Race, Ethnicity, and Delayed Time to COVID-19 Testing Among US Health Care Workers
Authors: Baymon DaMarcus E. , Vakkalanka J. Priyanka , Krishnadasan Anusha , Mohr Nicholas M. , Talan David A. , Hagen Melissa Briggs , Wallace Kelli , Harland Karisa K. , Aisiku Imoigele P. , Hou Peter C. ,   Preventing Emerging Infections Through Vaccine Effectiveness Testing (PREVENT) project, Smithline Howard A. , Lee Lilly C. , Lim Stephen C. , Moran Gregory J. , Steele Mark T. , Beiser David G. , Faine Brett , Nandi Utsav , Schrading Walter A. , Chinnock Brian , Chipman Anne , Fuentes Megan , LoVecchio Frank , Clinansmith Bradley , Landers Shannon , Horcher Alysia , Uribe Lisandra , Pathmarajah Kavitha , Poronsky Kye E. , Hashimoto Dean M. , Bahamon Monica , St. Romain Michelle , Kean Efrat , Krebs Elizabeth , Stubbs Amy , Roy Sara , Volturo Gregory , Higgins Amanda , Galbraith James , Crosby James C. , Mulrow Mary , Gonzalez Eva , Gierke Ryan , Farrar Jennifer L. , Xing Wei , Chung Yunmi , Yousaf Anna , Onukwube Okaro Jennifer , Abedi Glen R. , Nyanseor Sankan , Watts Christopher K. 
Published: April 2024

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.