Journal article
Residential urban tree canopy is associated with decreased mortality during tuberculosis treatment in California
The Science of the total environment, Vol.711, pp.134580-134580
04/01/2020
DOI: 10.1016/j.scitotenv.2019.134580
PMID: 32000313
Abstract
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•Tuberculosis is the leading cause of death from infection worldwide.•It is unknown if trees could mitigate the harmful effects of air pollution on tuberculosis patients.•Using Kaplan-Meier and Cox survival analyses, we determined the effects of trees on tuberculosis patient mortality.•Those living in neighborhoods with high percent tree cover were less likely to die during treatment.•Trees may provide health benefits to patients undergoing tuberculosis treatment.
Trees can sequester air pollutants, and air pollution is associated with poor tuberculosis outcomes. However, the health impacts of urban trees on tuberculosis patients are unknown. To elucidate the effects of urban tree canopy on mortality during tuberculosis treatment, we evaluated patients diagnosed with active tuberculosis in California from 2000 through 2012, obtaining patient data from the California tuberculosis registry. Our primary outcome was all-cause mortality during tuberculosis treatment. We determined percent tree cover using 1 mresolution color infrared orthoimagery categorized into land cover classes, then linked tree cover to four circular buffer zones of 50–300 m radii around patient residential addresses. We used the Kaplan-Meier method to estimate survival probabilities and Cox regression models to determine mortality hazard ratios, adjusting for demographic, socioeconomic, and clinical covariates. Our cohort included 33,962 tuberculosis patients of median age 47, 59% male, 51% unemployed, and 4.9% HIV positive. Tuberculosis was microbiologically confirmed in 79%, and 1.17% were multi-drug resistant (MDR). Median tree cover was 7.9% (50 m buffer). Patients were followed for 23,280 person-years with 2370 deaths during tuberculosis treatment resulting in a crude mortality rate of 1018 deaths per 10,000 person-years. Increasing tree cover quintiles were associated with decreasing mortality risk during tuberculosis treatment in all buffers, and the magnitude of association decreased incrementally with increasing buffer radius: In the 50 m buffer, patients living in neighborhoods with the highest quintile tree cover experienced a 22% reduction in mortality (HR 0.78, 95%CI 0.68–0.90) compared to those living in lowest quintile tree cover; whereas for 100, 200, and 300 m buffers, a 21%, 13%, and 11% mortality risk reduction was evident. In conclusion, urban tree canopy was associated with decreased mortality during tuberculosis treatment even after adjusting for multiple demographic, socioeconomic, and clinical factors, suggesting that trees might play a role in improving tuberculosis outcomes.
Details
- Title: Subtitle
- Residential urban tree canopy is associated with decreased mortality during tuberculosis treatment in California
- Creators
- Robert J Blount - Division of Pulmonary and Critical Care Medicine, University of Iowa, Iowa City, IA, USALisa Pascopella - Tuberculosis Control Branch, California Department of Public Health, Richmond, CA, USAPennan Barry - Tuberculosis Control Branch, California Department of Public Health, Richmond, CA, USAJoseph Zabner - Division of Pulmonary and Critical Care Medicine, University of Iowa, Iowa City, IA, USAEmma M Stapleton - Division of Pulmonary and Critical Care Medicine, University of Iowa, Iowa City, IA, USAJennifer Flood - Tuberculosis Control Branch, California Department of Public Health, Richmond, CA, USAJohn Balmes - Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, CA, USAPayam Nahid - Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, CA, USADonald G Catanzaro - Department of Biological Sciences, University of Arkansas, Fayetteville, AR, USA
- Resource Type
- Journal article
- Publication Details
- The Science of the total environment, Vol.711, pp.134580-134580
- Publisher
- Elsevier B.V
- DOI
- 10.1016/j.scitotenv.2019.134580
- PMID
- 32000313
- ISSN
- 0048-9697
- eISSN
- 1879-1026
- Grant note
- DOI: 10.13039/100000002, name: National Institutes of Health
- Language
- English
- Date published
- 04/01/2020
- Academic Unit
- Pulmonary, Critical Care, and Occupational Medicine; Occupational and Environmental Health; Stead Family Department of Pediatrics; Internal Medicine
- Record Identifier
- 9984066106802771
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