Urban Residential Greenness and Cancer Incidence: Longitudinal Approach -

Inass Kayyal-Tarabeia ¹ Aviad Zick ² Yakir Rottenberg ² Yaron Michael ³ Itamar Lensky ³ Michael Blank ⁴ Keren Agay-Shay ¹

¹Department of Population Health, Environmental Epidemiology Laboratory, Azreili Faculty of Medicine, Bar –Ilan University, Israel
²Ein-Kerem, Hadassah-Hebrew University, Israel
³Department of Geography and Environment, Bar-Ilan University, Israel
⁴Laboratory of Molecular and Cellular Cancer Biology, Azrieli Faculty of Medicine,, Bar Ilan University, Israel

Background: There is a growing evidence for the beneficial impacts of higher levels of residential greenness on various health outcomes. However, only few studies have considered its impact on cancer incidence in a longitudinal approach. Our objective was to evaluate theses associations in Tel Aviv, Israel.

Methods: We used the 1995 Israeli Central Bureau of statistics (CBS) census data which consisted of approximately 20% of the Israeli population at all ages. For every year the cohort had been linked to the following databases: The Israeli Cancer Registry, the Israeli Mortality Registry, the Israeli population registry and to the annual income tax authority (2011-2015) data. We excluded those with identified cancer before 1998 and individuals followed up until 31 December 2015 or until death or immigration occurred. Annual changes in address were geocoded at the census tract level and personal longitudinal exposure to mean of greenness during follow-up were calculated using temporal satellite-based Moderate Resolution Imaging Spectroradiometer (MODIS) Normalized Difference Vegetation Index (NDVI) data. We performed multivariable Cox proportional hazards models to estimate hazard ratios (HR) and 95% confidence intervals (CI).

Results: We included 35,738 individuals who lived in the city of Tel-Aviv at baseline and contributed 682,650 person-years. 2874 incidence cases of cancer were diagnosed during the follow-up (mean: 17.2 years, SD: 5.22). Crude beneficial associations between cumulative exposure to greenness was observed and after adjusting for age, sex and sociodemographic factors, living in the highest quartile compared with those living in the lowest quartile of cumulative average surrounding greenness had a lower hazard of all-cancer incidence (HR:0.72; 95% CI: 0.59, 0.86).

Conclusion: In this urban population, increased amounts of residential greenness were associated with reduced risks of cancer. Associations should be further explored for specific cancer sites, for other NDVI measures (Rapid Eye-higher spatial resolution) and for potential modifiers.