Population-weighted greenspace exposure tied to lower COVID-19 mortality rates: A nationwide dose-response study in the United States
Abstract
The COVID-19 outbreak has caused enormous deaths and profound social and economic disruption globally. Accumulating evidence suggests exposure to greenspace may reduce the risk of COVID-19 mortality. Greenspace exposure enhances immune functioning, reduces inflammation, and replenishes gut microbiota may protect against the risk of mortality among those with COVID-19. However, previous studies often fail to distinguish the health effect of different types of greenspace, explore the dose-response association and optimal buffer distance, and consider the spatial dynamics of population distribution and geographic locations of greenspace.
This study examined the associations among ratio of different types of greenspaces, population- weighted exposure to different types of greenspaces, and COVID-19 mortality rates using a negative binomial generalized linear mixed effects model across 3,025 counties in the United States, adjusted for socioeconomic, demographic, pre-existing chronic disease, policy and regulation, behavioral, and environmental factors. The population-weighted measure gave proportionally greater weight to greenspace near areas of higher population density.
Exposure to forest and pasture was negatively associated with COVID-19 mortality rates, while developed open space has insignificant or positive associations with mortality rates. Forest outside park has the largest effect size across all buffer distances, followed by forest inside park . The optimal exposure buffer distance is 1km for forest outside park , with 1 unit of increase in exposure associated with a 9.9% decrease in mortality rates (95% confidence interval: 6.9% -12.8%). The optimal exposure buffer distance of forest inside park is 400m, with 1 unit of increase in exposure, associated with a 4.7% decrease in mortality rates (95% confidence interval: 2.4% - 6.9%).
Greenspaces, especially nearby forest, may be effective at lowering the mortality risk of COVID-19 patients. Our findings suggest that policymakers and planners should prioritize forestry within walking distance of residential clusters to mitigate mortality rates during current and future respiratory pandemics.
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SciScore for 10.1101/2022.05.24.22275549: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your code and data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:4.3 Limitations and future research opportunities: This study has several limitations, which pose opportunities for future research. This is an ecological study using aggregated data at the county level. It is subjected to ecological fallacy. Future studies can use individual level data or experimental studies to confirm the causal relations and the potential underlying mechanisms (Jiang et al., 2021). Second, the unit of analysis is …
SciScore for 10.1101/2022.05.24.22275549: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your code and data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:4.3 Limitations and future research opportunities: This study has several limitations, which pose opportunities for future research. This is an ecological study using aggregated data at the county level. It is subjected to ecological fallacy. Future studies can use individual level data or experimental studies to confirm the causal relations and the potential underlying mechanisms (Jiang et al., 2021). Second, the unit of analysis is the county due to the availability of COVID-19 mortality data and other confounding variable. Though county data are widely used in nationwide studies, future studies should use finer-grained data (i.e., census tract level data). Different scales of analyses may reveal different associations between neighborhood greenspace and health outcomes (Richardson et al., 2012). Third, our research investigated associations using data from 2020, but the situation has continued to evolve with the emergence of vaccines and COVID-19 variants (e.g., Delta and Omicron). Future studies should consider the new situations accordingly.
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
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