Health equity in COVID-19 testing among patients of a large national pharmacy chain

Abstract

Background: Several social determinants of health and other structural factors drive racial and ethnic disparities in COVID-19 risk, morbidity, and mortality. Public-private collaborations with community pharmacies have been successful in expanding access to COVID-19 testing and reaching historically underserved communities. The objectives of this study were to describe individuals who sought testing for COVID-19 at a national community pharmacy chain and to understand potential racial and ethnic inequities in testing access, positivity, and infection with emerging variants of concern.

Methods: We conducted a cross-sectional study of individuals aged ≥18 who were tested for COVID-19 (SARS-CoV-2) at a Walgreens pharmacy or Walgreen-affiliated mass testing site between May 1, 2021 and February 28, 2022. Positivity was defined as the proportion of positive tests among all administered tests. A geographically balanced random subset of positive tests underwent whole genome sequencing to identify specific viral variants (alpha, delta, and omicron). Logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs) to compare the likelihood of testing positive and testing positive with an emerging variant of concern across race and ethnicity groups.

Results: A total of 18,576,360 tests were analyzed (16.0% tests were positive for COVID-19; 59.5% of tests were from White individuals and 13.1% were from Black individuals). American Indian or Alaska Native (OR = 1.12; 95%CI = 1.10-1.13), Hispanic or Latino (1.20; 95%CI = 1.120, 1.21), and Black (1.12; 95%CI = 1.12, 1.13) individuals were more likely to test positive for COVID-19 compared to White individuals. Non-White individuals were also more likely to test positive for emerging variants of concern (e.g., Black individuals were 3.34 (95%CI = 3.14-3.56) times more likely to test positive for omicron compared to White individuals during the transition period from delta to omicron).

Discussion: Using a national database of testing data, we found racial and ethnic differences in the likelihood of testing positive for COVID-19 and testing positive for emerging viral strains. These results demonstrate the feasibility of public-private collaborations with local pharmacies and pharmacy chains to support pandemic response and reach harder to reach populations with important health services.

Keywords: COVID-19; health equity; pharmacy; testing; whole genome sequencing.

Figure 1

Map of COVID-19 test positivity rate in the United States among adults testing for COVID-19 at a Walgreens pharmacy or Walgreen-affiliated mass testing site between May 2021 to February 2022. Positivity was calculated as the number of positive tests for SARS-CoV-2 divided by the total number of tests administered in each state during the study period. Northeast States Positivity Rate = CT: 10.0%, DE: 9.2%, MA: 12.0%, MD: 11.4%, ME: 9.2%, NH: 12.1%, NJ: 10.1%, NY: 10.7%, PA: 14.9%, RI: 9.8%, VT: 5.3%. Walgreens does not have stores in North Dakota, so there is no positivity estimate for this state.