Abstract

Background:

Access to green space has been hypothesized to have a beneficial impact on children’s mental well-being and cognitive development. The underlying mechanisms of the mental health benefits of green space are not fully understood, but different pathways have been suggested, such as the psychologically restoring capacities of green space, the ability to facilitate physical activity and social cohesion, and the mitigation of exposure to air pollution.

Objectives:

In this nationwide cohort study, we investigated associations between residential green space in early childhood and a clinical diagnosis of attention deficit hyperactivity disorder (ADHD).

Methods:

The cohort included individuals, who were born in Denmark between 1992 and 2007 ($n=\mathrm{814,689}$) and followed for a diagnosis of ADHD from age 5, during the period 1997–2016. We used the normalized difference vegetation index (NDVI) as a measure of vegetation greenness surrounding each residential address in a quadratic area of $210\mathrm{m}\times 210\mathrm{m}$ in which the residence was located in the center of the quadrate. Individual exposure to green space was calculated as the average of NDVI surrounding each individual’s residential address (or addresses if more than one) between birth and the fifth birthday. Multilevel modeling was used to estimate the incidence rate ratios (IRRs) with 95% confidence intervals (CI) for ADHD, according to exposure level and adjusted for calendar time, age, sex, parental socioeconomic status, neighborhood level socioeconomic status, and urbanicity.

Results:

Individuals living in areas defined by sparse green vegetation (lowest decile of NDVI) had an increased risk of developing ADHD, compared with individuals living in areas within the highest decile of NDVI ($\text{IRR}=1.55$; 95% CI: 1.46, 1.65). Adjusting for the known confounders attenuated the result, but the association remained ($\text{IRR}=1.20$; 95% CI: 1.13, 1.28).

Conclusion:

Our findings suggest that lower levels of green space in residential surroundings, during early childhood, may be associated with a higher risk of developing ADHD. https://doi.org/10.1289/EHP6729

中文翻译：

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儿童居住绿色空间与注意力缺陷多动障碍发展之间的关联：一项基于人群的队列研究

摘要

背景：

据推测，进入绿色空间会对儿童的心理健康和认知发展产生有益的影响。尚未充分了解绿色空间对心理健康的潜在机制，但已提出了不同的途径，例如绿色空间的心理恢复能力，促进体育活动和社会凝聚力的能力以及减轻暴露于空气中的能力。污染。

目标：

在这项全国性队列研究中，我们调查了儿童早期居住绿色空间与注意力缺陷多动障碍（ADHD）的临床诊断之间的关联。

方法：

队列中包括1992年至2007年之间在丹麦出生的个人（$ñ=\mathrm{814,689}$），然后在1997-2016年期间对5岁以上的ADHD进行诊断。我们使用归一化差异植被指数（NDVI）来衡量在一个二次方区域内每个住宅地址周围的植被绿度$210\mathrm{米}\times 210\mathrm{米}$其中住所位于正方形的中心。个体在绿地中的暴露量计算为出生至五岁生日之间每个人的住所地址（或多个地址，如果有一个以上）周围的NDVI平均值。根据暴露水平，并根据日历时间，年龄，性别，父母的社会经济地位，邻里水平的社会经济地位和城市化程度，使用多层次建模来估计多动症的发病率比率（IRR），其置信区间为95％。

结果：

与生活在NDVI最高分位数（EDVI）最高的地区相比，生活在稀疏绿色植被（NDVI最低的十分位数）的地区的人患多动症的风险增加。$\text{内部收益率}=1.55$; 95％CI：1.46、1.65）。调整已知的混杂因素会使结果减弱，但关联仍然存在（$\text{内部收益率}=1.20$; 95％CI：1.13、1.28）。

结论：

我们的发现表明，在儿童期早期，住宅环境中较低的绿色空间可能与罹患ADHD的风险较高相关。https://doi.org/10.1289/EHP6729