{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T03:56:25Z","timestamp":1787975785843,"version":"build-2784847793"},"reference-count":35,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2022,12,31]],"date-time":"2022-12-31T00:00:00Z","timestamp":1672444800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>PM2.5, a type of particulate matter with an aerodynamic diameter of less than 2.5 \u03bcm, is associated with the occurrence of cardiovascular diseases (CVDs), while greenness seems to be associated with better cardiovascular health. We identified 499,336 CVD cases in Wuhan\u2019s 74 municipal hospitals between 2017 and 2019. A high-resolution PM2.5 model and a normalized difference vegetation index (NDVI) map were established to estimate individual exposures. The time-stratified case-crossover design and conditional logistic regression models were applied to explore the associations between PM2.5 and CVDs under different levels of environmental factors. Greenness could alleviate PM2.5-induced hospitalization risks of cardiovascular diseases. Compared with patients in the low-greenness group (ER = 0.99%; 95% CI: 0.71%, 1.28%), patients in the high-greenness group (ER = 0.45%; 95% CI: 0.13%, 0.77%) showed a lower increase in total CVD hospitalizations. After dividing the greenness into quartiles and adding long-term PM2.5 exposure as a control factor, no significant PM2.5-associated hospitalization risks of CVD were identified in the greenest areas (quartile 4), whether the long-term PM2.5 exposure level was high or low. Intriguingly, in the least green areas (quartile 1), the PM2.5-induced excess risk of CVD hospitalization was 0.58% (95% CI: 0.04%, 1.11%) in the long-term high-level PM2.5 exposure group, and increased to 1.61% (95% CI: 0.95%, 2.27%) in the long-term low-level PM2.5 exposure group. In the subgroup analysis, males and participants aged 55\u201364 years showed more significant increases in the PM2.5-induced risk of contracting CVDs with a reduction in greenness and fine particle exposure conditions. High residential greenness can greatly alleviate the PM2.5-induced risk of cardiovascular admission. Living in the areas with long-term low-level PM2.5 may make people more sensitive to short-term increases in PM2.5, leading to CVD hospitalization.<\/jats:p>","DOI":"10.3390\/ijerph20010746","type":"journal-article","created":{"date-parts":[[2023,1,2]],"date-time":"2023-01-02T04:17:38Z","timestamp":1672633058000},"page":"746","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["PM2.5-Associated Hospitalization Risk of Cardiovascular Diseases in Wuhan: Cases Alleviated by Residential Greenness"],"prefix":"10.3390","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7675-1594","authenticated-orcid":false,"given":"Haomin","family":"Yang","sequence":"first","affiliation":[{"name":"Department of Biostatistics, School of Public Health, Wuhan University, Wuhan 430071, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianpeng","family":"Liao","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, School of Public Health, Wuhan University, Wuhan 430071, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, School of Public Health, Wuhan University, Wuhan 430071, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Can","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, School of Public Health, Wuhan University, Wuhan 430071, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuizhuang","family":"Jiao","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, School of Public Health, Wuhan University, Wuhan 430071, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaodie","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, School of Public Health, Wuhan University, Wuhan 430071, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zenghui","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, School of Public Health, Wuhan University, Wuhan 430071, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuxi","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, School of Public Health, Wuhan University, Wuhan 430071, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingyuan","family":"Liu","sequence":"additional","affiliation":[{"name":"Wuhan Information Center of Health and Family Planning, Wuhan 430021, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingling","family":"Liao","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Food Hygiene, School of Public Health, Medical College, Wuhan University of Science and Technology, Wuhan 430081, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4735-6974","authenticated-orcid":false,"given":"Lu","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, School of Public Health, Wuhan University, Wuhan 430071, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1789","DOI":"10.1016\/S0140-6736(18)32279-7","article-title":"Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990\u20132017: A systematic analysis for the Global Burden of Disease Study 2017","volume":"392","author":"James","year":"2018","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1038\/s41569-018-0119-4","article-title":"Epidemiology of cardiovascular disease in China: Current features and implications","volume":"16","author":"Zhao","year":"2019","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1161\/CIRCOUTCOMES.109.910711","article-title":"Future cardiovascular disease in china: Markov model and risk factor scenario projections from the coronary heart disease policy model-china","volume":"3","author":"Moran","year":"2010","journal-title":"Circ. Cardiovasc. Qual. Outcomes"},{"key":"ref_4","first-page":"o1664","article-title":"Air pollution is a public health emergency","volume":"378","author":"Holgate","year":"2022","journal-title":"BMJ (Clin. Res. Ed.)"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1056\/NEJMoa1817364","article-title":"Ambient Particulate Air Pollution and Daily Mortality in 652 Cities","volume":"381","author":"Liu","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"13200","DOI":"10.1021\/acs.est.2c03084","article-title":"Long-Term Exposure to Ambient Fine Particulate Matter and Incidence of Major Cardiovascular Diseases: A Prospective Study of 0.5 Million Adults in China","volume":"56","author":"Liu","year":"2022","journal-title":"Environ. Sci. Technol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1016\/j.jacc.2019.12.031","article-title":"Long-Term Exposure to Fine Particulate Matter and Cardiovascular Disease in China","volume":"75","author":"Liang","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"106715","DOI":"10.1016\/j.envint.2021.106715","article-title":"Air pollution and cardiovascular disease hospitalization\u2014Are associations modified by greenness, temperature and humidity?","volume":"156","author":"Klompmaker","year":"2021","journal-title":"Environ. Int."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1016\/j.envres.2018.06.030","article-title":"The health benefits of the great outdoors: A systematic review and meta-analysis of greenspace exposure and health outcomes","volume":"166","author":"Jones","year":"2018","journal-title":"Environ. Res"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.envres.2019.04.019","article-title":"The influence of green space on the short-term effects of particulate matter on hospitalization in the U.S. for 2000\u20132013","volume":"174","author":"Heo","year":"2019","journal-title":"Environ. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"154872","DOI":"10.1016\/j.scitotenv.2022.154872","article-title":"Left ventricular diastolic dysfunction and cardiovascular disease in different ambient air pollution conditions: A prospective cohort study","volume":"831","author":"Zheng","year":"2022","journal-title":"Sci. Total Environ."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1093\/aje\/kwr425","article-title":"Association of particulate air pollution with daily mortality: The China Air Pollution and Health Effects Study","volume":"175","author":"Chen","year":"2012","journal-title":"Am. J. Epidemiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1007\/s12519-022-00533-5","article-title":"Short-term effects of air pollution on respiratory diseases among young children in Wuhan city, China","volume":"18","author":"Huang","year":"2022","journal-title":"World J. Pediatr. WJP"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1186\/s12931-021-01731-x","article-title":"Effect of ambient fine particulates (PM(2.5)) on hospital admissions for respiratory and cardiovascular diseases in Wuhan, China","volume":"22","author":"Ren","year":"2021","journal-title":"Respir. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/j.healthplace.2018.09.005","article-title":"It\u2019s 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":"ref_16","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1016\/j.scitotenv.2017.09.098","article-title":"Ambient air pollution and daily hospital admissions for mental disorders in Shanghai, China","volume":"613\u2013614","author":"Chen","year":"2018","journal-title":"Sci. Total Environ."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Xu, Q., Li, X., Wang, S., Wang, C., Huang, F., Gao, Q., Wu, L., Tao, L., Guo, J., and Wang, W. (2016). Fine Particulate Air Pollution and Hospital Emergency Room Visits for Respiratory Disease in Urban Areas in Beijing, China, in 2013. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0153099"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1289\/ehp.0901485","article-title":"Case-crossover analysis of air pollution health effects: A systematic review of methodology and application","volume":"118","author":"Taracido","year":"2010","journal-title":"Environ. Health Perspect."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1016\/j.scitotenv.2016.11.008","article-title":"Seasonal and temperature modifications of the association between fine particulate air pollution and cardiovascular hospitalization in New York state","volume":"578","author":"Hsu","year":"2017","journal-title":"Sci. Total Environ."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"109095","DOI":"10.1016\/j.envres.2019.109095","article-title":"Inverse probability weighted distributed lag effects of short-term exposure to PM(2.5) and ozone on CVD hospitalizations in New England Medicare participants\u2014Exploring the causal effects","volume":"182","author":"Qiu","year":"2020","journal-title":"Environ. Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2034","DOI":"10.1093\/eurheartj\/ehq188","article-title":"Association between short-term exposure to ultrafine particles and hospital admissions for stroke in Copenhagen, Denmark","volume":"31","author":"Andersen","year":"2010","journal-title":"Eur. Heart J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1289\/ehp.111-1241344","article-title":"Personal PM2.5 exposure and markers of oxidative stress in blood","volume":"111","author":"Daneshvar","year":"2003","journal-title":"Environ. Health Perspect."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/j.toxlet.2009.12.002","article-title":"Acute effects of fine particles on cardiovascular system: Differences between the spontaneously hypertensive rats and wistar kyoto rats","volume":"193","author":"Zhao","year":"2010","journal-title":"Toxicol. Lett."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Yitshak-Sade, M., James, P., Kloog, I., Hart, J.E., Schwartz, J.D., Laden, F., Lane, K.J., Fabian, M.P., Fong, K.C., and Zanobetti, A. (2019). Neighborhood Greenness Attenuates the Adverse Effect of PM2.5 on Cardiovascular Mortality in Neighborhoods of Lower Socioeconomic Status. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16050814"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"106556","DOI":"10.1016\/j.envint.2021.106556","article-title":"Residential surrounding greenness and DNA methylation: An epigenome-wide association study","volume":"154","author":"Xu","year":"2021","journal-title":"Environ. Int."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1286","DOI":"10.1289\/ehp.1104609","article-title":"Surrounding greenness and exposure to air pollution during pregnancy: An analysis of personal monitoring data","volume":"120","author":"Dadvand","year":"2012","journal-title":"Environ. Health Perspect."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Chen, J., Yu, X., Bi, H., and Fu, Y. (2017). Indoor simulations reveal differences among plant species in capturing particulate matter. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0177539"},{"key":"ref_28","first-page":"347","article-title":"Plant species differences in particulate matter accumulation on leaf surfaces","volume":"427\u2013428","author":"Popek","year":"2012","journal-title":"Sci. Total Environ."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1016\/j.socscimed.2010.01.002","article-title":"Green space as a buffer between stressful life events and health","volume":"70","author":"Maas","year":"2010","journal-title":"Soc. Sci. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1007\/s40471-015-0043-7","article-title":"A Review of the Health Benefits of Greenness","volume":"2","author":"James","year":"2015","journal-title":"Curr. Epidemiol. Rep."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e01339","DOI":"10.1016\/j.heliyon.2019.e01339","article-title":"Urban green space cooling effect in cities","volume":"5","author":"Aram","year":"2019","journal-title":"Heliyon"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1016\/j.scitotenv.2018.07.311","article-title":"Urban climate modified short-term association of air pollution with pneumonia mortality in Hong Kong","volume":"646","author":"Sun","year":"2019","journal-title":"Sci. Total Environ."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1016\/j.envint.2017.08.012","article-title":"More than clean air and tranquillity: Residential green is independently associated with decreasing mortality","volume":"108","author":"Vienneau","year":"2017","journal-title":"Environ. Int."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2392","DOI":"10.1056\/NEJMoa1014296","article-title":"Changes in diet and lifestyle and long-term weight gain in women and men","volume":"364","author":"Mozaffarian","year":"2011","journal-title":"N. Engl. J. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1769","DOI":"10.1007\/s40279-017-0724-0","article-title":"Health Benefits of Light-Intensity Physical Activity: A Systematic Review of Accelerometer Data of the National Health and Nutrition Examination Survey (NHANES)","volume":"47","author":"Fuzeki","year":"2017","journal-title":"Sports Med."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/1\/746\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:49:00Z","timestamp":1760147340000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/1\/746"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,31]]},"references-count":35,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,1]]}},"alternative-id":["ijerph20010746"],"URL":"https:\/\/doi.org\/10.3390\/ijerph20010746","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,31]]}}}