LAUSR

INTRODUCTION: Rigorous SARS-CoV-2 testing is an important public health measure as it leads not only to early identification and prevention of transmission but also to optimization of emergency care and resource allocation Yet, the U S has experienced a significant burden of illness, with reports suggesting a disproportionate amount falling on racial/ethnic minorities METHODS: This is a serial cross-sectional analysis of population-based data from June 7 versus August 1 of eight racially/ethnically and geographically diverse states (AL, AZ, DE, IN, NV, OR, TN, TX) who offer publicly available county-level testing data Florida could not be reanalyzed because their testing data are no longer publicly available We analyzed the testing data and sociodemographic data sourced from the U S Census Bureau The outcome was the number of SARS-CoV-2 testing (PCR and/or serology) per 1,000 individuals at the county-level To identify factors associated with outcome, we fit a multivariable Poisson regression model including states, county-level death rate, mean household income, and proportion of major races/ ethnicities RESULTS: We examined data from 579 counties from the eight states The median rate of SARS-CoV-2 testing per 1,000 individuals differed widely, ranging from 66 in Texas to 177 in Delaware Both multivariable models from June and from August identified factors significantly associated with the rate of testing: state of county origin, county death rate per 1,000, % non-Hispanic white, and % Hispanic (all P<0 05) Comparing June versus August, changes in the model included a trend of increased testing per 1,000 for all eight states analyzed, a weakening effect for % non-Hispanic white and % Hispanic, and % non-Hispanic black no longer being significant CONCLUSIONS: When comparing the factors associated with testing in June versus August, all analyzed states trended towards increased testing per 1,000 whereas the effects of race/ethnicity have diminished Our findings should facilitate discussion on ways to further improve prevention and treatment strategies against this public health emergency