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Assessment of Disparities in COVID-19 Testing and Infection Across Language Groups in Seattle, Washington

Educational Objective
To understand the levels of disparities in COVID-19 testing and infection across language groups in Seattle, WA
1 Credit CME

Clinicians from New York, New York, have raised the alarm that the coronavirus disease 2019 (COVID-19) pandemic has taken a disproportionate toll on their local immigrant communities.1 Immigrants may be more susceptible to exposure because more of them work in essential industries or reside in larger multigenerational households.2 Limited English language proficiency (LEP) or low health literacy can present challenges to effective communication about disease transmission.3 Worries about stigma, deportation, or livelihood may supersede those of a health threat, however serious.4 It remains unclear whether these disparities have resulted in lower comparative access to testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a patient-initiated option in all but congregant settings, or in higher rates of infection among immigrants. To clarify this issue, we evaluated the proportion of patients who completed testing and the proportion of positive cases using language as a surrogate for immigrant status.

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Article Information

Accepted for Publication: August 7, 2020.

Published: September 24, 2020. doi:10.1001/jamanetworkopen.2020.21213

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Kim HN et al. JAMA Network Open.

Corresponding Authors: H. Nina Kim, MD, MSc, Department of Medicine, University of Washington School of Medicine, 325 Ninth Ave, PO Box 359930, Seattle, WA 98104 (hyangkim@uw.edu); Herbert C. Duber, MD, MPH, Department of Emergency Medicine, University of Washington, 325 Ninth Ave, PO Box 359930, Seattle, WA 98104 (hduber@uw.edu).

Author Contributions: Dr Kim had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Kim, Nkyekyer, Chew, Duber.

Acquisition, analysis, or interpretation of data: Kim, Lan, Neme, Pierre-Louis, Duber.

Drafting of the manuscript: Kim, Chew.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Kim, Lan.

Administrative, technical, or material support: Chew.

Supervision: Kim, Duber.

Conflict of Interest Disclosures: None reported.

Funding/Support: This work was made possible through the support of the University of Washington Division of Allergy and Infectious Diseases.

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

References
1.
Ross  J , Diaz  CM , Starrels  JL .  The disproportionate burden of COVID-19 for immigrants in the Bronx, New York.   JAMA Intern Med. 2020;180(8):1043-1044. doi:10.1001/jamainternmed.2020.2131PubMedGoogle ScholarCrossref
2.
Quinn  SC , Kumar  S , Freimuth  VS , Musa  D , Casteneda-Angarita  N , Kidwell  K .  Racial disparities in exposure, susceptibility, and access to health care in the US H1N1 influenza pandemic.   Am J Public Health. 2011;101(2):285-293. doi:10.2105/AJPH.2009.188029PubMedGoogle ScholarCrossref
3.
Lin  L , Savoia  E , Agboola  F , Viswanath  K .  What have we learned about communication inequalities during the H1N1 pandemic: a systematic review of the literature.   BMC Public Health. 2014;14(1):484. doi:10.1186/1471-2458-14-484PubMedGoogle ScholarCrossref
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Rodriguez  RM , Torres  JR , Sun  J ,  et al.  Declared impact of the US President’s statements and campaign statements on Latino populations’ perceptions of safety and emergency care access.   PLoS One. 2019;14(10):e0222837. doi:10.1371/journal.pone.0222837PubMedGoogle Scholar
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Nalla  AK , Casto  AM , Huang  MW ,  et al.  Comparative performance of SARS-CoV-2 detection assays using seven different primer-probe sets and one assay kit.   J Clin Microbiol. 2020;58(6):e00557-20. doi:10.1128/JCM.00557-20PubMedGoogle Scholar
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Green  AR , Nze  C .  Language-based inequity in health care: who is the “poor historian”?   AMA J Ethics. 2017;19(3):263-271. doi:10.1001/journalofethics.2017.19.3.medu1-1703PubMedGoogle ScholarCrossref
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