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Lopez, Cesar A.; Cunningham, Clark H.; Pugh, Sierra; Brandt, Katerina; Vanna, Usaphea P.; Delacruz, Matthew J.; Guerra, Quique; Goldstein, Samuel Jacob; Hou, Yixuan Jacob; & Gearhart, Margaret, et al. (Preprint). Disparities in Sars-Cov-2 Seroprevalence among Individuals Presenting for Care in Central North Carolina 2 over a Six-Month Period. medRxiv. PMCID: PMC8010775


Robust community-level SARS-CoV-2 prevalence estimates have been difficult to obtain in the American South and outside of major metropolitan areas. Furthermore, though some previous studies have investigated the association of demographic factors such as race with SARS-CoV-2 exposure risk, fewer have correlated exposure risk to surrogates for socioeconomic status such as health insurance coverage. We used a highly specific serological assay utilizing the receptor binding domain of the SARS-CoV-2 spike-protein to identify SARS-CoV-2 antibodies in remnant blood samples collected by the University of North Carolina Health system. We estimated the prevalence of SARS-CoV-2 in this cohort with Bayesian regression, as well as the association of critical demographic factors with higher prevalence odds. Between April 21st and October 3rd of 2020, a total of 9,624 unique samples were collected from clinical sites in central NC and we observed a seroprevalence increase from 2.9 (1.7, 4.3) to 9.1 (7.2, 11.1) over the study period. Individuals who identified as Latinx were associated with the highest odds ratio of SARS-CoV-2 exposure at 7.77 overall (5.20, 12.10). Increased odds were also observed among Black individuals and individuals without public or private health insurance. Our data suggests that for this care-accessing cohort, SARS-CoV-2 seroprevalence was significantly higher than cumulative total cases reported for the study geographical area six months into the COVID-19 pandemic in North Carolina. The increased odds of seropositivity by ethnoracial grouping as well as health insurance highlights the urgent and ongoing need to address underlying health and social disparities in these populations.


Reference Type

Journal Article

Year Published


Journal Title



Lopez, Cesar A.
Cunningham, Clark H.
Pugh, Sierra
Brandt, Katerina
Vanna, Usaphea P.
Delacruz, Matthew J.
Guerra, Quique
Goldstein, Samuel Jacob
Hou, Yixuan Jacob
Gearhart, Margaret
Wiethorn, Christine
Pope, Candace
Amditis, Carolyn
Pruitt, Kathryn
Newberry-Dillon, Cinthia
Schmitz, John L.
Premkumar, Lakshmanane
Adimora, Adaora A.
Emch, Michael E.
Boyce, Ross M.
Aiello, Allison E.
Fosdick, Bailey K.
Larremore, Daniel B.
de Silva, Aravinda M.
Juliano, Jonathan J.
Markmann, Alena J.

Article Type




Data Set/Study

University of North Carolina Health System


United States of America


North Carolina




Emch - 0000-0003-2642-965X
Aiello - 0000-0001-7029-2537
Boyce, R - 0000-0002-9489-6324