ArticleBMC public health2025
SARS-CoV-2 testing behavior in symptomatic adults in a U.S. national cohort, 2020-2023: influence of exposure risk, susceptibility and healthcare access.
Article in BMC public health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundCOVID-19 continues to circulate and cause illness, hospitalizations and death in the U.S, underscoring the importance of understanding SARS-CoV-2 testing behavior among symptomatic adults. Yet few studies have evaluated testing frequency in this population. We examined SARS-CoV-2 testing patterns, including at-home and laboratory tests, among adults with COVID-like symptoms from 2020 to 2023, and assessed the influence of exposure risk, susceptibility to COVID-19 complications, and barriers to healthcare access on frequency of testing when ill.
methodsThe CHASING COVID Cohort study comprises a diverse sample of U.S. adults, with data collected quarterly from March 2020 to December 2023. We categorized participants with COVID-like symptoms as 'frequent testers' if they tested ≥ 66% of the time when symptomatic, 'occasional testers' if they tested > 33% and < 66% of the time, and 'infrequent testers' if they tested ≤ 33% of the time. Informed by the Blumenshine Pandemic Disease Framework, we examined the impact of SARS-CoV-2 exposure risk, susceptibility to COVID-19 complications if infected, and barriers to healthcare access on testing frequency using crude and adjusted log-binomial regression models.
resultsA total of 3929 participants reported symptoms of COVID-like illness in at least two assessments. A quarter (25%) of participants were frequent testers, 47% were occasional testers, and 29% were infrequent testers. One-third (30%) had greater risk of SARS-CoV-2 exposure, 51% were susceptible to COVID-19 complications, 24% were uninsured, and 34% had no regular provider of care. Testing frequency was positively correlated with household income, educational attainment, COVID-19 vaccination, willingness to take antivirals, trust in public health agencies and healthcare providers for COVID-19 vaccine information. Those with more (versus less) exposure risk (aRR 1.14, 95% CI [1.01, 1.26]), COVID-19 susceptibility (aRR 1.17, 95% CI [1.05, 1.30]), no insurance (aRR 1.52, 95% CI [1.37, 1.70]), and no regular healthcare provider (aRR 1.32, 95% CI [1.19, 1.46]) were more likely to test infrequently.
conclusionsIndividuals with the greatest risk of SARS-CoV-2 exposure, susceptibility to COVID-19 complications, and barriers to healthcare access were the least likely to test when ill. Public health initiatives should prioritize improving testing uptake among these populations.
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