High-Needs Areas Saw Low COVID-19 Testing Access Despite Equity Push - PatientEngagementHIT.com

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By Sara Heath

February 10, 2021 - Most of the efforts to drive health equity in COVID-19 testing access were for naught, with neighborhoods with high instances of virus outbreak seeing lower testing rates, according to researchers from Brigham & Women’s Hospital.

The study, published as a research note in JAMA Network Open, compared the rate of testing need—calculated by positivity rates—and rate of testing in Massachusetts cities and towns and Boston neighborhoods. Overall, testing in areas with high occurrence of COVID-19 infection was still lower than in areas less hard-hit by the virus, the researchers concluded.

This came after the national medical industry experienced a racial reckoning, observing stark racial health disparities in COVID-19 infections that reflect the health disparities that existed long before the pandemic. During the pandemic’s initial peak during the early spring of 2020, public health and medical experts nationwide called attention to those disparities, calling for better reporting of COVID-19 infection and race.

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That data reporting was to help public health experts better target interventions, like putting more COVID-19 testing sites in hard-hit communities, experts reasoned.

“Allocating testing resources to locations of greatest need is important to mitigate subsequent waves of coronavirus disease 2019 (COVID-19),” the researchers wrote.

But although the data eventually provided an evidence base for those racial health disparities, and public health groups launched new community-based initiatives to drive trust in and access to testing in high-risk areas, those efforts still fell short, the Massachusetts-based research team said. The hardest-hit areas still produced less testing than areas with fewer infections and lower risk.

The team used data from the end of May until the middle of October—the period after the initial COVID-19 surge but before the holiday-related peak—to determine how new attention to health equity may have affected COVID-19 testing access. By the time of data collection, it had become apparent that COVID-19 was shining a light on some deep-rooted health disparities, and many public health leaders had at least said they would work to remedy them.

The researchers determined a testing gap by comparing the COVID-19 positivity rate in a given city or Boston neighborhood with the overall number of tests conducted.

Optimal testing alignment was defined by an equal positivity rate and testing rate. For example, optimal testing alignment for the community with the third-highest positivity rate in the state would mean that community also conducts the third-highest number of tests in the state.

But that kind of alignment rarely happened, the team reported. COVID-19 infection rates and testing intensity varied significantly across communities. In higher-income communities with lower infection rates, the researchers typically observed higher overall numbers of tests conducted.

In other words, communities with lower COVID-19 risk tended to have more testing capacity than those with worse outbreaks.

The relative testing gap increased by 9 percent each week of the study period, the researchers furthered, with increasing levels of socioeconomic vulnerability being linked with increasing testing gaps.

When adjusting for socioeconomic status, communities in which members commonly speak languages other than English and communities in which there was a high proportion of racial minority patients tended to have larger testing gaps. These gaps were small but statistically significant.

“These analyses indicate that, despite programs to promote equity and enhance epidemic control in socioeconomically vulnerable communities, testing resources across Massachusetts have been disproportionately allocated to more affluent communities,” the researchers said.

The analysis was unable to account for certain factors, like underutilization of testing resources. The state may have put in place extra testing capacity in hard-hit areas, like it did with its Stop the Spread campaign, but individuals in those hard-hit areas may not have visited the testing site.

While this area remains unresearched, limited trust in the medical establishment, fears about out-of-pocket costs, concerns about quarantining post-test, and other logistical barriers may have kept low-income patients with fewer personal resources from accessing a test.

These results indicate that the push for health equity requires more than an “if we build it, they will come,” mentality. Healthcare must offer both access to resources as well as build trust within the community to address health disparities.

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High-Needs Areas Saw Low COVID-19 Testing Access Despite Equity Push - PatientEngagementHIT.com
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