Neighborhood Greenness and Prostate Cancer: Association and Explanation in Diverse Populations
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Iyer, Hari S.
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CitationIyer, Hari S. 2020. Neighborhood Greenness and Prostate Cancer: Association and Explanation in Diverse Populations. Doctoral dissertation, Harvard T.H. Chan School of Public Health.
AbstractProstate cancer (CaP) is the most common non-cutaneous cancer diagnosed among men in the United States. Neighborhood greenness could confer benefits to men at risk of CaP by promoting healthy lifestyles and reducing mortality.
In Chapter 1, we estimated the association between neighborhood greenness and 28-year risk of lethal CaP in the Health Professionals Follow-up Study. We assigned satellite-derived Normalized Difference Vegetation Index (NDVI) with 1 kilometer resolution linked to the participants’ home or work address at the start of follow-up. An interquartile range increase in NDVI was associated with 5% lower rate of lethal CaP (aHR: 0.95, 95% CI: 0.88, 1.03), with stronger associations in non-movers (aHR: 0.92, 95% CI: 0.85, 1.01). Inverse associations were observed among men in high (aHR: 0.90, 95% CI: 0.82, 0.99) but not low (aHR: 1.11, 95% CI: 0.95, 1.29, Phet=0.086) population density areas. There was no evidence of mediation by vigorous physical activity.
In Chapter 2, we estimated the association between neighborhood greenness and 10-year cause-specific mortality among men with CaP in the Pennsylvania Cancer Registry. NDVI with 250m resolution was assigned to participants’ residential address at diagnosis. Comparing men in highest to lowest NDVI quintile, all-cause (aHR: 0.88, 95% CI: 0.84, 0.92, Ptrend<0.0001), prostate-specific (aHR: 0.88, 95% CI: 0.80, 0.99, Ptrend=0.0021), and cardiovascular-specific (aHR: 0.82, 95% CI: 0.74, 0.90, Ptrend<0.0001) mortality were lower. Hypothetical interventions to increase NDVI led to non-significant reductions in all-cause (-5.3%) and prostate-specific (-23.2%), but not cardiovascular-specific mortality disparities (+50.5%).
In Chapter 3, we estimated the association between neighborhood greenness and cardiometabolic risk factors in a cross-sectional, multi-country study in sub-Saharan Africa. NDVI with 250m resolution was assigned to a geocode corresponding to the center of the school or village where the participant was recruited. A 0.11 unit NDVI increase was associated with lower BMI (β: -1.01, 95% CI: -1.35, -0.67), lower odds of overweight/obesity (aOR: 0.73, 95% CI: 0.62, 0.85), diabetes (aOR: 0.77, 95% CI: 0.62, 0.96)), and having ≥3 allostatic load components compared to none (aOR: 0.66, 95% CI: 0.52, 0.85). Associations for BMI, overweight/obesity, and allostatic load remained statistically significant after Bonferroni correction.
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