COVID-19 Testing Rates are Lower in States with More Black and Poor Residents

Shannon M. Monnat and Kent Jason G. Cheng
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COVID-19 testing is essential to help reduce spread, strategically deliver treatment resources, and devise appropriate policy responses. There is already evidence that U.S. states with more confirmed infections (which can only be determined with testing) are more likely than their peer states with fewer confirmed cases to enact physical distancing protocols, thereby dramatically reducing travel and other mechanisms for virus spread. Resource constraints and different reactions by state governors have resulted in widespread testing variation across states.

To be clear, testing rates have been too low in all states, owing in large part to the delayed federal government response to the outbreak. However, of special concern is that testing rates to date have been lower in states with higher percent black populations and higher poverty rates (see Figures below). For example, whereas the average COVID-19 testing rate in states with the lowest percent black populations (bottom 25th percentile of percent black) is 403.5 per 100,000 population, the average rate among states with the highest percent black populations (top 25th percentile) is only 206.4 per 100,000 population. Rates are also lowest in states with the highest poverty rates. Testing disparities have implications for disparities in COVID-19 outcomes. Without proper testing and physical distancing protocols, these states risk a surge in severe COVID-19 cases, overwhelming their already resource strapped healthcare systems. Ultimately, lower testing rates in states with larger racial/ethnic minority and poor populations will exacerbate already high and rising geographic disparities in health and mortality.

Figure 1: COVID-19 Testing Rates by State % non-Hispanic Black and % Poverty; Figure 2: Average COVID-19 Testing Rates by State Quartiles of % non-Hispanic Black and % Poverty
Data Sources: Testing data are current as of 03/30/20 and are from the COVID Tracking Project ( Poverty and racial composition data are from the U.S. Census Bureau Annual Population Estimates. Notes: The categories in the X-axis for Figure 2 represent quartiles. Error bars in Figure 2 represent 95% confidence intervals.

About the Authors
Shannon Monnat is the Lerner Chair for Public Health Promotion, Associate Professor of Sociology, and Co-Director of the Policy, Place, and Population Health Lab in the Maxwell School of Citizenship and Public Affairs at Syracuse University ( Kent Jason G. Cheng is a PhD Social Science Student at the Maxwell School of Citizenship and Public Affairs, Syracuse University (

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