“Residential greenness and site-specific cancer: A registry based cohort of 144,427 participants with a 21-years of follow-up, Tel-Aviv district, Israel”

Abstract

BackgroundFew longitudinal studies evaluated the beneficial associations between cumulative residential greenness and site-specific cancer. Our objective was to evaluate the associations between cumulative residential greenness exposure and site-specific cancer incidence (lung, bladder, breast, prostate, and skin cancer) within a registry-based cohort study. MethodsThis study was based on 144,427 participants who lived in the Tel Aviv district during 1995–2015. The residential greenness exposure was estimated for every participant, as the weighted mean residential greenness exposure, based on the mean Normalized Difference Vegetation Index (NDVI) in the residential area and the duration of the residence in this area. Cox regression models were used to evaluate the unadjusted and adjusted associations between exposure to greenness and cancer incidence during 1998–2015 (Hazard Ratios (HRs) and 95% Confidence Intervals (CIs)). Covariates included in adjusted models were selected based on prior knowledge and directed acyclic graphs. We imputed missing data and further sensitivity analyses were conducted. ResultsAfter adjustments, beneficial associations between exposure to greenness and cancer incidence were observed. An interquartile range (IQR) increase in NDVI was associated with a lower HRs for lung cancer (HRadj. = 0.75 95% CI: 0.66–0.85), bladder cancer (HRadj. = 0.71, 95% CI: 0.62–0.82), breast cancer (HRadj. = 0.81, 95% CI: 0.74–0.88), prostate cancer (HRadj. = 0.77, 95% CI: 0.70–0.86) and skin cancer (HRadj. = 0.78, 95% CI: 0.69–0.88). Generally, the patterns of associations were consistent between complete-case models and imputed models, when estimated for participants aged 16 years or 40 years and older at baseline, when stratified by area level socioeconomic status, when evaluated for non-movers participants and after further adjustment to social determinants of health. ConclusionResidential greenness may reduce the risk for lung, bladder, breast, prostate, and skin cancers. If our observations will be replicated, it may present a useful avenue for public-health intervention to reduce cancer burden.