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

PLoS One. 2023 Aug 23;18(8):e0289292. doi: 10.1371/journal.pone.0289292. eCollection 2023.

Authors

Lilia Antonova^{1

2}, Chandy Somayaji³, Jillian Cameron³, Monica Sirski⁴, Maria E Sundaram^{5

6}, James Ted McDonald⁷, Sharmistha Mishra^{6

8

9}, Jeffrey C Kwong^{6

10

11

12

13}, Alan Katz^{4

14}, Stefan Baral¹⁵, Lisa Caulley^{1

2

16}, Andrew Calzavara⁶, Martin Corsten¹⁷, Stephanie Johnson-Obaseki^{1

2}

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, ON, Canada.
² Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
³ New Brunswick Institute for Research, Data, and Training, University of New Brunswick, Fredericton, NB, Canada.
⁴ Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada.
⁵ Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, Marshfield, WI, United States of America.
⁶ ICES, Toronto, ON, Canada.
⁷ Department of Political Science, University of New Brunswick, Fredericton, NB, Canada.
⁸ Department of Medicine, University of Toronto, Toronto, ON, Canada.
⁹ MAP Center for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
¹⁰ Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
¹¹ Public Health Ontario, Toronto, Ontario, Canada.
¹² Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
¹³ University Health Network, Toronto, ON, Canada.
¹⁴ Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
¹⁵ Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, MD, United States of America.
¹⁶ Department of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands.
¹⁷ Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, NS, Canada.

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.

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.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

COVID-19 Testing*
COVID-19* / diagnosis
COVID-19* / epidemiology
Cross-Sectional Studies
Female
Humans
Income
Ontario / epidemiology
Pandemics
SARS-CoV-2

Grants and funding

This work was supported by Public Health Ontario. This study was also supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health (MOH) and the Ministry of Long-Term Care (MLTC). This document used data adapted from the Statistics Canada Postal CodeOM Conversion File, which is based on data licensed from Canada Post Corporation, and/or data adapted from the Ontario Ministry of Health Postal Code Conversion File, which contains data copied under license from ©Canada Post Corporation and Statistics Canada. This study was supported by the Ontario Health Data Platform (OHDP), a Province of Ontario initiative to support Ontario’s ongoing response to COVID-19 and its related impacts. The analyses for Ontario and Manitoba were supported by the Canadian Institutes of Health Research (VR5-172683). This work was supported by the Department of Health and Vitalité Health Network of the Province of New Brunswick under a contract with the New Brunswick Institute for Research, Data and Training at the University of New Brunswick. The results and conclusions are those of the authors and no official endorsement by the Government of New Brunswick or Vitalité Health Network was intended or should be inferred. The study sponsors did not participate in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; or the decision to submit the manuscript for publication. Parts of this material are based on data and/or information compiled and provided by the Canadian Institute for Health Information (CIHI) and by Ontario Health (OH). However, the analyses, conclusions, opinions and statements expressed herein are solely those of the authors, and do not reflect those of the funding or data sources; no endorsement by ICES, MOH, MLTC, OHDP, its partners, the Province of Ontario, CIHI or OH is intended or should be inferred. J.C.K. is supported by a Clinician-Scientist Award from the University of Toronto Department of Family and Community Medicine. SM is supported by a Tier 2 Canada Research Chair in Mathematical Modeling and Program Science. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.