Viral and antibody testing for coronavirus disease 2019 (covid-19): factors associated with positivity in electronic health records from the united states

Background. Insufficient information on SARS-CoV-2 testing results exists in clinical practice from the United States. Methods. We conducted an observational retrospective cohort study using Optum(R) de-identified COVID-19 electronic health records from the United States to characterize patients who received a SARS-CoV-2 viral or antibody test between February 20, 2020 and July 10, 2020. We assessed temporal trends in testing and positivity by demographic and clinical characteristics; evaluated concordance between viral and antibody tests; and identified factors associated with positivity via multivariable logistic regression. Results. Our study population included 891,754 patients. Overall positivity rate for SARS-CoV-2 was 9% and 12% for viral and antibody tests, respectively. Positivity rate was inversely associated with the number of individuals tested and decreased over time across regions and race/ethnicities. Among patients who received a viral test followed by an antibody test, concordance ranged from 90%-93% depending on the duration between the two tests which is notable given uncertainties related to specific viral and antibody test characteristics. The following factors increased the odds of viral and antibody positivity in multivariable models: male, Hispanic or non-Hispanic Black and Asian, uninsured or Medicaid insurance, Northeast residence, dementia, diabetes, and obesity. Charlson Comorbidity Index was negatively associated with test positivity. We identified symptoms that were positively associated with test positivity, as well as, commonly co-occurring symptoms / conditions. Pediatric patients had reduced odds of a positive viral test, but conversely had increased odds of a positive antibody test. Conclusions. This study identified sociodemographic and clinical factors associated with SARS-CoV-2 testing and positivity within routine clinical practice from the United States.