The Impact of Racial Disparity in Environmental Factors on Racial Disparity in SARS-CoV-2 Infection Rates: A Nationwide Study in the USA

Background: The striking racial disparity in SARS-CoV-2 infection rates in the United States has been frequently reported. It is unclear to what extent the racial disparity in environmental exposure is related to the racial disparity in SARS-CoV-2 infection rates. We adopted 1416 counties in the contiguous United States as research sites to explore the differences in population exposure to green spaces and urbanized areas across racial population groups and the associated health outcomes.Methods: To ensure that the selected counties were representative, we applied a random selection strategy based on geographic spatial distribution and obtained robust results. First, we used 30-m-spatial resolution land cover and racial mappings to quantify the racial disparity between black and white people in exposure to green spaces and other environments in each county. Then, we investigated the association between the racial disparity in those environmental exposures and racial disparity in SARS-CoV-2 infection rates. We conducted multivariate sensitivity analysis to make our findings more robust.Findings: We found, compared to white people, black people had significantly higher infection rates, less exposure to green space, and more exposure to urbanized areas with three levels of development intensity. Further, we found that greater exposure to green spaces and urban areas with low or medium development intensity were significantly associated with lower racial disparity in infection rates (R2 = 0∙370, p < 0∙001). Among all environmental exposures, exposure to forests outside parks yielded the strongest association with lower racial disparity in infection rates.Interpretation: Our findings suggest that providing access to nearby urban forests and adopting low or moderate urban development can reduce racial disparity in public health outcomes.Funding Information: This work was supported by University Research Committee of The University of Hong Kong (grant: 102010054.088616.01100.302.01), The University of Hong Kong HKU-100 Scholars Fund, and National Natural Science Foundation of China (No. 51908202).Declaration of Interests: The authors declare no competing interests.