Disparities in COVID-19 Testing and Infection Across Language Groups

Quick Takes

  • Non-English-speaking patients were less likely to be tested for COVID-19 than English-speaking patients (4.7% vs. 5.6%), while test positivity was nearly five-fold greater in non-English-speaking patients than in English-speaking patients (18.6% vs. 4.0%).
  • These findings support the idea that access to care is limited in some immigrant groups at relatively high risk for COVID-19.

Study Questions:

How have severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing and test results differed between English-speaking and non-English-speaking patients?

Methods:

This cross-sectional study was conducted within the University of Washington Medicine system, which includes three hospitals and 300 clinics. All living patients with at least one encounter in the system between January 1, 2019 and February 28, 2020 comprised the study population. The proportion of patients undergoing SARS-CoV-2 nasopharyngeal swab testing from February 29 to May 31, 2020, as well as the proportion of positive tests, were assessed. Results were stratified based on preferred spoken language, as captured upon patient registration.

Results:

Overall, 30,925 of 562,242 patients (5.5%) underwent SARS-CoV-2 testing. The mean age of tested patients was 49 years, and 52.2% were women. Among tested patients, 1,869 (6.0%) were non-English-speaking. Non-English-speaking patients were less likely to be tested than English-speaking patients (4.7% vs. 5.6%). Test positivity was 4.6-fold greater in non-English-speaking patients than in English-speaking patients (18.6% vs. 4.0%).

Language groups with low proportions of patients tested included Arabic (2.8%), Mandarin/Cantonese (2.6%), and Somali (3.6%). For the Arabic- and Mandarin/Cantonese-speaking groups, test positivity was similar to that of the English-speaking group (3.1% and 6.1%, respectively), while Somali-speaking patients had higher test positivity (17.6%).

Three language groups had testing proportions similar to those of English-speaking patients, while their test positivity rate was higher: Spanish (5.7% tested, 25.1% positive), Tigrinya (an Ethiopic language, with 5.8% tested and 15.5% positive), and Vietnamese (5.8% tested, 17.6% positive).

The language group with the highest testing proportion was Tagalog (9.4%), and test positivity for this group was relatively high at 16.1%. Other groups with high test positivity included Amharic (an Ethiopic language, 23.3%) and Cambodian/Khmer (26.9%).

Conclusions:

As compared with English-speaking patients, a smaller proportion of non-English-speaking patients underwent SARS-CoV-2 testing, with a greater proportion of positive test results. Results varied considerably among language groups. These findings support the idea that access to care is limited in some immigrant groups at relatively high risk for coronavirus disease 2019 (COVID-19).

Perspective:

This study adds to the growing body of literature illustrating greater risk of COVID-19 infection in communities of color. As the authors comment, some of the variation in testing among language groups may have reflected the effects of local outreach efforts, including mobile clinics and drive-up testing. Although the overall population was large, some language groups contained fairly small numbers of patients, and patients who had not sought care prior to SARS-CoV-2 testing were not included in the analysis, limiting generalizability of the results. Further work is needed to establish the most effective means of eliminating disparities in testing.

Clinical Topics: Prevention

Keywords: Coronavirus, COVID-19, Diagnostic Tests, Routine, Emigrants and Immigrants, Health Services Accessibility, Language, Minority Health, Mobile Health Units, Primary Prevention, Public Health, severe acute respiratory syndrome coronavirus 2


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