A higher ratio of green spaces means a lower racial disparity in severe acute respiratory syndrome coronavirus 2 infection rates: A nationwide study of the United States

Abstract

There is striking racial disparity in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection rates in the United States. We hypothesize that the disparity is significantly smaller in areas with a higher ratio of green spaces at the county level. This study used the 135 most urbanized counties across the United States as sample sites. County level data on the SARS-CoV-2 infection rates of black and white individuals in each county were collected. The ratio of green spaces by land-cover type at the county level was calculated from satellite imagery. An ecological hierarchical regression analysis measured cross-sectional associations between racial disparity in infection rates and green spaces, after controlling for socioeconomic, demographic, pre-existing chronic disease, and built-up area factors. We found significantly higher infection rate among black individuals compared to white individuals. More importantly, a higher ratio of green spaces at the county level is significantly associated with a lower racial disparity in the SARS-CoV-2 infection rate. Further, we identified four green space factors that have significant negative associations with the racial disparity in SARS-CoV-2 infection rates, including open space in developed areas, forest, shrub and scrub, and grassland and herbaceous. We suggest that green spaces are an equalizing salutogenic factor, modifying infection exposure.HighlightsThe first study to identify significant relationships between green spaces and the racial disparity of SARS-CoV-2 infection rates.A nationwide study of the 135 most urbanized counties of the United States.A within-subject study: The black-white racial disparity of SARS-CoV-2 infection rates was measured within each county.A higher ratio of green spaces in a county is associated with a lower racial disparity of SARS-CoV-2 infection rates after controlling for socio-economic, demographic, pre-existing chronic disease, and built-up area factors.Four green space factors are significantly associated with a lower racial disparity of SARS-CoV-2 infection rates.

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