Elsevier

Environmental Research

Volume 217, 15 January 2023, 114906
Environmental Research

Association of greenness with COVID-19 deaths in India: An ecological study at district level

https://doi.org/10.1016/j.envres.2022.114906Get rights and content

Highlights

  • The first attempt to examine the association between greenness exposure and COVID-19 deaths in India.

  • Increasing greenness (NDVI) was associated with a reduced risk of COVID-19 death.

  • Consistency in associations in case of analyses restricted to districts with a rather good overall death registration.

  • The association was modified by material deprivation and air pollution.

Abstract

Background

The world has witnessed a colossal death toll due to the novel coronavirus disease-2019 (COVID-19). A few environmental epidemiology studies have identified association of environmental factors (air pollution, greenness, temperature, etc.) with COVID-19 incidence and mortality, particularly in developed countries. India, being one of the most severely affected countries by the pandemic, still has a dearth of research exploring the linkages of environment and COVID-19 pandemic.

Objectives

We evaluate whether district-level greenness exposure is associated with a reduced risk of COVID-19 deaths in India.

Methods

We used average normalized difference vegetation index (NDVI) from January to March 2019, derived by Oceansat-2 satellite, to represent district-level greenness exposure. COVID-19 death counts were obtained through May 1, 2021 (around the peak of the second wave) from an open portal: covid19india.org. We used hierarchical generalized negative binomial regressions to check the associations of greenness with COVID-19 death counts. Analyses were adjusted for air pollution (PM2.5), temperature, rainfall, population density, proportion of older adults (50 years and above), sex ratio over age 50, proportions of rural population, household overcrowding, materially deprived households, health facilities, and secondary school education.

Results

Our analyses found a significant association between greenness and reduced risk of COVID-19 deaths. Compared to the districts with the lowest NDVI (quintile 1), districts within quintiles 3, 4, and 5 have respectively, around 32% [MRR = 0.68 (95% CI: 0.51, 0.88)], 39% [MRR = 0.61 (95% CI: 0.46, 0.80)], and 47% [MRR = 0.53 (95% CI: 0.40, 0.71)] reduced risk of COVID-19 deaths. The association remains consistent for analyses restricted to districts with a rather good overall death registration (>80%).

Conclusion

Though cause-of-death statistics are limited, we confirm that exposure to greenness was associated with reduced district-level COVID-19 deaths in India. However, material deprivation and air pollution modify this association.

Keywords

Greenness
COVID-19 deaths
NDVI
Environmental health
India

Data availability

Data will be made available on request.

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