Differential Effects of Race/Ethnicity and Social Vulnerability on COVID-19 Positivity, Hospitalization, and Death in the San Francisco Bay Area

Cho, Wendy K. Tam; Hwang, David G.

doi:10.1007/s40615-022-01272-z

Cited by 4 publications

(9 citation statements)

References 32 publications

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“…Of the 7,280 individuals testing positive for COVID-19, 696 (6.5%) were hospitalized at UCSF Health. As noted previously [9], although Asian patients had the second-lowest rates of testing positive for COVID-19 amongst the four racial/ethnic groups, Asian patients demonstrated the highest rate of hospitalization. To investigate this observation further, a logistic regression was performed that included race/ethnicity, sociodemographic factors, and biomedical risk factors as independent variables, and COVID-19 hospitalization as the dependent variable.…”

Section: Resultssupporting

confidence: 74%

“…In the intervening century since the 1918 influenza pandemic, despite an overall demographic shift toward a more pluralistic and multi-racial society in many regions of the United States, racial and ethnic disparities continue to persist in various domains, including in health, and are evident not just for Black Americans but for Americans belonging to a range of racial and ethnic minorities. During the current coronavirus pandemic, Black and Hispanic individuals have tested positive for COVID-19 at higher rates than White individuals [5, 6, 7, 8], and COVID-19-related hospitalizations and deaths have disproportionately affected American Indian, Asian, Black, and Hispanic persons [9, 10, 11, 12]. Despite widespread recognition of racial health disparities dating back more than a century, considerable disagreement and uncertainty remain as to whether the principal cause of health inequities is more firmly rooted in race or in racism.…”

Section: Introductionmentioning

confidence: 99%

“…In order to better understand the relative contributions of biomedical, racial/ethnic, and socioeconomic factors to health disparities in the COVID-19 pandemic, we examined COVID-19 test positivity and hospitalization rates in a racially, ethnically, and socioeconomically diverse region of the United States, the San Francisco Bay Area. The Bay Area is of particular value for conducting such a study due to its pluralistic racial and ethnic composition and the region’s relative decoupling of race/ethnicity and socioeconomic status as compared to many other US metropolitan areas, particularly for Asian individuals [9].…”

Section: Introductionmentioning

confidence: 99%

“…We previously reported an initial analysis of racial and ethnic differences in COVID-19 test positivity and hospitalization rates among patients of a large, multi-hospital, multi-clinic academic health care system in the San Francisco Bay Area [9]. We found that higher social vulnerability, Black race, and Hispanic ethnicity were associated with a higher rate of COVID-19 positivity, whereas COVID-19 hospitalization and morbidity rates were highest among Asian patients.…”

Section: Introductionmentioning

confidence: 99%

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Racial/Ethnic, Biomedical, and Sociodemographic Risk Factors for COVID-19 Positivity and Hospitalization in the San Francisco Bay Area

Cho

Hwang

2022

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BACKGROUNDThe COVID-19 pandemic has uncovered clinically meaningful racial/ethnic disparities in COVID-19-related health outcomes. Current understanding of the basis for such an observation remains incomplete, with both biomedical and social/contextual variables proposed as potential factors.PURPOSEUsing a logistic regression model, we examined the relative contributions of race/ethnicity, biomedical, and socioeconomic factors to COVID-19 test positivity and hospitalization rates in a large academic health care system in the San Francisco Bay Area prior to the advent of vaccination and other pharmaceutical interventions for COVID-19.RESULTSWhereas socioeconomic factors, particularly those contributing to increased social vulnerability, were associated with test positivity for COVID-19, biomedical factors and disease co-morbidities were the major factors associated with increased risk of COVID-19 hospitalization. Hispanic individuals had a higher rate of COVID-19 positivity, while Asian persons had higher rates of COVID-19 hospitalization. Diabetes was an important risk factor for COVID-19 hospitalization, particularly among Asian patients, for whom diabetes tended to be more frequently undiagnosed and higher in severity.CONCLUSIONSWe observed that biomedical, racial/ethnic, and socioeconomic factors all contributed in varying but distinct ways to COVID-19 test positivity and hospitalization rates in a large, multiracial, socioeconomically diverse metropolitan area of the United States. The impact of a number of these factors differed according to race/ethnicity. Improving over-all COVID-19 health outcomes and addressing racial and ethnic disparities in COVID-19 out-comes will likely require a comprehensive approach that incorporates strategies that target both individual-specific and group contextual factors.

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Section: Resultssupporting

confidence: 74%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Racial/Ethnic, Biomedical, and Sociodemographic Risk Factors for COVID-19 Positivity and Hospitalization in the San Francisco Bay Area

Cho

Hwang

2022

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“…Similarly, in several geographic areas of the United States, a strong association between living in a disadvantaged area and the risk of getting SARS-CoV-2 infection and of being hospitalized for SARS-CoV-2 infection has been reported [30]. On the other hand, a study in San Francisco reported a relationship between social vulnerability and COVID-19 hospitalization rates, although this study noted that COVID-19 outcomes were not systematically explained by increased social vulnerability, as this relationship occurred only in white people but not in those of other ethnic groups [31]. Our data do not support that living in an area of higher social deprivation increases the likelihood of being hospitalized for COVID-19.…”

Section: Discussionmentioning

confidence: 61%

Economic Migrants and Clinical Course of SARS-CoV-2 Infection: A Follow-Up Study

Martínez-Alfonso¹,

Mesas

Jimenez-Olivas³

et al. 2022

Int J Public Health

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Objective: To analyze whether social deprivation and economic migrant (EM) status influence the risk of being hospitalized with COVID-19.Methods: This was a retrospective follow-up study including all patients older than 18 years attending the Daroca Health Center in Madrid, Spain, diagnosed with COVID-19 during September 2020. Data on EM status and other sociodemographic, lifestyle and comorbidities that could affect the clinical course of the infection were obtained from electronic medical records.Results: Of the 796 patients positive for COVID-19, 44 (5.53%) were hospitalized. No significant differences were observed between those who were hospitalized and those who were not in the mean of social deprivation index or socioeconomic status, but EM status was associated with the risk of being hospitalized (p = 0.028). Logistic regression models showed that years of age (OR = 1.07; 95% CI: 1.04–1.10), EM status (OR = 5.72; 95% CI: 2.56–12.63) and hypertension (OR = 2.22; 95% CI: 1.01–4.85) were the only predictors of hospitalization.Conclusion: Our data support that EM status, rather than economic deprivation, is the socioeconomic factor associated with the probability of hospital admission for COVID-19 in Madrid, Spain.

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Advocating for language equity: a community-public health partnership

Kurlander,

Lam,

Dawson-Hahn

et al. 2023

Front. Public Health

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In the United States, 21.5% of individuals aged 5 or older speak a language other than English at home and 8.2% have Limited English Proficiency (LEP). LEP individuals experience healthcare disparities, including lower access to healthcare services, poorer health outcomes, and higher levels of uninsurance. The COVID-19 pandemic highlighted and exacerbated these health disparities and unmet healthcare needs. In Alameda County (CA), where 46% of foreign-born residents speak a language other than English at home, community-based organizations have been crucial in providing translated materials and one-on-one support to ensure LEP residents receive critical COVID-19 updates and services. Refugee and Immigrant Collaborative for Empowerment (RICE) is a multilingual coalition of seven Alameda County community-based organizations led by the Korean Community Center of the East Bay (KCCEB). During the COVID-19 pandemic, RICE expanded its public health role to fill service and information gaps, advocate on behalf of LEP groups, and build a linguistically and culturally responsive public health safety network. This community case study describes a three-part advocacy-focused intervention that RICE undertook from September 2021 to October 2022. It included (1) a community needs survey, (2) a landscape assessment of the Alameda County Health Department’s (ACPHD) communication materials and online platforms, and (3) relationship building with the ACPHD. The community survey revealed differences across LEP subgroups and highlighted the importance of gathering data disaggregated by language preference. The landscape assessment allowed RICE to understand the ACPHD’s decision-making process and develop data-informed advocacy requests on behalf of LEP communities. Effective communication and coordination between RICE and the ACPHD shortened the feedback loop between public health authorities and LEP communities and laid the groundwork for the RICE organizations to be part of the ACPHD’s future decision making. Data disaggregation, language equity-based advocacy, and cross-sector collaboration were critical ingredients in RICE’s intervention. RICE’s partnership and relationship of mutual accountability with the ACPHD may provide a useful model for other community-based organizations and public health departments seeking to form similar partnerships.

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Differential Effects of Race/Ethnicity and Social Vulnerability on COVID-19 Positivity, Hospitalization, and Death in the San Francisco Bay Area

Cited by 4 publications

References 32 publications

Racial/Ethnic, Biomedical, and Sociodemographic Risk Factors for COVID-19 Positivity and Hospitalization in the San Francisco Bay Area

Racial/Ethnic, Biomedical, and Sociodemographic Risk Factors for COVID-19 Positivity and Hospitalization in the San Francisco Bay Area

Economic Migrants and Clinical Course of SARS-CoV-2 Infection: A Follow-Up Study

Advocating for language equity: a community-public health partnership

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