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Independent and interactive associations of green space and air pollution with blood lipid biomarkers: A longitudinal
Jing Xu1, Yishu Li1, Guoqiang Ma1
1Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Hebei Province Key Laboratory of Environment and Human Health, Shijiazhuang, China.
Background:
Evidence on the independent and interactive associations of green space and air pollution with novel blood lipid biomarkers remains limited. This longitudinal cohort study aimed to examine the independent and interactive associations of green space and air pollution exposure with blood lipid biomarkers.
Methods:
The study included 17,242 adults undergoing health examinations in Shijiazhuang, China (2021-2023). Linear mixed-effects models estimated associations of green space and air pollution exposure with blood lipid biomarkers, including the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and the atherogenic index of plasma (AIP). Interaction terms, restricted cubic splines, and mediation analyses evaluated interaction effects, nonlinear exposure-response relationships, and mediation effects.
Results:
Associations with green space were most pronounced within the 500-m buffer. Each one-standard deviation (SD) increase in NDVI was associated with lower NHHR (β = -0.103; 95% CI: -0.114, -0.091) and AIP (β = -0.009; 95% CI: -0.012, -0.006). Among air pollutants, PM₂.₅ showed a stronger positive association with NHHR (β = 0.085 per SD; 95% CI: 0.081, 0.089), whereas PM₁₀ exhibited a stronger association with AIP (β = 0.006 per SD; 95% CI: 0.005, 0.007). Significant interactions were observed between NDVI and multiple air pollutants for both biomarkers (Pinteraction < 0.05). Air pollution mixture indices statistically mediated part of the associations between green space exposure and NHHR (13.5%) and AIP (34%).
Conclusion:
Green space exposure was associated with more favorable lipid biomarkers, whereas air pollution showed adverse associations. Green space is associated with weaker air pollution-related dyslipidemia.
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