Sociodemographic characteristics and COVID-19 testing rates: spatiotemporal patterns and impact of test accessibility in Sweden

  1. Beatrice Kennedy
  2. Georgios Varotsis
  3. Ulf Hammar
  4. Diem Nguyen
  5. Germán D Carrasquilla
  6. Vera van Zoest
  7. Robert S Kristiansson
  8. Hugo Fitipaldi
  9. Koen F Dekkers
  10. Meena Daivadanam
  11. Mats Martinell
  12. Jonas Björk
  13. Tove Fall

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Abstract

Background

Diagnostic testing is essential for disease surveillance and test–trace–isolate efforts. We aimed to investigate if residential area sociodemographic characteristics and test accessibility were associated with Coronavirus Disease 2019 (COVID-19) testing rates.

Methods

We included 426 224 patient-initiated COVID-19 polymerase chain reaction tests from Uppsala County in Sweden from 24 June 2020 to 9 February 2022. Using Poisson regression analyses, we investigated if postal code area Care Need Index (CNI; median 1.0, IQR 0.8–1.4), a composite measure of sociodemographic factors used in Sweden to allocate primary healthcare resources, was associated with COVID-19 daily testing rates after adjustments for community transmission. We assessed if the distance to testing station influenced testing, and performed a difference-in-difference-analysis of a new testing station targeting a disadvantaged neighbourhood.

Results

We observed that CNI, i.e. primary healthcare need, was negatively associated with COVID-19 testing rates in inhabitants 5–69 years. More pronounced differences were noted across younger age groups and in Uppsala City, with test rate ratios in children (5–14 years) ranging from 0.56 (95% CI 0.47–0.67) to 0.87 (95% CI 0.80–0.93) across three pandemic waves. Longer distance to the nearest testing station was linked to lower testing rates, e.g. every additional 10 km was associated with a 10–18% decrease in inhabitants 15–29 years in Uppsala County. The opening of the targeted testing station was associated with increased testing, including twice as high testing rates in individuals aged 70–105, supporting an intervention effect.

Conclusions

Ensuring accessible testing across all residential areas constitutes a promising tool to decrease inequalities in testing.

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  1. Version published to 10.1093/eurpub/ckad209
  2. Version published to 10.1101/2020.12.15.20248247v2 on medRxiv
  3. ScreenIT

    SciScore for 10.1101/2020.12.15.20248247: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: The study was approved by the Ethical Review Board in Sweden (DNR 2020-04210).
    Consent: Informed consent was not obtained from individuals tested for COVID-19 since only information on aggregate group level was extracted.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableSocioeconomic and demographic variables: We extracted information on demographic and socioeconomic variables, on an aggregate level per postal code area, from Statistics Sweden, including adult population size (≥18 years), mean age (years), sex distribution (% female inhabitants), highest achieved education level in the population aged 25-64 years (categorized as compulsory/primary education only, secondary education, or university education), proportion engaged in work or studies in a population aged 20-64 years (categorized as occupied with work and/or studies, or not occupied with work nor studies), median yearly net income for the population aged ≥20 years (in 10,000 SEK), and proportion of population aged ≥18 years with foreign background (foreign background defined as born in a country other than Sweden, and/or born in Sweden but with both parents born in another country than Sweden).

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Strengths and limitations: Strengths of the study include the detailed data extracted from population and health registers on postal code area level demography, socioeconomic circumstances, and hospitalizations due to COVID-19. Since all tests in the region were administered by the Uppsala County Council, the study encompasses all tests from a defined geographical area. In addition, we could explore the potential impact of area characteristics within a Swedish county with a uniform centralized testing strategy, testing recommendations, and test booking procedures. Some potential limitations apply. First, the aggregate data study design limits the application of our findings to individuals. Second, all testing data originates from a single county in Sweden, and we cannot ascertain that our findings are generalizable to the other twenty counties in Sweden with different testing strategies, population compositions and geospatial structures. As an example, distance to the nearest test station may be even more influential for example in the eight northern counties in Sweden that occupy more than twice the geographical area of Uppsala County. Third, our results may not apply to other countries with test strategies encompassing home tests, antigen tests, and/or screening of asymptomatic individuals. Conclusion: We observed a large variability in COVID-19 testing rates across different postal code areas within a single county in Sweden. Community infection rates, as assessed by hospi...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

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  4. Version published to 10.1101/2020.12.15.20248247v1 on medRxiv