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@ARTICLE{Zhang:181847,
      author       = {H. Zhang and A. Zhu$^*$ and L. Liu and Y. Zeng and R. Liu
                      and Z. Ma and M. Liu and J. Bi and J. S. Ji},
      title        = {{A}ssessing the effects of ultraviolet radiation,
                      residential greenness and air pollution on vitamin {D}
                      levels: {A} longitudinal cohort study in {C}hina.},
      journal      = {Environment international},
      volume       = {169},
      issn         = {0160-4120},
      address      = {Amsterdam [u.a.]},
      publisher    = {Elsevier Science},
      reportid     = {DKFZ-2022-02262},
      pages        = {107523},
      year         = {2022},
      abstract     = {Vitamin D metabolism is essential in aging and can be
                      affected by multiple environmental factors. However, most
                      studies conducted single exposure analyses. We aim to assess
                      the individual and combined effects of ultraviolet (UV)
                      radiation, residential greenness, fine particulate matter
                      (PM2.5), and ozone (O3) on vitamin D levels in a national
                      cohort study of older adults in China. We used the 2012 and
                      2014 Chinese Longitudinal Healthy Longevity Survey data, and
                      measured the environmental exposure in the same year. We
                      interpolated the UV radiation from monitoring stations,
                      measured residential greenness through satellite-derived
                      Normalized Difference Vegetation Index (NDVI), modeled PM2.5
                      with satellite data, and estimated O3 using machine
                      learning. We dichotomized serum 25-hydroxy vitamin D
                      (25(OH)D), the primary circulating form of vitamin D, into
                      non-deficiency (≥50 nmol/L) and deficiency (<50 nmol/L)
                      categories. We used the generalized estimating equation for
                      analysis, adjusted for sociodemographic information,
                      lifestyle, physical condition, and season of blood draw, and
                      calculated joint odds ratios based on the Cumulative Risk
                      Index. We also explored the interaction between interested
                      exposures, modification of participants' characteristics,
                      and potential mediation. We included 1,336 participants,
                      with a mean age of 83 at baseline. In single exposure
                      models, the odds ratios of vitamin D deficiency (VDD) for
                      per interquartile range increase in UV radiation, NDVI,
                      PM2.5, and O3 and decrease were 0.39 (95 $\%$ CI:0.33,0.46),
                      0.90 (0.81,1.00), 1.65 (1.53,1.78), 1.67 (1.46,1.92),
                      respectively. UV radiation mediated nearly 48 $\%$ and 78
                      $\%$ of the relationship between VDD and PM2.5 and O3,
                      respectively. The association between UV radiation and VDD
                      was stronger in females than men (OR: 2.25 vs 1.22). UV
                      radiation, residential greenness can protect against VDD,
                      while, PM2.5 and O3 increase the risk of VDD. UV radiation
                      partly mediated the association between air pollution and
                      VDD.},
      keywords     = {Air pollution (Other) / Green space (Other) / Ultraviolet
                      radiation (Other) / Vitamin D deficiency (Other)},
      cin          = {C070},
      ddc          = {600},
      cid          = {I:(DE-He78)C070-20160331},
      pnm          = {313 - Krebsrisikofaktoren und Prävention (POF4-313)},
      pid          = {G:(DE-HGF)POF4-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:36137427},
      doi          = {10.1016/j.envint.2022.107523},
      url          = {https://inrepo02.dkfz.de/record/181847},
}