Accessibility to SARS-CoV-2 swab test during the Covid-19 pandemic: Did age make the difference?

Abstract

Although COVID-19 affects older people more severely, health policies during the first wave of the pandemic often prioritized younger individuals. We investigated whether age had influenced the access to a diagnostic test for SARS-CoV-2 infection and whether clinical complexity and healthcare resources availability could have impacted such differences. This work included 126,741 Italian participants in the EPICOVID19 web-based survey, who reported having had contacts with known/suspected COVID-19 cases (epidemiological criterion) and/or COVID-19-like signs/symptoms (clinical criterion) from February to June 2020. Data on sociodemographic, medical history and access to SARS-CoV-2 nasopharyngeal swab (NPS) were collected. Logistic regressions estimated the probability of accessing NPS as a function of age and the possible modifying effect of chronic diseases' number and residential areas in such association. A total of 6136 (4.8%) participants had undergone an NPS. Older participants had lower NPS frequencies than the younger ones when reporting epidemiological (14.9% vs. 8.8%) or both epidemiological and clinical criteria (17.5% vs. 13.7%). After adjustment for potential confounders, including epidemiological and clinical criteria, the chance of NPS access decreased by 29% (OR=0.71, 95%CI:0.63-0.79) in older vs. younger individuals. Such disparity was accentuated in areas with greater healthcare resources. In conclusion, in the first wave of the pandemic, age may have affected the access to COVID-19 diagnostic testing, disadvantaging older people.

Keywords: Ageism; COVID-19 diagnostic testing; Health Resources; Multimorbidity.

Fig. 1

Frequency of swab testing in young and older individuals by epidemiological and clinical criteria Notes: P-values refer to the chi-square test to compare the frequency of nasopharyngeal swab test between individuals aged < vs. ≥65 years. Epidemiological criterion concerned any reported contact with a suspected or confirmed COVID-19 case. Clinical criterion concerned any reported symptom or condition in the months February to May 2020, among fever, cough, headache, myalgia, olfactory or taste disorders, shortness of breath, sore throat/rhinorrhea, chest pain, feeling of a fast beat, gastrointestinal disorders, conjunctivitis, and pneumonia.

Fig. 2

Binary logistic regression for the association between age ≥65 years (vs. <65 years) and access to nasopharyngeal swab, in the sample as a whole and stratified by number of chronic diseases Notes. Odds ratios derive from a binary logistic regression with age≥65 years (reference category <65 years) as main exposure and access to a nasopharyngeal swab (yes vs. no) as the outcome. Model is adjusted for sex, educational level, criteria for a nasopharyngeal swab, respiratory diseases, cardiovascular diseases, arterial hypertension, area of residence, month at symptoms’ onset. *p<0.05, ***p<0.001.

Fig. 3

Binary logistic regression for the association between age ≥65 years (vs. <65 years) and access to nasopharyngeal swab, in the sample as a whole and stratified by area of residence Notes. Odds ratios derive from a binary logistic regression with age ≥65 years (reference category <65 years) as main exposure and access to a nasopharyngeal swab (yes vs. no) as the outcome. Model is adjusted for sex, educational level, criteria for a nasopharyngeal swab, respiratory diseases, cardiovascular diseases, arterial hypertension, month at symptoms’ onset. Area 1 includes Piedmont, Lombardy, Emilia Romagna, Liguria, Marche, and Aosta Valley (proportion of individuals aged ≥65 years: 10.9%). Area 2 includes Tuscany, Trentino Alto Adige, and Apulia (proportion of individuals aged ≥65 years: 10.0%). Area 3 includes Veneto, Lazio, Friuli Venezia Giulia, Molise, and Campania (proportion of individuals aged ≥65 years: 9.9%). Area 4 includes Sicily, Sardinia, Umbria, Calabria, and Basilicata. The 297 individuals living in the Republic of San Marino, other countries, or unknown are excluded from the analysis (proportion of individuals aged ≥65 years: 7.1%). *p<0.05, ***p<0.001.