Determinants of residential greenness and its association with prostate cancer risk: A case-control study in Singapore

Yueh Jia Lee; Wei Qi Loh; Trung Kien Dang; Cecilia Woon Chien Teng; Wen-Chi Pan; Chih-Da Wu; Sin Eng Chia; Wei Jie Seow

doi:10.1016/j.envres.2023.116903

Determinants of residential greenness and its association with prostate cancer risk: A case-control study in Singapore

Environ Res. 2023 Nov 15;237(Pt 2):116903. doi: 10.1016/j.envres.2023.116903. Epub 2023 Aug 18.

Authors

Yueh Jia Lee¹, Wei Qi Loh¹, Trung Kien Dang¹, Cecilia Woon Chien Teng¹, Wen-Chi Pan², Chih-Da Wu³, Sin Eng Chia⁴, Wei Jie Seow⁵

Affiliations

¹ Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #10-01, Singapore, 117549.
² Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
³ Department of Geomatics, National Cheng Kung University, Tainan, Taiwan; National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan; Innovation and Development Center of Sustainable Agriculture, National Chung-Hsing University, Tainan, Taiwan.
⁴ Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #10-01, Singapore, 117549; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, 10 Medical Dr, Singapore, 117597.
⁵ Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #10-01, Singapore, 117549; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, 10 Medical Dr, Singapore, 117597. Electronic address: ephswj@nus.edu.sg.

PMID: 37598842
DOI: 10.1016/j.envres.2023.116903

Abstract

Background: Exposure to greenness has been shown to be beneficial to health, but few studies have examined the association between residential greenness and prostate cancer (PCa) risk. Our main objectives were to identify the determinants of residential greenness, and to investigate if residential greenness was associated with PCa risk in Singapore.

Methods: The hospital-based case-control study was conducted between April 2007 and May 2009. The Singapore Prostate Cancer Study (SPCS) comprised 240 prostate cancer cases and 268 controls, whose demographics and residential address were collected using questionnaires. Residential greenness was measured by normalized difference vegetation index (NDVI) around the participants' homes using a buffer size of 1 km. Determinants of NDVI were identified using a multivariable linear regression model. Logistic regression models were used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) of associations between NDVI and PCa risk, adjusting for potential confounders.

Results: Having a BMI within the second quartile, as compared to the lowest quartile, was associated with higher levels of NDVI (β-coefficient = 0.263; 95% CI = 0.040-0.485) after adjusting for covariates. Additionally, being widowed or separated, as compared to being married, was associated with lower levels of NDVI (β-coefficient = -0.393; 95% CI = -0.723, -0.063). An interquartile range (IQR) increase in NDVI was positively associated with prostate cancer risk OR = 1.45; 95% CI = 1.02-2.07). Stratified analysis by tumour grade and stage showed that higher NDVI was associated with higher risk of low grade PCa.

Conclusion: Our findings suggested that residential greenness was associated with higher risk of PCa in Singapore. Future studies on the quality and type of green spaces, as well as other factors of residential greenness, in association with PCa risk should be conducted to better understand this relationship.

Keywords: Case-control study; Environmental epidemiology; NDVI; Prostate cancer; Residential greenness.