Associations of residential greenness with lung function and chronic obstructive pulmonary disease in China

Studies on the association of greenness with respiratory health are scarce in developing countries, and previous studies in China have focused on only one or two indicators of lung function.

The study aims to evaluate the associations of residential greenness with full-spectrum lung function indicators and prevalence of chronic obstructive pulmonary disease (COPD).

This nationwide cross-sectional survey included 50,991 participants from the China Pulmonary Health study. Lung function indicators included four categories: indicators of obstructive ventilatory dysfunction (FEV₁, FVC and FEV₁/FVC); an indicator of large-airway dysfunction (PEF); indicators of small-airway dysfunction (FEF_25-75% and FEV₃/FEV₆); and other indicators. Residential greenness was assessed by the Normalized Difference Vegetation Index (NDVI). Multivariable linear regression models and logistic regression models were used to analyze associations of greenness with lung function and COPD prevalence.

Within the 500 m buffer, an interquartile range (IQR) increase in NDVI was associated with higher FEV₁ (24.76 mL), FVC (16.52 mL), FEV₁/FVC (0.38), FEF_50% (56.34 mL/s), FEF_75% (33.43 mL/s), FEF_25-75% (60.73 mL/s), FEV₃ (18.59 mL), and FEV₆ (21.85 mL). However, NDVI was associated with lower PEF. In addition, NDVI was significantly associated with 10% lower odds of COPD. The stratified analyses found that the associations were only significant in middle-young people, females, and nonsmokers. The associations were influenced by geographic regions.

Residential greenness was associated with better lung function and lower odds of COPD in China. These findings provide a scientific basis for healthy community planning.