Exploring "Equigenesis" in the Associations Between Green Space and Kidney Health Among Middle-Aged and Older Adults Using Street View Data

BACKGROUND AND OBJECTIVES: This study systematically explores the association between community green space and preventing kidney failure among middle-aged and older adults in China, using street view data. RESEARCH DESIGN AND METHODS: The 33 Chinese Community Health Study was used to conduct the analysis. We used street view data to assess street view green space (SVG) exposure and clearly distinguished the difference between grass (SVG-grass) and trees (SVG-tree). The normalized difference vegetation index (NDVI) was also used. Kidney failure was defined as a serum creatinine concentration of above 177 mol/L. We used multilevel logistic regression models (controlled for a series of covariates) to examine the associations between SVG and the odds of middle-aged and older adults having kidney failure. We also tested whether middle-aged and older adults from socioeconomically disadvantaged groups are likely to derive greater benefits from the effects of green space ("equigenesis"). RESULTS: The results showed that both SVG (OR = 0.353; 95% CI = 0.171-0.731) and SVG-trees (OR = 0.327; 95% CI = 0.146-0.736) were negatively associated with the likelihood of middle-aged and older adults experiencing kidney failure, but there was no significant evidence of any links between either SVG-grass (OR = 0.567; 95% CI = 0.300-1.076) or the NDVI (OR = 0.398; 95% CI = 0.237-1.058) and kidney failure. Furthermore, the moderation analysis indicated that income and educational attainment have a moderating effect on the association between green space and the improvement of kidney health, which suggests that green space has greater positive effects on the kidney health of disadvantaged groups. DISCUSSION AND IMPLICATIONS: To reduce inequalities in relation to kidney disease through urban planning, policymakers are advised to provide more visual green space-especially trees-within the community and to focus in particular on socioeconomically disadvantaged population groups.