The Association between Long-Term Neighborhood Greenness and Lethal Prostate Cancer in a Prospective Cohort Study of Male Health Professionals in the United States

摘要

Background Emerging literature documents health benefits of natural environments. We studied the association between neighborhood greenness and 26-year incidence of lethal prostate cancer (CaP), effect modification by address type (home or workplace), and mediation by vigorous physical activity. Methods Participants in the Health Professionals Follow-up Study, a nationwide prospective cohort, were followed from 1986 to 2012. We excluded those with history of CaP or missing address. Lethal CaP was defined by metastasis or CaP death. Neighborhood greenness was measured using normalized difference vegetation index (NDVI) with lkm2 resolution. Participants were assigned NDVI corresponding to their address at start of follow-up, taking averages over four seasonal measures. NDVI was modeled using quintiles. Data were analyzed using sequentially adjusted Cox regression models: 1) age, calendar year, race, family history, smoking, BMI at 21, PSA screening, census median income and home value, walkability index; 2) vigorous and non-vigorous physical activity, current BMI. Results 46,494 participants met eligibility criteria. Men in greener neighborhoods at baseline experienced lower rates of lethal CaP (model 1: Q2 v Ql, aHR: 0.84, 95% CI: 0.67-1.05; Q3 aHR: 0.86, 95% CI: 0.69-1.07; Q4 aHR: 0.77, 95% CI: 0.61-0.97; Q5 aHR: 0.86, 95% CI: 0.69-1.09, ptrend=0.11). Protective associations were strongest among men (39%) reporting work addresses (Q2 v Ql, aHR: 0.73, 95% CI: 0.51-1.02; Q3 aHR: 0.61, 95% CI: 0.42-0.89; Q4 aHR: 0.55, 95% CI: 0.37-0.83; Q5 aHR: 0.65, 95% CI: 0.42-1.00, ptrend=0.0005). Further adjustment for mediators (model 2) did not change effect estimates. Conclusions Our findings suggest a protective association between neighborhood greenness and lethal CaP independent of physical activity, though overall results were not statistically significant. Stronger associations at work suggest benefits may arise from passive rather than active engagement with nature.