Publication date: Sep 22, 2023
To assess the distribution and clustering of COVID-19 testing and incidence over space and time, U. S. Department of Veteran’s Affairs (VA) data were used to describe where and when Veterans experienced highest proportions of test positivity. Data for 6,342,455 Veterans who utilized VA services between January 1, 2018 and September 30, 2021 were assessed for COVID-19 testing and test positivity. Testing and positivity proportions by county were mapped and focused-cluster tests identified significant clustering aroung VA facilities. Spatial cluster analysis also identified where and when Veterans experienced highest proportions of test positivity. Within the Veterans study population and our time window, 21. 3% received at least one COVID-19 test, and 20. 4% of those tested had at least one positive test. There was statistically significant clustering of testing around VA facilities, revealing regional variation in testing practices. Veterans experienced highest test positivity proportions between November 2020 and January 2021 in a cluster of states in the Midwest, compared to those who received testing outside of the identified cluster (RR: 3. 45). Findings reflect broad regional trends in COVID-19 positivity which can inform VA policy and resource allocation. Additional analysis is needed to understand patterns during Delta and Omicron variant periods.