Coronavirus Testing Disparities Associated with Community Level Deprivation, Racial Inequalities, and Food Insecurity in West Virginia.

Hendricks, Brian; Paul, Rajib; Smith, Cassie; Wen, Sijin; Kimble, Wes; Amjad, Ayne; Atkins, Amy; Hodder, Sally

PURPOSE Social determinants of health and racial inequalities impact healthcare access and subsequent coronavirus testing. Limited studies have described the impact of these inequities on rural minorities living in Appalachia This study investigates factors affecting testing in rural communities. METHODS PCR testing data were obtained for March through September 2020. Spatial regression analyses were fit at the census tract level. Model outcomes included testing and positivity rate. Covariates included rurality, percent Black population, food insecurity, and area deprivation index (a comprehensive indicator of socio-economic status). RESULTS Small clusters in coronavirus testing were detected sporadically, while test positivity clustered in mid-eastern and southwestern WV. In regression analyses, percent food insecurity (IRR = 3.69*109, (796, 1.92*1016)), rurality (IRR=1.28, (1.12, 1.48)), and percent population Black (IRR = 0.88, (0.84, 0.94)) had substantial effects on coronavirus testing. However, only percent food insecurity (IRR = 5.98 * 104, (3.59, 1.07*109)) and percent Black population (IRR = 0.94, (0.90, 0.97)) displayed substantial effects on the test positivity rate. CONCLUSIONS Findings highlight disparities in coronavirus testing among communities with rural minorities. Limited testing in these communities may misrepresent coronavirus incidence.