Veterans of Color Are More Likely to be Tested for COVID-19 at VA than White Veterans and are More Likely to Test Positive
People of color have an increased risk of COVID-19 infection related to the adverse social determinants of health (SDH) they face, such as living in areas with high-density housing and high poverty rates. Although financial barriers to care are lower at VA, Veterans are not immune to the negative impact of SDH that they face outside the VA healthcare system. This retrospective cohort analysis evaluated the characteristics associated with obtaining a COVID-19 test within the VA healthcare system – and receiving a positive test result from February 8 through December 28, 2020. Using VA data, investigators identified 6,292,800 actively enrolled Veterans and examined the likelihood of obtaining a COVID-19 test and the risk of receiving a positive test result by patient demographics, while controlling for patient comorbidities, VA facility characteristics (i.e., patient population ethnicities, urban or rural setting), and county-level social determinants of health. Of the 6,292,800 Veterans assessed, 822,934 (13%) were tested for COVID-19, and 82,094 (10% of those tested) received a positive test.
- VA is testing a significantly higher proportion of traditionally disenfranchised patient groups for COVID-19 than other healthcare systems. However, Black and Hispanic/Latino Veterans have an increased risk of receiving a positive test result for COVID-19, despite receiving more tests than White and non-Hispanic/Latino Veterans.
- Overall, Veterans who were female, Black/African American, Hispanic/Latino, lived in urban settings, had a low income, or had a disability had an increased likelihood of obtaining a COVID-19 test, while Veterans who were Asian had a decreased likelihood.
- Compared with Veterans who were White, Veterans who were Black/African American were 23% more likely and Native Hawaiian/Other Pacific Islander 13% more likely to receive a positive test result. Hispanic/Latino Veterans had a 43% higher risk of receiving a positive test result than non-Hispanic/Latino Veterans.
- Veterans with disabilities or who were low-income were more likely to obtain a COVID-19 test but had a lower risk of receiving a positive test.
- Although disparities are significantly smaller at VA, the test positivity differences suggest that Veterans are not immune to the negative external effects of SDH. Results suggest that other factors (e.g., external social inequities) are driving disparities in COVID-19 prevalence.
- This study only evaluated COVID-19 tests performed at VA, thus results may not be representative of Veterans who received a test elsewhere.
Drs. Ferguson and Abdel Magid are part of the Big Data Scientist Training Enhancement Program (BD-STEP) and HSR&D’s Center for Innovation to Implementation (Ci2i) in Palo Alto, CA. All authors except Dr. Purnell are part of the VA Palo Alto Health Care System. Dr. Purnell is with the VA St. Louis Healthcare System.
Ferguson J, Abdel Magid H, Purnell A, Kiang M, and Osborne T. Differences in COVID-19 Testing and Test Positivity among Veterans, United States, 2020. Public Health Reports. April 7, 2021; online ahead of print.