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

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  • Mullachery, Pricila H.
  • Li, Ran
  • Melly, Steven
  • Kolker, Jennifer
  • Barber, Sharrelle
  • Diez Roux, Ana V.
  • Bilal, Usama

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.

Suggested Citation

  • Mullachery, Pricila H. & Li, Ran & Melly, Steven & Kolker, Jennifer & Barber, Sharrelle & Diez Roux, Ana V. & Bilal, Usama, 2022. "Inequities in spatial accessibility to COVID-19 testing in 30 large US cities," Social Science & Medicine, Elsevier, vol. 310(C).
    • Handle: RePEc:eee:socmed:v:310:y:2022:i:c:s027795362200613x
    DOI: 10.1016/j.socscimed.2022.115307
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    References listed on IDEAS

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    1. Jeffrey E. Harris, 2021. "Los Angeles County SARS-CoV-2 Epidemic: Critical Role of Multi-generational Intra-household Transmission," Journal of Bioeconomics, Springer, vol. 23(1), pages 55-83, April.
    2. Edmund Seto & Esther Min & Carolyn Ingram & BJ Cummings & Stephanie A. Farquhar, 2020. "Community-Level Factors Associated with COVID-19 Cases and Testing Equity in King County, Washington," IJERPH, MDPI, vol. 17(24), pages 1-13, December.
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    Cited by:

    1. Chen, Yue & Jia, Shunping & Xu, Qi & Xiao, Zhongsheng & Zhang, Shujing, 2023. "Measuring the dynamic accessibility to COVID-19 testing sites in the 15-min city: A focus on service congestion and mobility difference," Journal of Transport Geography, Elsevier, vol. 111(C).
    2. G. Arbia & V. Nardelli & N. Salvini & I. Valentini, 2024. "New accessibility measures based on unconventional big data sources," Papers 2401.13370, arXiv.org.
    3. Gagnon-Dufresne, Marie-Catherine & Gautier, Lara & Beaujoin, Camille & Boivin, Pauline & Coulibaly, Abdourahmane & Richard, Zoé & Gomes de Medeiros, Stéphanie & Dutra Da Nóbrega, Raylson Emanuel & de , 2023. "Did the design and planning of testing and contact tracing interventions for COVID-19 consider social inequalities in health? A multiple case study from Brazil, Canada, France & Mali," Social Science & Medicine, Elsevier, vol. 335(C).

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