The Impact of Air Pollution on Physical Functioning Decline and the Benefits of Greenness: Evidence From a Nationwide Cohort Study.

ABSTRACT

BACKGROUND: Physical functional limitations (PFLs) increase the vulnerability of adults, but their pathogenesis remains unclear. METHODS: We conducted a nationwide longitudinal study on 62 749 records from 18 878 adults (aged ≥45) from 28 provinces in China. Risk of PFLs was assessed using a validated 9-item questionnaire. Exposure levels of air pollutants (PM10, PM2.5, and PM1) and greenness (normalized difference vegetation index, NDVI) were estimated using a satellite-based spatiotemporal model. We used the cumulative link mixed effects model to estimate the associations between short-term and long-term exposure to air pollutants, greenness, and risk of PFLs. We employed the interaction effect model to evaluate interactions between air pollutants and greenness. RESULTS: Participants were 60.9 ±â€…9.6 years, with an average follow-up of 5.87 (1.65) years. Exposure to air pollution was significantly associated with a higher risk of PFLs. For instance, the odds ratio (OR) associated with each 10 µg/m3 higher in 6-month averaged PM10, PM2.5, and PM1 were 1.025 (95% CI 1.015-1.035), 1.035 (95% CI 1.018-1.054), and 1.029 (95% CI 1.007-1.050), respectively. Conversely, exposure to greenness was associated with decreased risk of PFLs; the OR associated with each 1-unit higher in 1-year averaged NDVI was 0.724 (95% CI 0.544-0.962). Furthermore, higher greenness levels were found to mitigate the adverse effects of 1-year, 6-month, 1-month averaged PM10, and 1-year averaged PM2.5 on the risk of PFLs. CONCLUSIONS: Air pollution raises the risk of PFLs, whereas greenness could mitigate the adverse effects. Reducing air pollution and enhancing greenness could prevent physical functioning.