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. 2021 Jul-Aug;136(4):483-492.
doi: 10.1177/00333549211009498. Epub 2021 Apr 7.

Differences in COVID-19 Testing and Test Positivity Among Veterans, United States, 2020

Jacqueline M Ferguson  1   2 , Hoda S Abdel Magid  1   3   4 , Amanda L Purnell  5 , Mathew V Kiang  1   2   6 , Thomas F Osborne  1   7
Affiliations

Differences in COVID-19 Testing and Test Positivity Among Veterans, United States, 2020

Jacqueline M Ferguson et al. Public Health Rep. 2021 Jul-Aug.

Abstract

Objective: COVID-19 disproportionately affects racial/ethnic minority groups in the United States. We evaluated characteristics associated with obtaining a COVID-19 test from the Veterans Health Administration (VHA) and receiving a positive test result for COVID-19.

Methods: We conducted a retrospective cohort analysis of 6 292 800 veterans in VHA care at 130 VHA medical facilities. We assessed the number of tests for SARS-CoV-2 administered by the VHA (n = 822 934) and the number of positive test results (n = 82 094) from February 8 through December 28, 2020. We evaluated associations of COVID-19 testing and test positivity with demographic characteristics of veterans, adjusting for facility characteristics, comorbidities, and county-level area-based socioeconomic measures using nested generalized linear models.

Results: In fully adjusted models, veterans who were female, Black/African American, Hispanic/Latino, urban, and low income and had a disability had an increased likelihood of obtaining a COVID-19 test, and veterans who were Asian had a decreased likelihood of obtaining a COVID-19 test. Compared with veterans who were White, veterans who were Black/African American (risk ratio [RR] = 1.23; 95% CI, 1.19-1.27) and Native Hawaiian/Other Pacific Islander (RR = 1.13; 95% CI, 1.05-1.21) had an increased likelihood of receiving a positive test result. Hispanic/Latino veterans had a 43% higher likelihood of receiving a positive test result than non-Hispanic/Latino veterans did.

Conclusions: Although veterans have access to subsidized health care at the VHA, the increased risk of receiving a positive test result for COVID-19 among Black and Hispanic/Latino veterans, despite receiving more tests than White and non-Hispanic/Latino veterans, suggests that other factors (eg, social inequities) are driving disparities in COVID-19 prevalence.

Keywords: COVID-19; descriptive epidemiology; health disparities; social determinants of health; veterans.

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Conflict of interest statement

Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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