{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T10:25:53Z","timestamp":1758191153822,"version":"3.44.0"},"reference-count":54,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T00:00:00Z","timestamp":1758067200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Childhood autism spectrum disorder (ASD) is a global public health concern and its prevalence is increasing rapidly in developing countries such as China. The mechanism behind ASD development remains unclear. Greenness exposure is reportedly associated with various health outcomes, however, the connection between greenness exposure and ASD is relatively unexplored.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We designed a two-stage screening process and conducted city-wide screening for early childhood ASD to investigate the association between greenness exposure and ASD prevalence in a megacity in southwest China.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We screened 13,458 children from 0\u201352 months through 20 local primary care hospitals and the estimated ASD prevalence was 0.55%. We matched greenness exposure, air pollution exposure, and weather condition with ASD diagnosis outcomes based on the study subject\u2019s geographic information. Gender (male) and age (older) were significantly associated with higher odds of being diagnosed with ASD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Although the association between ASD diagnosis and greenness was not statistically significant, real-world data may help improve ASD screening methods and guide future studies. Our findings highlight the potential role of real-world environmental and health data in informing sustainable urban and pediatric health policies.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1666873","type":"journal-article","created":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T05:39:43Z","timestamp":1758087583000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Real-world evidence from a multi-center pediatric network: greenness exposure and autism spectrum disorder in urban China"],"prefix":"10.3389","volume":"13","author":[{"given":"Wenxu","family":"Yang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shiwen","family":"He","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sophia","family":"Zuoqiu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,17]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1016\/j.healthplace.2018.11.005","article-title":"Exposure to nature for children with autism spectrum disorder: benefits, caveats, and barriers","volume":"55","author":"Li","year":"2019","journal-title":"Health Place"},{"key":"ref2","volume-title":"Understanding and supporting the social interaction of autistic children and young people","year":"2025"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"778","DOI":"10.1002\/aur.2696","article-title":"Global prevalence of autism: a systematic review update","volume":"15","author":"Zeidan","year":"2022","journal-title":"Autism Res"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"27","DOI":"10.3390\/brainsci10050274","article-title":"Epidemiology of autism Spectrum disorders: a review of worldwide prevalence estimates since 2014","volume":"10","author":"Chiarotti","year":"2020","journal-title":"Brain Sci"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"e09193","DOI":"10.1016\/j.heliyon.2022.e09193","article-title":"The quality of life of people with ASD through physical activity and sports","volume":"8","author":"Cuesta-Gomez","year":"2022","journal-title":"Heliyon"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"970611","DOI":"10.3389\/fpsyt.2022.970611","article-title":"Awareness and knowledge of autism spectrum disorder in Western China: promoting early identification and intervention","volume":"13","author":"Wei","year":"2022","journal-title":"Front Psych"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1186\/2040-2392-4-7","article-title":"Prevalence of autism in mainland China, Hong Kong and Taiwan: a systematic review and meta-analysis","volume":"4","author":"Sun","year":"2013","journal-title":"Mol Autism"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"961","DOI":"10.1007\/s12264-020-00530-6","article-title":"Prevalence of autism Spectrum disorder in China: a Nationwide multi-center population-based study among children aged 6 to 12 years","volume":"36","author":"Zhou","year":"2020","journal-title":"Neurosci Bull"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1016\/j.healthplace.2018.07.006","article-title":"Gray space and green space proximity associated with higher anxiety in youth with autism","volume":"53","author":"Larson","year":"2018","journal-title":"Health Place"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1016\/j.envint.2017.07.010","article-title":"Inverse relationship between urban green space and childhood autism in California elementary school districts","volume":"107","author":"Wu","year":"2017","journal-title":"Environ Int"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph15030445","article-title":"Urban green space and its impact on human health","volume":"15","author":"Kondo","year":"2018","journal-title":"Int J Environ Res Public Health"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"e162","DOI":"10.1016\/S2542-5196(18)30051-2","article-title":"Residential greenness and prevalence of major depressive disorders: a cross-sectional, observational, associational study of 94\u2008879 adult UK biobank participants","volume":"2","author":"Sarkar","year":"2018","journal-title":"Lancet Planet Health"},{"key":"ref13","volume-title":"Chengdu statistical yearbook","year":"2018"},{"key":"ref14","year":"2019"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"7933","DOI":"10.1016\/j.ecolind.2021.107933","article-title":"Analyzing ecological environment change and associated driving factors in China based on NDVI time series data","volume":"129","author":"Jiang","year":"2021","journal-title":"Ecol Indic"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1016\/j.healthplace.2018.09.005","article-title":"It's not easy assessing greenness: a comparison of NDVI datasets and neighborhood types and their associations with self-rated health in new York City","volume":"54","author":"Reid","year":"2018","journal-title":"Health Place"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1016\/j.jag.2014.01.009","article-title":"Temporal dynamics of spatial heterogeneity over cropland quantified by time-series NDVI, near infrared and red reflectance of Landsat 8 OLI imagery","volume":"30","author":"Ding","year":"2014","journal-title":"Int J Appl Earth Obs Geoinf"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"298","DOI":"10.1016\/j.rse.2015.04.004","article-title":"Characteristics of Landsat 8 OLI-derived NDVI by comparison with multiple satellite sensors and in-situ observations","volume":"164","author":"Ke","year":"2015","journal-title":"Remote Sens Environ"},{"key":"ref19","author":"Yang","year":"2024"},{"key":"ref20","year":"2021"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"106898","DOI":"10.1016\/j.envint.2021.106898","article-title":"In utero exposure to near-roadway air pollution and autism spectrum disorder in children","volume":"158","author":"Carter","year":"2022","journal-title":"Environ Int"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"118422","DOI":"10.1016\/j.atmosenv.2021.118422","article-title":"Association between ambient air pollution and childhood respiratory diseases in low- and middle-income Asian countries: a systematic review","volume":"256","author":"Ibrahim","year":"2021","journal-title":"Atmos Environ"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1007\/s10803-017-3304-0","article-title":"Association between air pollution exposure, cognitive and adaptive function, and ASD severity among children with autism Spectrum disorder","volume":"48","author":"Kerin","year":"2018","journal-title":"J Autism Dev Disord"},{"key":"ref24","volume-title":"Air quality report","year":"2022"},{"key":"ref25","volume-title":"NOMADS Data at NCEP","year":"2022"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1016\/j.atmosenv.2017.02.023","article-title":"Spatiotemporal prediction of continuous daily PM2.5 concentrations across China using a spatially explicit machine learning algorithm","volume":"155","author":"Zhan","year":"2017","journal-title":"Atmos Environ"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"464","DOI":"10.1016\/j.envpol.2017.10.029","article-title":"Spatiotemporal prediction of daily ambient ozone levels across China using random forest for human exposure assessment","volume":"233","author":"Zhan","year":"","journal-title":"Environ Pollut"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"4180","DOI":"10.1021\/acs.est.7b05669","article-title":"Satellite-based estimates of daily NO(2) exposure in China using hybrid random forest and spatiotemporal kriging model","volume":"52","author":"Zhan","year":"","journal-title":"Environ Sci Technol"},{"key":"ref29","volume-title":"IBM SPSS statistics for windows, version 24.0","year":"2016"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1007\/s40572-018-0179-y","article-title":"A review of epidemiologic studies on greenness and health: updated literature through 2017","volume":"5","author":"Fong","year":"2018","journal-title":"Curr Environ Health Rep"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"677","DOI":"10.3390\/genes14030677","article-title":"The autism spectrum: behavioral, psychiatric and genetic associations","volume":"14","author":"Genovese","year":"2023","journal-title":"Genes"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"508","DOI":"10.1016\/s0140-6736(18)31129-2","article-title":"Autism spectrum disorder","volume":"392","author":"Lord","year":"2018","journal-title":"Lancet"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1097\/CHI.0b013e31819b3848","article-title":"Timing of identification among children with an autism spectrum disorder: findings from a population-based surveillance study","volume":"48","author":"Shattuck","year":"2009","journal-title":"Journal of the American Academy of Child and Adolescent Psychiatry"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"827","DOI":"10.1007\/s10803-007-0450-9","article-title":"The modified checklist for autism in toddlers: a follow-up study investigating the early detection of autism spectrum disorders","volume":"38","author":"Kleinman","year":"2008","journal-title":"J Autism Dev Disord"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"1717","DOI":"10.1007\/s10802-017-0393-3","article-title":"Comparing attention to socially-relevant stimuli in autism Spectrum disorder and developmental coordination disorder","volume":"46","author":"Sumner","year":"2018","journal-title":"J Abnorm Child Psychol"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"44","DOI":"10.59519\/mper6105","article-title":"Advancements in early intervention for children with autism: a five-year review","volume":"6","author":"Hadzic","year":"2024","journal-title":"Multidisciplinarni Pristupi u Edukaciji i Rehabilitaciji"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"5100","DOI":"10.3390\/jcm11175100","article-title":"The efficacy of early interventions for children with autism Spectrum disorders: a systematic review and Meta-analysis","volume":"11","author":"Daniolou","year":"2022","journal-title":"J Clin Med"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"e718","DOI":"10.1016\/S2542-5196(21)00229-1","article-title":"Green space and mortality in European cities: a health impact assessment study","volume":"5","author":"Barboza","year":"2021","journal-title":"Lancet Planet Health"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"102168","DOI":"10.1016\/j.healthplace.2019.102168","article-title":"Exploring the linkage between greenness exposure and depression among Chinese people: mediating roles of physical activity, stress and social cohesion and moderating role of urbanicity","volume":"58","author":"Liu","year":"2019","journal-title":"Health Place"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"1693","DOI":"10.1002\/aur.2172","article-title":"Temporal and geographical variability of prevalence and incidence of autism Spectrum disorder diagnoses in children in Catalonia, Spain","volume":"12","author":"P\u00e9rez-Crespo","year":"2019","journal-title":"Autism Res"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"4790","DOI":"10.3390\/ijerph18094790","article-title":"Associations between nature exposure and health: a review of the evidence","volume":"18","author":"Jimenez","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"7937","DOI":"10.1073\/pnas.1503402112","article-title":"Green spaces and cognitive development in primary schoolchildren","volume":"112","author":"Dadvand","year":"2015","journal-title":"Proc Natl Acad Sci USA"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"5188","DOI":"10.1073\/pnas.1807504116","article-title":"Residential green space in childhood is associated with lower risk of psychiatric disorders from adolescence into adulthood","volume":"116","author":"Engemann","year":"2019","journal-title":"Proc Natl Acad Sci USA"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1016\/j.healthplace.2019.05.014","article-title":"Mental, physical and social health benefits of immersive nature-experience for children and adolescents: a systematic review and quality assessment of the evidence","volume":"58","author":"Mygind","year":"2019","journal-title":"Health Place"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1186\/s13229-1","article-title":"Autism spectrum disorder at the crossroad between genes and environment: contributions, convergences, and interactions in ASD developmental pathophysiology","volume":"11","author":"Cheroni","year":"2020","journal-title":"Mol Autism"},{"key":"ref46","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1007\/978-3-031-24926-6_30","article-title":"Early intensive behavioral intervention for autism Spectrum disorder","volume-title":"Handbook of clinical child psychology: Integrating theory and research into practice","author":"Creem","year":"2023"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"111487","DOI":"10.1016\/j.envres.2021.111487","article-title":"Effects of air pollution on health: a mapping review of systematic reviews and meta-analyses","volume":"201","author":"Dominski","year":"2021","journal-title":"Environ Res"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"1561","DOI":"10.1038\/s41380-020-00885-2","article-title":"Prenatal air pollution influences neurodevelopment and behavior in autism spectrum disorder by modulating mitochondrial physiology","volume":"26","author":"Frye","year":"2021","journal-title":"Mol Psychiatry"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"1197","DOI":"10.1001\/jamapediatrics.2023.4003","article-title":"Persistence of autism Spectrum disorder from early childhood through school age","volume":"177","author":"Harstad","year":"2023","journal-title":"JAMA Pediatr"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"819","DOI":"10.1016\/s2215-0366(19)30289-5","article-title":"Prevalence of co-occurring mental health diagnoses in the autism population: a systematic review and meta-analysis","volume":"6","author":"Lai","year":"2019","journal-title":"Lancet Psychiatry"},{"key":"ref51","volume-title":"R: A language and environment for statistical computing","year":"2018"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"862","DOI":"10.1177\/1362361320971107","article-title":"Age at autism spectrum disorder diagnosis: a systematic review and meta-analysis from 2012 to 2019","volume":"25","author":"van \u2018t Hof","year":"2021","journal-title":"Autism"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"112292","DOI":"10.1016\/j.envres.2021.112292","article-title":"Exposure to urban green space may both promote and harm mental health in socially vulnerable neighborhoods: a neighborhood-scale analysis in new York City","volume":"204","author":"Yoo","year":"2022","journal-title":"Environ Res"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"e520","DOI":"10.1542\/peds.2013-0763","article-title":"Economic burden of childhood autism spectrum disorders","volume":"133","author":"Lavelle","year":"2014","journal-title":"Pediatrics"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1666873\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T05:39:47Z","timestamp":1758087587000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1666873\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,17]]},"references-count":54,"alternative-id":["10.3389\/fpubh.2025.1666873"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1666873","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,17]]},"article-number":"1666873"}}