Determinants of differences in RT-PCR testing rates among Southeast Asian countries during the first six months of the COVID-19 pandemic

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PLOS Global Public Health


A positive correlation has been demonstrated between gross domestic product (GDP) per capita and COVID-19 tests per 1000 people. Although frequently used as an indicator of economic performance, GDP per capita does not directly reflect income distribution inequalities and imposed health costs. In this longitudinal ecological study, we aimed to determine if, besides GDP per capita, indicators relating to governance, public health measures enforcement, and health and research investment explain differences in RT-PCR testing rates among countries in Southeast Asia (SEA) during the first six months of the COVID-19 pandemic. Using open-access COVID-19 panel data, we estimated the effect of various indicators (GDP per capita, health expenditure per capita, number of researchers per one million population, corruption perceptions index, stringency index, regional authority index) on daily COVID-19 testing by performing fixed-effects negative binomial regression. After accounting for all indicators, the number of daily confirmed COVID-19 cases, and population density, the model provided a 2019 GDP per capita coefficient of 0.0046330 (95% CI: 0.0040171, 0.0052488; p <0.001), indicating that a rise in 2019 GDP per capita by 100 international dollars is associated with a 46.33% increase in the number of daily tests performed. Additionally, all indicators were significantly associated with the daily number of RT-PCR testing on multivariable analysis. In conclusion, we identified different country-level indicators significantly associated with differences in COVID-19 testing rates among SEA countries. Due to the study’s ecological design, we caution on applying our results to the individual level given potential for systematic differences between the included countries. Additional investigation is likewise needed to understand how government expenditure on healthcare may have impacted COVID-19 testing capacity during the initial stages of the pandemic.