Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, United States of America; Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, United States of America.
Sci Total Environ. 2022 Aug 25;836:155302. doi: 10.1016/j.scitotenv.2022.155302. Epub 2022 Apr 18.
Mask-wearing and social distancing are critical prevention measures that have been implemented to stem the spread of COVID-19. The degree to which these measures are adhered to in the US, however, may be influenced by access to outdoor resources such as green space, as well as mask mandates that may vary by state.
To examine the association between the presence or absence of statewide mask mandates and green space exposure with COVID-19 cumulative incidence in the US.
In October 2020, COVID-19 case data for each US county was downloaded from USA Facts, in addition to statewide mask mandates from a database maintained by the American Association of Retired Persons. The Normalized Difference Vegetation Index from the US Geological Survey (USGS), was used as a measure of greenspace, while the 2016 National Land Cover Database was used to assess tree canopy exposure as an alternative measure of greenspace. We performed generalized linear regression to evaluate associations with COVID-19 incidence, adjusting for potential confounders such as other environmental factors (i.e., air pollution and climate) and socio-economic factors derived from the CDC social vulnerability index. In addition, we also performed spatial regression analyses to account for spatial autocorrelation across counties.
Counties with mandatory mask-wearing policies had a lower cumulative incidence of COVID-19 (B = -0.299, SE = 0.038). Among environmental factors, precipitation (B = 0.005, SE = 0.001) and PM 2.5 (B = 0.072, SE = 0.012) were associated with a higher incidence of COVID-19, while tree canopy (B = -0.501, SE = 0.129) was associated with a lower risk of COVID-19. COVID-19 incidence was higher in counties with socially vulnerable populations regarding socioeconomic status, minority status, and housing and transportation.
Mandatory mask regulation, exposure to green space, and reduced exposure to air pollution may reduce COVID-19 incidence in the US. Additional public health policies should consider ways to mitigate environmental conditions that may contribute to the risk of COVID-19, especially for vulnerable populations.
戴口罩和保持社交距离是阻止 COVID-19 传播的关键预防措施。然而，在美国，这些措施的遵守程度可能受到获取户外资源（如绿色空间）的影响，以及州际之间可能存在的口罩强制令的影响。
研究全美范围内是否存在口罩强制令以及绿色空间暴露与 COVID-19 累计发病率之间的关系。
2020 年 10 月，从美国事实（USA Facts）下载了每个美国县的 COVID-19 病例数据，此外还从美国退休人员协会（American Association of Retired Persons）维护的数据库中下载了全州范围内的口罩强制令。美国地质调查局（USGS）的归一化植被指数（Normalized Difference Vegetation Index）被用作衡量绿地的指标，而 2016 年国家土地覆盖数据库（2016 National Land Cover Database）则被用来评估树冠暴露作为衡量绿地的替代指标。我们使用广义线性回归来评估与 COVID-19 发病率的关联，并调整了其他环境因素（如空气污染和气候）和来自疾病预防控制中心社会脆弱性指数的社会经济因素等潜在混杂因素。此外，我们还进行了空间回归分析，以解释各县之间的空间自相关。
有强制戴口罩政策的县 COVID-19 的累计发病率较低（B = -0.299，SE = 0.038）。在环境因素中，降水（B = 0.005，SE = 0.001）和 PM2.5（B = 0.072，SE = 0.012）与 COVID-19 发病率较高有关，而树冠（B = -0.501，SE = 0.129）与 COVID-19 风险较低有关。在社会经济地位、少数民族地位、住房和交通方面处于社会弱势地位的县 COVID-19 发病率较高。
强制口罩规定、接触绿色空间以及减少接触空气污染可能会降低美国的 COVID-19 发病率。额外的公共卫生政策应考虑减轻可能导致 COVID-19 风险的环境条件的方法，特别是对弱势群体。
