Comparison of socio-economic determinants of COVID-19 testing and positivity in Canada: A multi-provincial analysis

Lilia Antonova; Chandy Somayaji; Jillian Cameron; Monica Sirski; Maria E. Sundaram; James Ted McDonald; Sharmistha Mishra; Jeffrey C. Kwong; Alan Katz; Stefan Baral; Lisa Caulley; Andrew Calzavara; Martin Corsten; Stephanie Johnson-Obaseki

doi:10.1371/journal.pone.0289292

Comparison of socio-economic determinants of COVID-19 testing and positivity in Canada: A multi-provincial analysis

Lilia Antonova
, Chandy Somayaji
, Jillian Cameron
, Monica Sirski
, Maria E. Sundaram
, James Ted McDonald
, Sharmistha Mishra
, Jeffrey C. Kwong
, Alan Katz
, Stefan Baral
, Lisa Caulley
, Andrew Calzavara
, Martin Corsten
, Stephanie Johnson-Obaseki

Epidemiology

University of Ottawa
Ottawa Hospital Research Institute
University of New Brunswick
University of Manitoba
Marshfield Clinic
Institute for Clinical Evaluative Sciences
University of Toronto
Public Health Ontario
University Health Network
Johns Hopkins Bloomberg School of Public Health
Dalhousie University

Research output: Contribution to journal › Article › Academic › peer-review

6 Citations (Scopus)

39 Downloads (Pure)

Abstract

BACKGROUND:

The effects of the COVID-19 pandemic have been more pronounced for socially disadvantaged populations. We sought to determine how access to SARS-CoV-2 testing and the likelihood of testing positive for COVID-19 were associated with demographic factors, socioeconomic status (SES) and social determinants of health (SDH) in three Canadian provinces.

METHODS:

An observational population-based cross-sectional study was conducted for the provinces of Ontario, Manitoba and New Brunswick between March 1, 2020 and April 27, 2021, using provincial health administrative data. After excluding residents of long-term care homes, those without current provincial health insurance and those who were tested for COVID-19 out of province, records from provincial healthcare administrative databases were reviewed for 16,900,661 healthcare users. Data was modelled separately for each province in accordance to a prespecified protocol and follow-up consultations among provincial statisticians and collaborators. We employed univariate and multivariate regression models to examine determinants of testing and test results.

RESULTS:

After adjustment for other variables, female sex and urban residency were positively associated with testing, while female sex was negatively associated with test positivity. In New Brunswick and Ontario, individuals living in higher income areas were more likely to be tested, whereas in Manitoba higher income was negatively associated with both testing and positivity. High ethnocultural composition was associated with lower testing rates. Both high ethnocultural composition and high situational vulnerability increased the odds of testing positive for SARS-CoV-2. DISCUSSION: We observed that multiple demographic, income and SDH factors were associated with SARS-CoV-2 testing and test positivity. Barriers to healthcare access identified in this study specifically relate to COVID-19 testing but may reflect broader inequities for certain at-risk groups.

Original language	English
Article number	e0289292
Journal	PLoS ONE
Volume	18
Issue number	8 August
DOIs	https://doi.org/10.1371/journal.pone.0289292
Publication status	Published - 23 Aug 2023

Bibliographical note

Publisher Copyright:
© 2023 Antonova et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

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Comparison of socio-economic determinants of COVID-19 testing and positivity in Canada A multi-provincial analysisFinal published version, 1.35 MBLicence: CC BY

Cite this

Antonova, L., Somayaji, C., Cameron, J., Sirski, M., Sundaram, M. E., McDonald, J. T., Mishra, S., Kwong, J. C., Katz, A., Baral, S., Caulley, L., Calzavara, A., Corsten, M., & Johnson-Obaseki, S. (2023). Comparison of socio-economic determinants of COVID-19 testing and positivity in Canada: A multi-provincial analysis. PLoS ONE, 18(8 August), Article e0289292. https://doi.org/10.1371/journal.pone.0289292

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title = "Comparison of socio-economic determinants of COVID-19 testing and positivity in Canada: A multi-provincial analysis",

abstract = "BACKGROUND: The effects of the COVID-19 pandemic have been more pronounced for socially disadvantaged populations. We sought to determine how access to SARS-CoV-2 testing and the likelihood of testing positive for COVID-19 were associated with demographic factors, socioeconomic status (SES) and social determinants of health (SDH) in three Canadian provinces. METHODS: An observational population-based cross-sectional study was conducted for the provinces of Ontario, Manitoba and New Brunswick between March 1, 2020 and April 27, 2021, using provincial health administrative data. After excluding residents of long-term care homes, those without current provincial health insurance and those who were tested for COVID-19 out of province, records from provincial healthcare administrative databases were reviewed for 16,900,661 healthcare users. Data was modelled separately for each province in accordance to a prespecified protocol and follow-up consultations among provincial statisticians and collaborators. We employed univariate and multivariate regression models to examine determinants of testing and test results. RESULTS: After adjustment for other variables, female sex and urban residency were positively associated with testing, while female sex was negatively associated with test positivity. In New Brunswick and Ontario, individuals living in higher income areas were more likely to be tested, whereas in Manitoba higher income was negatively associated with both testing and positivity. High ethnocultural composition was associated with lower testing rates. Both high ethnocultural composition and high situational vulnerability increased the odds of testing positive for SARS-CoV-2. DISCUSSION: We observed that multiple demographic, income and SDH factors were associated with SARS-CoV-2 testing and test positivity. Barriers to healthcare access identified in this study specifically relate to COVID-19 testing but may reflect broader inequities for certain at-risk groups.",

author = "Lilia Antonova and Chandy Somayaji and Jillian Cameron and Monica Sirski and Sundaram, \{Maria E.\} and McDonald, \{James Ted\} and Sharmistha Mishra and Kwong, \{Jeffrey C.\} and Alan Katz and Stefan Baral and Lisa Caulley and Andrew Calzavara and Martin Corsten and Stephanie Johnson-Obaseki",

note = "Publisher Copyright: {\textcopyright} 2023 Antonova et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.",

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Antonova, L, Somayaji, C, Cameron, J, Sirski, M, Sundaram, ME, McDonald, JT, Mishra, S, Kwong, JC, Katz, A, Baral, S, Caulley, L, Calzavara, A, Corsten, M & Johnson-Obaseki, S 2023, 'Comparison of socio-economic determinants of COVID-19 testing and positivity in Canada: A multi-provincial analysis', PLoS ONE, vol. 18, no. 8 August, e0289292. https://doi.org/10.1371/journal.pone.0289292

TY - JOUR

T1 - Comparison of socio-economic determinants of COVID-19 testing and positivity in Canada

T2 - A multi-provincial analysis

AU - Antonova, Lilia

AU - Somayaji, Chandy

AU - Cameron, Jillian

AU - Sirski, Monica

AU - Sundaram, Maria E.

AU - McDonald, James Ted

AU - Mishra, Sharmistha

AU - Kwong, Jeffrey C.

AU - Katz, Alan

AU - Baral, Stefan

AU - Caulley, Lisa

AU - Calzavara, Andrew

AU - Corsten, Martin

AU - Johnson-Obaseki, Stephanie

N1 - Publisher Copyright: © 2023 Antonova et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PY - 2023/8/23

Y1 - 2023/8/23

N2 - BACKGROUND: The effects of the COVID-19 pandemic have been more pronounced for socially disadvantaged populations. We sought to determine how access to SARS-CoV-2 testing and the likelihood of testing positive for COVID-19 were associated with demographic factors, socioeconomic status (SES) and social determinants of health (SDH) in three Canadian provinces. METHODS: An observational population-based cross-sectional study was conducted for the provinces of Ontario, Manitoba and New Brunswick between March 1, 2020 and April 27, 2021, using provincial health administrative data. After excluding residents of long-term care homes, those without current provincial health insurance and those who were tested for COVID-19 out of province, records from provincial healthcare administrative databases were reviewed for 16,900,661 healthcare users. Data was modelled separately for each province in accordance to a prespecified protocol and follow-up consultations among provincial statisticians and collaborators. We employed univariate and multivariate regression models to examine determinants of testing and test results. RESULTS: After adjustment for other variables, female sex and urban residency were positively associated with testing, while female sex was negatively associated with test positivity. In New Brunswick and Ontario, individuals living in higher income areas were more likely to be tested, whereas in Manitoba higher income was negatively associated with both testing and positivity. High ethnocultural composition was associated with lower testing rates. Both high ethnocultural composition and high situational vulnerability increased the odds of testing positive for SARS-CoV-2. DISCUSSION: We observed that multiple demographic, income and SDH factors were associated with SARS-CoV-2 testing and test positivity. Barriers to healthcare access identified in this study specifically relate to COVID-19 testing but may reflect broader inequities for certain at-risk groups.

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Comparison of socio-economic determinants of COVID-19 testing and positivity in Canada: A multi-provincial analysis

Abstract

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