Inequities in spatial accessibility to COVID-19 testing in 30 large US cities

Abstract

Testing for SARS-CoV-2 infection has been a key strategy to mitigate and control the COVID-19 pandemic. Wide spatial and racial/ethnic disparities in COVID-19 outcomes have emerged in US cities. Previous research has highlighted the role of unequal access to testing as a potential driver of these disparities. We described inequities in spatial accessibility to COVID-19 testing locations in 30 large US cities. We used location data from Castlight Health Inc corresponding to October 2021. We created an accessibility metric at the level of the census block group (CBG) based on the number of sites per population in a 15-minute walkshed around the centroid of each CBG. We also calculated spatial accessibility using only testing sites without restrictions, i.e., no requirement for an appointment or a physician order prior to testing. We measured the association between the social vulnerability index (SVI) and spatial accessibility using a multilevel negative binomial model with random city intercepts and random SVI slopes. Among the 27,195 CBG analyzed, 53% had at least one testing site within a 15-minute walkshed, and 36% had at least one site without restrictions. On average, a 1-decile increase in the SVI was associated with a 3% (95% Confidence Interval: 2% - 4%) lower accessibility. Spatial inequities were similar across various components of the SVI and for sites with no restrictions. Despite this general pattern, several cities had inverted inequity, i.e., better accessibility in more vulnerable areas, which indicates that some cities may be on the right track when it comes to promoting equity in COVID-19 testing. Testing is a key component of the strategy to mitigate transmission of SARS-CoV-2 and efforts should be made to improve accessibility to testing, particularly as new and more contagious variants become dominant.

Keywords: COVID-19; GIS; Health disparities; Health equity; Testing; Urban health.

Fig. 1

Sites per population in the block group 15-min walkshed by city Footnotes: Dashed line represents the median value for all cities. This plot excludes outliers, i.e., top 1% of the CBGs with values ranging from 0.65 to 5 sites per 1000 people. Cities are ordered from lowest to highest median value of site per 1000 population.

Fig. 2

Inequities in testing accessibility between census block groups at the top and bottom deciles of the social vulnerability index. Footnote: Ratios are shown on the log scale. Lines in red represent worse outcomes for most vulnerable communities (i.e., lower rates of sites per population for the top 10 percent most vulnerable CBGs compared to the 10 percent least vulnerable). Lines in green represent better outcomes for vulnerable communities. (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)

Fig. 3

Relationship between sites per 1000 population and social vulnerability in 30 US cities, by census region. Footnote: Shown are loess smoothers of spatial accessibility of testing sites on the social vulnerability index. Solid black line represents the loess smoother for the cities in the region.