Abstract

BACKGROUND: In 2020, early U.S. COVID-19 testing sites offered diagnostic capacity to patients and were important sources of epidemiological data about the spread of the novel pandemic disease. However, little research has comprehensively described American testing sites' distribution by race/ethnicity and sought to identify any relation to known disparities in COVID-19 outcomes.METHODS: Locations of U.S. COVID-19 testing sites were gathered from April 16 to May 28, 2020. Geographic testing disparities were evaluated with comparisons of the demographic makeup of zip codes around each testing site versus Monte Carlo simulations, aggregated to statewide and nationwide levels. Testing disparities were compared to disparities in mortality observed one to three weeks later using multivariable regression between states, controlling for confounding disparities and characteristics.RESULTS: Nationwide, COVID-19 testing sites geographically overrepresented white residents on May 7, underrepresented Hispanic residents on April 16, May 7, and May 28, and overrepresented Black residents on May 28 compared to random distribution within counties, with new sites added over time exhibiting inconsistent disparities for Black and Hispanic populations. For every 1 percentage point increase in under-representation of Hispanic populations in zip codes with testing, mortality among the state's Hispanic population was 1.04 percentage points more over-representative (SE=0.415, P=0.01).CONCLUSIONS: American testing sites were not distributed equitably by race during this analysis, often underrepresenting minority populations who bear a disproportionate burden of COVID-19 cases and deaths. With an easy-to-implement measure of geographic disparity, these results provide empirical support for the consideration of access when distributing preventive resources.

View details for DOI 10.1111/eci.13669

View details for PubMedID 34390487