Disparities in COVID-19 Testing and Infection Among Beneficiaries in the Military Health System During the First Year of the Pandemic

TL;DR

This study found racial, gender, and rank-based disparities in COVID-19 testing and infection rates among U.S. Military Health System beneficiaries, despite universal healthcare coverage.

Contribution

The study reveals disparities in testing and infection within a universally insured system, highlighting inequities not solely tied to access to care.

Findings

Women were more likely to be tested but less likely to test positive for COVID-19.

Black and Asian/Pacific Islander beneficiaries were more likely to be tested, and Black beneficiaries were more likely to test positive.

Junior Enlisted members were less likely to be tested, while Junior Officers were more likely to be tested than Senior Enlisted members.

Abstract

Although disparities in access to COVID-19 testing and infection rates were identified in civilian literature, it is unclear whether the universally-insured U.S. Military Health System (MHS) experienced similar inequities. We examined whether there were disparities by race, sex, and rank within the MHS’ direct care sector during the early pandemic period.

Retrospective study of adult TRICARE beneficiaries from March 1, 2020 to February 28, 2021. Likelihood of COVID-19 testing and infection, among eligible beneficiaries, for each exposure variable was assessed using logistic regression.

697,769 beneficiaries received COVID-19 testing during the study period with 56,037 testing positive. Women were more likely to be tested than men (OR: 1.23, 95% CI: 1.21–1.24), but less likely to test positive (OR: 0.87, 95% CI: 0.85–0.89). Compared to White beneficiaries, Black and Asian/Pacific Islander beneficiaries were more likely to be tested (OR: 1.07, 95% CI: 1.07–1.08; OR: 1.23, 95% CI: 1.21–1.24). Black beneficiaries were more likely to test positive (OR: 1.10, 95% CI: 1.07–1.13). Junior Enlisted members were less likely, while Junior Officers were more likely to be tested than Senior Enlisted members (OR: 0.73, 95% CI: 0.73–0.74; OR: 1.20, 95% CI: 1.18–1.21). Junior and Senior officers were less likely to test positive (OR: 0.92, 95% CI: 0.89–0.95; OR: 0.70, 95% CI: 0.67–0.74).

Despite universal healthcare coverage, disparities in COVID-19 testing and infection rates by race, sex, and sponsor rank were identified within the MHS. Further research of underlying factors of observed disparities and targeted outreach are necessary for equitable care.

The online version contains supplementary material available at 10.1007/s40615-025-02315-x.

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