Associations between greenness and predicted COVID-19-like illness incidence in the United States and the United Kingdom
Author(s)
Type
Journal Article
Abstract
UNLABELLED: Green spaces may be protective against COVID-19 incidence. They may provide outdoor, ventilated, settings for physical and social activities and therefore decrease transmission risk. We examined the association between neighborhood greenness and COVID-19-like illness incidence using individual-level data. METHODS: The study population includes participants enrolled in the COVID Symptom Study smartphone application in the United Kingdom and the United States (March-November 2020). All participants were encouraged to report their current health condition and suspected risk factors for COVID-19. We used a validated symptom-based classifier that predicts COVID-19-like illness. We estimated the Normalized Difference Vegetation Index (NDVI), for each participant's reported neighborhood of residence for each month, using images from Landsat 8 (30 m2). We used time-varying Cox proportional hazards models stratified by age, country, and calendar month at study entry and adjusted for the individual- and neighborhood-level risk factors. RESULTS: We observed 143,340 cases of predicted COVID-19-like illness among 2,794,029 participants. Neighborhood NDVI was associated with a decreased risk of predicted COVID-19-like illness incidence in the fully adjusted model (hazard ratio = 0.965, 95% confidence interval = 0.960, 0.970, per 0.1 NDVI increase). Stratified analyses showed protective associations among U.K. participants but not among U.S. participants. Associations were slightly stronger for White individuals, for individuals living in rural neighborhoods, and for individuals living in high-income neighborhoods compared to individuals living in low-income neighborhoods. CONCLUSIONS: Higher levels of greenness may reduce the risk of predicted COVID-19-like illness incidence, but these associations were not observed in all populations.
Date Issued
2023-02-01
Date Acceptance
2023-01-20
Citation
Environmental Epidemiology, 2023, 7 (1)
ISSN
2474-7882
Publisher
Lippincott, Williams & Wilkins
Journal / Book Title
Environmental Epidemiology
Volume
7
Issue
1
Copyright Statement
© 2023 The Authors. Published by Wolters Kluwer Health, Inc.
on behalf of The Environmental Epidemiology. All rights reserved. This is an
open-access article distributed under the terms of the Creative Commons
Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it
is permissible to download and share the work provided it is properly cited. The
work cannot be changed in any way or used commercially without permission
from the journal.
on behalf of The Environmental Epidemiology. All rights reserved. This is an
open-access article distributed under the terms of the Creative Commons
Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it
is permissible to download and share the work provided it is properly cited. The
work cannot be changed in any way or used commercially without permission
from the journal.
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/36788976
Subjects
Built Environment
COVID
Green space
Natural environment
Publication Status
Published
Coverage Spatial
United States
Article Number
ARTN e244