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Background <p>COVID-19 continues to circulate and cause illness, hospitalizations and death in the U.S, underscoring the importance of understanding SARS-CoV-2 testing behavior among symptomatic adults. Yet few studies have evaluated testing frequency in this population. We examined SARS-CoV-2 testing patterns, including at-home and laboratory tests, among adults with COVID-like symptoms from 2020 to 2023, and assessed the influence of exposure risk, susceptibility to COVID-19 complications, and barriers to healthcare access on frequency of testing when ill.</p> Methods <p>The CHASING COVID Cohort study comprises a diverse sample of U.S. adults, with data collected quarterly from March 2020 to December 2023. We categorized participants with COVID-like symptoms as ‘frequent testers’ if they tested ≥ 66% of the time when symptomatic, ‘occasional testers’ if they tested &gt; 33% and &lt; 66% of the time, and ‘infrequent testers’ if they tested ≤ 33% of the time. Informed by the Blumenshine Pandemic Disease Framework, we examined the impact of SARS-CoV-2 exposure risk, susceptibility to COVID-19 complications if infected, and barriers to healthcare access on testing frequency using crude and adjusted log-binomial regression models.</p> Results <p>A total of 3929 participants reported symptoms of COVID-like illness in at least two assessments. A quarter (25%) of participants were frequent testers, 47% were occasional testers, and 29% were infrequent testers. One-third (30%) had greater risk of SARS-CoV-2 exposure, 51% were susceptible to COVID-19 complications, 24% were uninsured, and 34% had no regular provider of care. Testing frequency was positively correlated with household income, educational attainment, COVID-19 vaccination, willingness to take antivirals, trust in public health agencies and healthcare providers for COVID-19 vaccine information. Those with more (versus less) exposure risk (aRR 1.14, 95% CI [1.01, 1.26]), COVID-19 susceptibility (aRR 1.17, 95% CI [1.05, 1.30]), no insurance (aRR 1.52, 95% CI [1.37, 1.70]), and no regular healthcare provider (aRR 1.32, 95% CI [1.19, 1.46]) were more likely to test infrequently.</p> Conclusions <p>Individuals with the greatest risk of SARS-CoV-2 exposure, susceptibility to COVID-19 complications, and barriers to healthcare access were the least likely to test when ill. Public health initiatives should prioritize improving testing uptake among these populations.</p>

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SARS-CoV-2 testing behavior in symptomatic adults in a U.S. national cohort, 2020–2023: influence of exposure risk, susceptibility and healthcare access

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月8日

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  • Jenna Sanborn,
  • Saba Qasmieh,
  • Kate Penrose,
  • Angela Parcesepe,
  • Yanhan Shen,
  • Rachael Piltch-Loeb,
  • Josefina Nuñez,
  • Denis Nash,
  • McKaylee Robertson

摘要

Background

COVID-19 continues to circulate and cause illness, hospitalizations and death in the U.S, underscoring the importance of understanding SARS-CoV-2 testing behavior among symptomatic adults. Yet few studies have evaluated testing frequency in this population. We examined SARS-CoV-2 testing patterns, including at-home and laboratory tests, among adults with COVID-like symptoms from 2020 to 2023, and assessed the influence of exposure risk, susceptibility to COVID-19 complications, and barriers to healthcare access on frequency of testing when ill.

Methods

The CHASING COVID Cohort study comprises a diverse sample of U.S. adults, with data collected quarterly from March 2020 to December 2023. We categorized participants with COVID-like symptoms as ‘frequent testers’ if they tested ≥ 66% of the time when symptomatic, ‘occasional testers’ if they tested > 33% and < 66% of the time, and ‘infrequent testers’ if they tested ≤ 33% of the time. Informed by the Blumenshine Pandemic Disease Framework, we examined the impact of SARS-CoV-2 exposure risk, susceptibility to COVID-19 complications if infected, and barriers to healthcare access on testing frequency using crude and adjusted log-binomial regression models.

Results

A total of 3929 participants reported symptoms of COVID-like illness in at least two assessments. A quarter (25%) of participants were frequent testers, 47% were occasional testers, and 29% were infrequent testers. One-third (30%) had greater risk of SARS-CoV-2 exposure, 51% were susceptible to COVID-19 complications, 24% were uninsured, and 34% had no regular provider of care. Testing frequency was positively correlated with household income, educational attainment, COVID-19 vaccination, willingness to take antivirals, trust in public health agencies and healthcare providers for COVID-19 vaccine information. Those with more (versus less) exposure risk (aRR 1.14, 95% CI [1.01, 1.26]), COVID-19 susceptibility (aRR 1.17, 95% CI [1.05, 1.30]), no insurance (aRR 1.52, 95% CI [1.37, 1.70]), and no regular healthcare provider (aRR 1.32, 95% CI [1.19, 1.46]) were more likely to test infrequently.

Conclusions

Individuals with the greatest risk of SARS-CoV-2 exposure, susceptibility to COVID-19 complications, and barriers to healthcare access were the least likely to test when ill. Public health initiatives should prioritize improving testing uptake among these populations.