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

Abstract

BACKGROUND: Higher COVID-19 incidence and morbidity have been amply documented for US Black and Hispanic populations but not as clearly for other racial and ethnic groups. Efforts to elucidate the mechanisms underlying racial health disparities can be confounded by the relationship between race/ethnicity and socioeconomic status. OBJECTIVE: Examine race/ethnicity and social vulnerability effects on COVID-19 outcomes in the San Francisco Bay Area, an ethnically and socioeconomically diverse region. DESIGN: Retrospective cohort study. SETTING: Geocoded patient records from the University of California, San Francisco Health system between January 1, 2020 to December 31, 2020. PATIENTS: Patients who underwent polymerase chain reaction testing for COVID-19. EXPOSURES: Race/ethnicity and Social Vulnerability Index (SVI). MAIN MEASURES: COVID-19 test frequency, positivity, hospitalization rates, and mortality. KEY RESULTS: Higher social vulnerability, but not race/ethnicity, was associated with less frequent testing yet a higher likelihood of testing positive. Asian hospitalization rates (11.5\%) were double that of White patients (5.4\%) and exceeded the rates for Black (9.3\%) and Hispanic (6.9\%) groups. A modest relationship between higher hospitalization rates and increasing social vulnerability was evident only for White individuals. The Hispanic group had the lowest mean age at death and thus highest years of expected life lost due to COVID-19. CONCLUSIONS: COVID-19 outcomes were not consistently explained by greater socioeconomic vulnerability. Asian individuals showed disproportionately high rates of hospitalization regardless of socioeconomic status. Study of the San Francisco Bay Area population not only provides valuable insights into the differential contributions of race/ethnicity and social determinants of health to COVID-19 outcomes but also emphasizes that all racial groups have experienced the toll of the pandemic, albeit in different ways and to varying degrees.