@article{fdi:010088052,
  title = {{S}ocial deprivation and {SARS}-{C}o{V}-2 testing : a population-based analysis in a highly contrasted southern {F}rance region},
  author = {{L}andier, {J}ordi and {B}assez, {L}. and {B}endiane, {M}. {K}. and {C}haud, {P}. and {F}ranke, {F}. and {N}auleau, {S}. and {D}anjou, {F}. and {M}alfait, {P}. and {R}ebaudet, {S}. and {G}audart, {J}.},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground{T}esting was the cornerstone of the {COVID}-19 epidemic response in most countries until vaccination became available for the general population. {S}ocial inequalities generally affect access to healthcare and health behaviors, and {COVID}-19 was rapidly shown to impact deprived population more drastically. {I}n support of the regional health agency in {P}rovence-{A}lpes-{C}ote d'{A}zur ({PACA}) in {S}outh-{E}astern {F}rance, we analyzed the relationship between testing rate and socio-demographic characteristics of the population, to identify gaps in testing coverage and improve targeting of response strategies. {M}ethods{W}e conducted an ecological analysis of {SARS}-{C}o{V}-2/{COVID}-19 testing rate in the {PACA} region, based on data aggregated at the finest spatial resolution available in {F}rance ({IRIS}) and by periods defined by public health implemented measures and major epidemiological changes. {U}sing general census data, population density, and specific deprivation indices, we used principal component analysis followed by hierarchical clustering to define profiles describing local socio-demographic characteristics. {W}e analyzed the association between these profiles and testing rates in a generalized additive multilevel model, adjusting for access to healthcare, presence of a retirement home, and the age profile of the population. {R}esults{W}e identified 6 socio-demographic profiles across the 2,306 analyzed {IRIS} spatial units: privileged, remote, intermediate, downtown, deprived, and very deprived (ordered by increasing social deprivation index). {P}rofiles also ranged from rural (remote) to high density urban areas (downtown, very deprived). {F}rom {J}uly 2020 to {D}ecember 2021, we analyzed {SARS}-{C}o{V}-2/{COVID}-19 testing rate over 10 periods. {T}esting rates fluctuated strongly but were highest in privileged and downtown areas, and lowest in very deprived ones. {T}he lowest adjusted testing rate ratios (a{TRR}) between privileged (reference) and other profiles occurred after implementation of a mandatory healthpass for many leisure activities in {J}uly 2021. {P}eriods of contextual testing near {C}hristmas displayed the largest a{TRR}, especially during the last periods of 2021 after the end of free convenience testing for unvaccinated individuals. {C}onclusion{W}e characterized in-depth local heterogeneity and temporal trends in testing rates and identified areas and circumstances associated with low testing rates, which the regional health agency targeted specifically for the deployment of health mediation activities.},
  keywords = {testing ; access to health care ; deprivation ; {COVID}-19 ; geoepidemiology ; {F}rance ; population-based ; {FRANCE}},
  booktitle = {},
  journal = {{F}rontiers in {P}ublic {H}ealth},
  volume = {11},
  numero = {},
  pages = {1162711 [11 p.]},
  year = {2023},
  DOI = {10.3389/fpubh.2023.1162711},
  URL = {https://www.documentation.ird.fr/hor/fdi:010088052},
}