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. 2024 Apr 1;7(4):e245697.
doi: 10.1001/jamanetworkopen.2024.5697.

Race, Ethnicity, and Delayed Time to COVID-19 Testing Among US Health Care Workers

DaMarcus E Baymon  1 , J Priyanka Vakkalanka  2   3 , Anusha Krishnadasan  4 , Nicholas M Mohr  2   3   5 , David A Talan  4   6 , Melissa Briggs Hagen  7 , Kelli Wallace  8 , Karisa K Harland  2 , Imoigele P Aisiku  1 , Peter C Hou  1 ; Preventing Emerging Infections Through Vaccine Effectiveness Testing (PREVENT) project
Collaborators, Affiliations

Race, Ethnicity, and Delayed Time to COVID-19 Testing Among US Health Care Workers

DaMarcus E Baymon et al. JAMA Netw Open. .

Abstract

Importance: Access to COVID-19 testing is critical to reducing transmission and supporting early treatment decisions; when made accessible, the timeliness of testing may also be an important metric in mitigating community spread of the infection. While disparities in transmission and outcomes of COVID-19 have been well documented, the extent of timeliness of testing and the association with demographic factors is unclear.

Objectives: To evaluate demographic factors associated with delayed COVID-19 testing among health care personnel (HCP) during the COVID-19 pandemic.

Design, setting, and participants: This cross-sectional study used data from the Preventing Emerging Infections Through Vaccine Effectiveness Testing study, a multicenter, test-negative, case-control vaccine effectiveness study that enrolled HCP who had COVID-19 symptoms and testing between December 2020 and April 2022. Data analysis was conducted from March 2022 to Junne 2023.

Exposure: Displaying COVID-19-like symptoms and polymerase chain reaction testing occurring from the first day symptoms occurred up to 14 days after symptoms occurred.

Main outcomes and measures: Variables of interest included patient demographics (sex, age, and clinical comorbidities) and COVID-19 characteristics (vaccination status and COVID-19 wave). The primary outcome was time from symptom onset to COVID-19 testing, which was defined as early testing (≤2 days) or delayed testing (≥3 days). Associations of demographic characteristics with delayed testing were measured while adjusting for clinical comorbidities, COVID-19 characteristics, and test site using multivariable modeling to estimate relative risks and 95% CIs.

Results: A total of 5551 HCP (4859 female [82.9%]; 1954 aged 25-34 years [35.2%]; 4233 non-Hispanic White [76.3%], 370 non-Hispanic Black [6.7%], and 324 non-Hispanic Asian [5.8%]) were included in the final analysis. Overall, 2060 participants (37.1%) reported delayed testing and 3491 (62.9%) reported early testing. Compared with non-Hispanic White HCP, delayed testing was higher among non-Hispanic Black HCP (adjusted risk ratio, 1.18; 95%CI, 1.10-1.27) and for non-Hispanic HCP of other races (adjusted risk ratio, 1.17; 95% CI, 1.03-1.33). Sex and age were not associated with delayed testing. Compared with clinical HCP with graduate degrees, all other professional and educational groups had significantly delayed testing.

Conclusions and relevance: In this cross-sectional study of HCP, compared with non-Hispanic White HCP and clinical HCP with graduate degrees, non-Hispanic Black HCP, non-Hispanic HCP of other races, and HCP all other professional and education backgrounds were more likely to have delayed COVID-19 testing. These findings suggest that time to testing may serve as a valuable metric in evaluating sociodemographic disparities in the response to COVID-19 and future health mitigation strategies.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Harland reported receiving grants from the Centers for Disease Control and Prevention outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Flowchart of Final Sample
Figure 2.
Figure 2.. Distribution of Delayed Testing by Testing Month and Participating Site
Figure 3.
Figure 3.. Risk of Early vs Late Testing for COVID-19
Reference groups include having a clinical job with a graduate degree for education, non-Hispanic White for race, 18 to 24 years for age, and female for sex. aRR indicates adjusted relative risk.
See this image and copyright information in PMC

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