pei Ye Tian Wei Wang Gang Huang Zengwu Wang |
| author_facet | Nuerguli Tuerdi Xue Cao Haosu Tang Yujie Zhang Congyi Zheng Xin Wang Chenye Chang Yixin Tian Xue Yu Xuyan Pei Ye Tian Wei Wang Gang Huang Zengwu Wang |
| author_sort | Nuerguli Tuerdi |
| collection | DOAJ |
| description | Heatwaves have been associated with an increased risk of stroke, while residential greenness may offer protective benefits. This prospective cohort study examined 22,702 participants aged 35 years or older, with no prior history of cardiovascular disease (CVD), from the China Hypertension Survey (CHS) conducted between 2012 and 2015. Participants were followed up between 2018 and 2019. Heatwaves were defined as daily maximum temperatures exceeding the 92.5th percentile of the warm season for at least three consecutive days. Residential greenness was quantified using the Normalized Difference Vegetation Index (NDVI) within buffers of 300, 500, and 1000 m from participants' residences. Multivariable Cox proportional hazards models evaluated the independent and combined effects of heatwaves and greenness on stroke risk, while restricted cubic spline analyses explored nonlinear relationships. Interaction effects were assessed using both multiplicative and additive Cox regression models. During follow-up, 597 stroke events occurred. Each additional 3-day increase in heatwave days was associated with an increased stroke risk (HR: 1.19, 95 % CI: 1.08–1.31). Interaction analyses demonstrated a synergistic effect between heatwaves and lower residential greenness (NDVI300 m, NDVI500 m and NDVI1000 m) on stroke risk, with significant additive(RERI > 0, P < 0.05) and multiplicative interactions (HR > 1, P < 0.05). The strongest protective effects of greenness were observed within a 500 m buffer zone, particularly for individuals under 60 years, rural residents, and those with higher educational attainment. This study highlights the potential benefits of enhancing greenness for cardiovascular health and provides valuable insights for environmental governance and public health policy in China. |
| format | Article |
| id | doaj-art-d6669a10f35346e494a5253a57e5dbeb |
| institution | DOAJ |
| issn | 0147-6513 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Ecotoxicology and Environmental Safety |
| spelling | doaj-art-d6669a10f35346e494a5253a57e5dbeb2025-08-20T03:07:51ZengElsevierEcotoxicology and Environmental Safety0147-65132025-07-0129911835610.1016/j.ecoenv.2025.118356Combined effect of heatwaves and residential greenness on the risk of stroke among Chinese adults: A national cohort studyNuerguli Tuerdi0Xue Cao1Haosu Tang2Yujie Zhang3Congyi Zheng4Xin Wang5Chenye Chang6Yixin Tian7Xue Yu8Xuyan Pei9Ye Tian10Wei Wang11Gang Huang12Zengwu Wang13Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College& Chinese Academy of Medical Sciences, Beijing 102308, ChinaDivision of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College& Chinese Academy of Medical Sciences, Beijing 102308, ChinaState Key Laboratory of Numerical Modeling for Atmospheric Sciences and Geophysical Fluid Dynamics, Institute of Atmospheric Physics, Chinese Academy of Sciences, Beijing 100029, China; University of Chinese Academy of Sciences, Beijing 100049, ChinaDivision of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College& Chinese Academy of Medical Sciences, Beijing 102308, ChinaDivision of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College& Chinese Academy of Medical Sciences, Beijing 102308, ChinaDivision of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College& Chinese Academy of Medical Sciences, Beijing 102308, ChinaSchool of Population Medicine and Public Health, Peking Union Medical College& Chinese Academy of Medical Sciences, Beijing, ChinaDivision of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College& Chinese Academy of Medical Sciences, Beijing 102308, ChinaSchool of Population Medicine and Public Health, Peking Union Medical College& Chinese Academy of Medical Sciences, Beijing, ChinaDivision of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College& Chinese Academy of Medical Sciences, Beijing 102308, ChinaDivision of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College& Chinese Academy of Medical Sciences, Beijing 102308, ChinaDivision of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College& Chinese Academy of Medical Sciences, Beijing 102308, ChinaState Key Laboratory of Numerical Modeling for Atmospheric Sciences and Geophysical Fluid Dynamics, Institute of Atmospheric Physics, Chinese Academy of Sciences, Beijing 100029, China; University of Chinese Academy of Sciences, Beijing 100049, ChinaDivision of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College& Chinese Academy of Medical Sciences, Beijing 102308, China; Correspondence to: Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No. 15 (Lin), Fengcunxili, Mentougou District, Beijing 102308, China.Heatwaves have been associated with an increased risk of stroke, while residential greenness may offer protective benefits. This prospective cohort study examined 22,702 participants aged 35 years or older, with no prior history of cardiovascular disease (CVD), from the China Hypertension Survey (CHS) conducted between 2012 and 2015. Participants were followed up between 2018 and 2019. Heatwaves were defined as daily maximum temperatures exceeding the 92.5th percentile of the warm season for at least three consecutive days. Residential greenness was quantified using the Normalized Difference Vegetation Index (NDVI) within buffers of 300, 500, and 1000 m from participants' residences. Multivariable Cox proportional hazards models evaluated the independent and combined effects of heatwaves and greenness on stroke risk, while restricted cubic spline analyses explored nonlinear relationships. Interaction effects were assessed using both multiplicative and additive Cox regression models. During follow-up, 597 stroke events occurred. Each additional 3-day increase in heatwave days was associated with an increased stroke risk (HR: 1.19, 95 % CI: 1.08–1.31). Interaction analyses demonstrated a synergistic effect between heatwaves and lower residential greenness (NDVI300 m, NDVI500 m and NDVI1000 m) on stroke risk, with significant additive(RERI > 0, P < 0.05) and multiplicative interactions (HR > 1, P < 0.05). The strongest protective effects of greenness were observed within a 500 m buffer zone, particularly for individuals under 60 years, rural residents, and those with higher educational attainment. This study highlights the potential benefits of enhancing greenness for cardiovascular health and provides valuable insights for environmental governance and public health policy in China.http://www.sciencedirect.com/science/article/pii/S014765132500692Xstrokeresidential greennessheatwavesmultiplicative interactionsadditive interactions |
| spellingShingle | Nuerguli Tuerdi Xue Cao Haosu Tang Yujie Zhang Congyi Zheng Xin Wang Chenye Chang Yixin Tian Xue Yu Xuyan Pei Ye Tian Wei Wang Gang Huang Zengwu Wang Combined effect of heatwaves and residential greenness on the risk of stroke among Chinese adults: A national cohort study Ecotoxicology and Environmental Safety stroke residential greenness heatwaves multiplicative interactions additive interactions |
| title | Combined effect of heatwaves and residential greenness on the risk of stroke among Chinese adults: A national cohort study |
| title_full | Combined effect of heatwaves and residential greenness on the risk of stroke among Chinese adults: A national cohort study |
| title_fullStr | Combined effect of heatwaves and residential greenness on the risk of stroke among Chinese adults: A national cohort study |
| title_full_unstemmed | Combined effect of heatwaves and residential greenness on the risk of stroke among Chinese adults: A national cohort study |
| title_short | Combined effect of heatwaves and residential greenness on the risk of stroke among Chinese adults: A national cohort study |
| title_sort | combined effect of heatwaves and residential greenness on the risk of stroke among chinese adults a national cohort study |
| topic | stroke residential greenness heatwaves multiplicative interactions additive interactions |
| url | http://www.sciencedirect.com/science/article/pii/S014765132500692X |
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