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

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.