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Using Lorenz Curves to Measure Racial Inequities in COVID-19 Testing

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME

Racial disparities have been widely documented during the coronavirus disease 2019 (COVID-19) pandemic, but there has been limited focus on equitable allocation of the pandemic’s most critical but limited resource: COVID-19 testing. Equitable testing is paramount to a successful COVID-19 response and is essential for early case detection, self-isolation, and overall prevention of onward transmission.13 We adapted a well-established tool for measuring inequity from economics—the Lorenz curve4—to put forth a metric for quantifying COVID-19 related inequities.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: November 16, 2020.

Published: January 8, 2021. doi:10.1001/jamanetworkopen.2020.32696

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Mody A et al. JAMA Network Open.

Corresponding Author: Aaloke Mody, MD, Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine in St Louis, 4523 Clayton Ave, Campus Box 8051, St Louis, MO 63110 (aaloke.mody@wustl.edu).

Author Contributions: Drs Mody and Geng had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Mody, Geng.

Acquisition, analysis, or interpretation of data: Mody, Pfeifauf.

Drafting of the manuscript: All authors.

Critical revision of the manuscript for important intellectual content: Mody, Pfeifauf.

Statistical analysis: Mody.

Administrative, technical, or material support: Mody.

Supervision: Geng.

Conflict of Interest Disclosures: None reported.

Funding/Support: This project has been funded in part by the State of Missouri under a contract awarded to Washington University. This work was also supported by the National Center for Advancing Translational Sciences (grant KL2 TR002346 to Dr Mody) and the National Institute of Allergy and Infectious Diseases (grant K24 AI134413 to Dr Geng).

Role of the Funder/Sponsor: The funders 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.

Disclaimer: The contents do not necessarily reflect the reviews and policies of the State of Missouri, nor does mention of trade names or commercial products constitute endorsement of recommendation for use.

Additional Contributions: We thank the Institute for Informatics (I2) at Washington University in St Louis for assistance with data extraction from the electronic health records.

Additional Information: Testing data were collected and managed by the State of Missouri, and deidentified data were shared with authors via a data use agreement.

References
1.
Huerto  R , Goold  SD , Newton  D . Targeted coronavirus testing is essential for health equity. Health Affairs. Published June 15, 2020. Accessed December 9, 2020. https://www.healthaffairs.org/do/10.1377/hblog20200611.868893/full/
2.
Wen  LS , Sadeghi  NB . Addressing racial health disparities in the COVID-19 pandemic: immediate and long-term policy solutions. Health Affairs. Published July 20, 2020. Accessed December 9, 2020. https://www.healthaffairs.org/do/10.1377/hblog20200716.620294/full/
3.
Lieberman-Cribbin  W , Tuminello  S , Flores  RM , Taioli  E .  Disparities in COVID-19 testing and positivity in New York City.   Am J Prev Med. 2020;59(3):326-332. doi:10.1016/j.amepre.2020.06.005PubMedGoogle ScholarCrossref
4.
Lorenz  MO .  Methods of measuring the concentration of wealth.   Pub Am Stat Assoc. 1905;9(70):209-219. doi:10.2307/2276207Google Scholar
5.
Webb Hooper  M , Nápoles  AM , Pérez-Stable  EJ .  COVID-19 and racial/ethnic disparities.   JAMA. 2020;323(24):2466-2467. doi:10.1001/jama.2020.8598PubMedGoogle ScholarCrossref
6.
Kakani  P , Chandra  A , Mullainathan  S , Obermeyer  Z .  Allocation of COVID-19 relief funding to disproportionately Black counties.   JAMA. 2020;324(10):1000-1003. doi:10.1001/jama.2020.14978PubMedGoogle ScholarCrossref
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