Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Feb 7;7(1):e244.
doi: 10.1097/EE9.0000000000000244. eCollection 2023 Feb.

Associations between greenness and predicted COVID-19-like illness incidence in the United States and the United Kingdom

Kelly Chen  1 , Jochem O Klompmaker  1   2 , Charlotte J Roscoe  1 , Long H Nguyen  3 , David A Drew  3   4 , Peter James  1   5 , Francine Laden  1   2 , Daniela Fecht  6 , Weiyi Wang  6 , John Gulliver  7 , Jonathan Wolf  8 , Claire J Steves  9 , Tim D Spector  9 , Andy T Chan  3   4   10 , Jaime E Hart  1   2
Affiliations

Associations between greenness and predicted COVID-19-like illness incidence in the United States and the United Kingdom

Kelly Chen et al. Environ Epidemiol. .

Abstract

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.

Keywords: Built Environment; COVID; Green space; Natural environment.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflicts of interest with regard to the content of this report.

Figures

Figure 1.
Figure 1.
Hazard ratios (and 95% CIs) for predicted COVID-19–like illness incidence presented by a 0.1 increase in 3-month moving average neighborhood NDVI among participants in the full CCS cohort (n = 2,794,029), among U.K. participants (n = 2,557,464) and among U.S. participants (n = 236,565) during follow-up from 24 March 2020 to 30 November 2020. In the basic model, we adjusted for calendar month, and stratified by country, age (<18, 18–65, and >65 years), and calendar month at study entry. In the fully adjusted model, we adjusted for all covariates.
See this image and copyright information in PMC

References

    1. Sohrabi C, Alsafi Z, O’Neill N, et al. World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19). Int J Surg. 2020;76:71–76. - PMC - PubMed
    1. Johns Hopkins Coronavirus Resource Center. Available at: https://coronavirus.jhu.edu/us-map. Accessed Jan 17, 2022.
    1. Chu DK, Akl EA, Duda S, et al. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. Lancet. 2020;395:1973–1987. - PMC - PubMed
    1. van Doremalen N, Bushmaker T, Morris DH, et al. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. N Engl J Med. 2020;382:1564–1567. - PMC - PubMed
    1. VoPham T, Weaver MD, Hart JE, Ton M, White E, Newcomb PA. Effect of social distancing on COVID-19 incidence and mortality in the US. medRxiv 2020.