Residential greenspace and COVID-19 morbidity and mortality: A nationwide cohort study in Denmark

Jiawei Zhang*, Youn Hee Lim, Jie Chen, Samuel Hyman, Thomas Cole-Hunter, Stéphane Tuffier, George Napolitano, Marie Bergmann, Laust H. Mortensen, Jørgen Brandt, Natalie Mueller, Evelise Pereira Barboza, Kees de Hoogh, Gerard Hoek, Steffen Loft, Zorana Jovanovic Andersen

*Corresponding author af dette arbejde

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Abstract

Background
Identifying modifiable environmental determinants of health is important for improving the resilience of populations to infectious disease. We examined the association between residential greenspace and COVID-19 morbidity and mortality using a Danish Nationwide Cohort, and estimate the potential health benefits of greening initiatives.
Methods
We followed all Danish adults aged 50 or older (N = 2,111,233) using the Danish National COVID-19 Surveillance System for COVID-19 incident infection, hospitalization and mortality, from 1 March 2020 to 26 April 2021. Greenspace was characterized using Normalized Difference Vegetation Index (NDVI) at 300x300m grid-cell level and linked to residential addresses. We used Cox regression to assess the association between greenspace and COVID-19 morbidity and mortality, and applied effect modification analyses to identify the most susceptible groups by sociodemographic status and comorbidity. Following a health impact assessment (HIA), we also estimated the preventable burden of disease attributable to greenspace under different counterfactual scenarios.
Results
During an average of 14 months follow-up, 62,880 participants were infected with SARS-CoV-2, of whom 8,759 were hospitalized, and 2,382 died, with COVID-19. We observed a negative association between residential greenspace and COVID-19 morbidity and mortality, with hazard ratios (95 % confidence interval) of 0.98 (0.97, 0.99) for SARS-CoV-2 infection, 0.97 (0.94, 0.99) for COVID-19 hospitalization, and 0.96 (0.91, 1.01) for COVID-19 mortality per interquartile range (0.08 unit) increase in NDVI. Stronger associations were observed in the elderly, those with lower SES, and major chronic diseases than their corresponding groups. Regarding the HIA, we estimated that increasing greenspace around residences up to WHO recommended levels would have prevented 8–14 % of COVID-19 events during the first 14 months, with the largest benefits among those with the lowest income, education, or without employment.
Conclusion
Greening initiatives in urban areas could help prevent COVID-19, and likely other infectious disease, with socially disadvantaged groups benefiting most.
OriginalsprogEngelsk
Artikelnummer109173
TidsskriftEnvironment International
Vol/bind194
Antal sider9
ISSN0160-4120
DOI
StatusUdgivet - 2024

Bibliografisk note

Funding Information:
The research described in this article was conducted under contract to the Health Effects Institute (HEI) (4978/RFA20-1B/20-12), an organisation jointly funded by the US Environmental Protection Agency (EPA) (assistance award number CR-83590201) and certain motor vehicle and engine manufacturers. The contents of this article do not necessarily reflect the views of HEI, or its sponsors, nor do they necessarily reflect the views and policies of the EPA or motor vehicle and engine manufacturers. This study was also funded by the Novo Nordisk Foundation Challenge Programme (NNF17OC0027812).

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© 2024

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