Racial, Ethnic, and Geographic Disparities in Novel Coronavirus (SARS-CoV-2) Test Positivity in North Carolina

Turner, Nicholas A; Pan, William; Martinez-Bianchi, Viviana S; Panayotti, Gabriela M Maradiaga; Planey, Arrianna M; Woods, Christopher W; Lantos, Paul M

BACKGROUND: Emerging evidence suggests that Black and Hispanic communities in the United States are disproportionately affected by coronavirus disease 2019 (COVID-19). A complex interplay of socioeconomic and healthcare disparities likely contribute to disproportionate COVID-19 risk METHODS: We conducted a geospatial analysis to determine whether individual and neighborhood level attributes predict local odds of testing positive for SARS-CoV-2. We analyzed 29,138 SARS-CoV-2 tests within the 6 -county catchment area for Duke University Health System from March to June 2020. We used generalized additive models to analyze the spatial distribution of SARS-CoV-2 positivity. Adjusted models included individual-level age, gender, and race, as well as neighborhood level ADI, population density, demographic composition, and household size RESULTS: Our dataset included 27,099 negative and 2,039 positive unique SARS-CoV-2 tests. The odds of a positive SARS-CoV-2 test were higher for males (OR 1.43, 95% CI 1.30-1.58), Blacks (OR 1.47, 95% CI 1.27-1.70), and Hispanics (OR 4.25, 955 CI 3.55-5.12). Among neighborhood-level predictors, percent Black population (OR 1.14, 95% CI 1.05-1.25) and percent Hispanic population (OR 1.23, 95% CI 1.07-1.41) also influenced the odds of a positive SARS-CoV-2 test. Population density, average household size, and area deprivation index were not associated with SARS-CoV-2 test results after adjusting for race CONCLUSIONS: The odds of testing positive for SARS-CoV-2 were higher for both Black and Hispanic individuals, as well as within neighborhoods with a higher proportion of Black or Hispanic residents – confirming that Black and Hispanic communities are disproportionately affected by SARS-CoV-2