Green spaces reduce the deadly impact of air pollution on people with type 2 diabetes

New Research Shows Green Spaces Lower Mortality Risks in Type 2 Diabetes Patients

A recent study published in the journal eBioMedicine reveals that green spaces can significantly lower mortality risks in type 2 diabetes patients by reducing harmful air pollutants like PM2.5 and nitrogen dioxide. This offers a promising strategy for urban environments.

Background

Diabetes is a rapidly growing global health concern, with over 500 million cases by 2021 and a global prevalence of 6.1%. In China, the diabetes rates are especially high at 12.4%, leading to significant healthcare burdens and costs. It is important to understand all the risk factors for diabetes completely, as it is also a risk factor for mortality due to other diseases, such as cardiovascular disease.

• Peripheral vascular disease risk: Among type 2 diabetes patients, PM2.5 exposure had the strongest association with mortality due to peripheral vascular disease, highlighting a key vulnerable group in polluted areas.

Exposure to air pollution is a key risk factor for type 2 diabetes, contributing to 20% of diabetes-related mortality in 2019. On the other hand, green spaces have been linked to lower mortality rates associated with non-communicable diseases such as diabetes and cardiovascular disease. This is due to the various health benefits green spaces offer, including unpolluted air and spaces to exercise. The study also highlights that green spaces can lower PM2.5 and nitrogen dioxide levels by 23.8% and 26.6%, respectively.

However, there is a shortage of studies that have quantifiably examined the impact of air pollution on mortality rates in the diabetic population or explored the mediating effects of green spaces on this association between air pollution and diabetes.

About the Study

In this study, researchers in China conducted a long-term follow-up of a prospective cohort of newly diagnosed type 2 diabetes mellitus patients in Shanghai. The aim was to assess the increase in mortality risk due to air pollution exposure and examine how green spaces might reduce this risk.

The prospective cohort consisted of over 170,000 individuals over the age of 20 who were diagnosed with type 2 diabetes between 2011 and 2013. The study focused on all-cause and specific-cause mortality, including mortality due to respiratory diseases, cardiovascular disease, cancer, and diabetes-associated complications. Satellite-based models were used to assess air pollution exposure, and the measured pollutants included PM2.5, nitrogen dioxide, and PM10. The study also utilized restricted cubic splines to model non-linear exposure-response relationships.

The Normalized Difference Vegetation Index was used to quantify the green spaces surrounding the participants’ residences. Baseline questionnaires provided information on covariates, and sensitivity analyses were conducted to adjust for traffic noise levels and exclude early deaths due to the COVID-19 pandemic.

Results

The study followed the 174,063 participants for a period of 7.9 years and reported that 22,205 participants died during this period from various causes. Exposure to PM2.5 was significantly associated with an increased risk of all-cause mortality. The strongest associations with PM2.5 exposure were observed for peripheral vascular disease and gastrointestinal cancer. Nitrogen dioxide exposure was associated with an increased mortality risk from cardiovascular disease and cancer.

• Air pollution mediation by green spaces: Green spaces helped lower mortality risk by reducing PM2.5 by 23.8% and nitrogen dioxide by 26.6%, reinforcing the role of green infrastructure in mitigating pollution’s health effects.

Residential green spaces were linked to a decrease in mortality from various causes except respiratory diseases. The most significant decrease in mortality risk was observed for peripheral vascular disease. The protective effect of green spaces was attributed mainly to their ability to lower the concentrations of nitrogen dioxide and PM2.5.

Conclusions

The study concludes that long-term exposure to PM2.5 and nitrogen dioxide in areas with high air pollution increases mortality risk among type 2 diabetes patients. However, green spaces can mitigate the harmful effects of air pollution by lowering pollution levels. It emphasizes the importance of maintaining green spaces, especially in urban areas where the interaction between green space and nitrogen dioxide exposure is most significant.

Sources:

1. Wu, C., Liu, J., Li, Y., Qin, L., Gu, R., Feng, J., Xu, L., Meng, X., Chen, J., Chen, R., Shi, Y., & Kan, H. (2024). Association of residential air pollution and green space with all-cause and cause-specific mortality in individuals with diabetes: an 11-year prospective cohort study. EBioMedicine, 108. DOI:10.1016/j.ebiom.2024.105376, https://www.thelancet.com/journals/ebiom/article/PIIS2352-3964(24)00412-2/fulltext

SDGs, Targets, and Indicators

1. SDG 3: Good Health and Well-being

   • Target 3.4: By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.
   • Indicator 3.4.2: Mortality rate attributed to cardiovascular disease, cancer, diabetes, or chronic respiratory disease.

2. SDG 11: Sustainable Cities and Communities

   • Target 11.7: By 2030, provide universal access to safe, inclusive, and accessible, green and public spaces, particularly for women and children, older persons, and persons with disabilities.
   • Indicator 11.7.1: Average share of the built-up area of cities that is open space for public use for all, by sex, age, and persons with disabilities.

3. SDG 13: Climate Action

   • Target 13.2: Integrate climate change measures into national policies, strategies, and planning.
   • Indicator 13.2.1: Number of countries that have integrated mitigation, adaptation, impact reduction, and early warning into primary, secondary, and tertiary curricula.

Table: SDGs, Targets, and Indicators

Analysis

The article addresses or connects to the following SDGs:

1. SDG 3: Good Health and Well-being
2. SDG 11: Sustainable Cities and Communities
3. SDG 13: Climate Action

Based on the article’s content, the specific targets that can be identified are:

1. Target 3.4: By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.
2. Target 11.7: By 2030, provide universal access to safe, inclusive, and accessible, green and public spaces, particularly for women and children, older persons, and persons with disabilities.
3. Target 13.2: Integrate climate change measures into national policies, strategies, and planning.

The indicators mentioned or implied in the article that can be used to measure progress towards the identified targets are:

1. Indicator 3.4.2: Mortality rate attributed to cardiovascular disease, cancer, diabetes, or chronic respiratory disease.
2. Indicator 11.7.1: Average share of the built-up area of cities that is open space for public use for all, by sex, age, and persons with disabilities.
3. Indicator 13.2.1: Number of countries that have integrated mitigation, adaptation, impact reduction, and early warning into primary, secondary, and tertiary curricula.

The article highlights the impact of green spaces on mortality rates in type 2 diabetes patients and the role of green spaces in reducing air pollution. This is relevant to SDG 3 as it aims to reduce premature mortality from non-communicable diseases. The specific target 3.4 focuses on reducing premature mortality, and the indicator 3.4.2 measures the mortality rate attributed to diseases like diabetes.

The article also emphasizes the importance of green spaces in urban areas, which connects to SDG 11. Target 11.7 aims to provide universal access to safe and inclusive green spaces, particularly for vulnerable groups. The indicator 11.7.1 measures the average share of open space in cities for public use.

Furthermore, the article mentions the need to integrate climate change measures into policies and planning, aligning with SDG 13. Target 13.2 focuses on integrating climate change measures, and the indicator 13.2.1 measures the integration of climate change into curricula.

Overall, the article highlights the relevance of green spaces in improving health outcomes, reducing air pollution, and addressing climate change, aligning with multiple SDGs and their respective targets and indicators.

Source: news-medical.net