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

Wendy K.Tam Cho, David G. Hwang

Research output: Contribution to journalArticlepeer-review


Background: The 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. Purpose: Using a logistic regression model, we examined the relative contributions ofrace/ethnicity, biomedical, and socioeconomic factors to COVID-19 test positivity and hospitalizationrates in a large academic health care system in the San Francisco Bay Area prior tothe advent of vaccination and other pharmaceutical interventions for COVID-19. Results: Whereas 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. The excess hospitalization risk attributed to Asian race was not explained by differences in the examined biomedical or sociodemographic variables. 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. Conclusion: We 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, multi-racial, socioeconomically diverse metropolitan area of the United States. The impact of a number of these factors differed according to race/ethnicity. Improving overall COVID-19 health outcomes and addressing racial and ethnic disparities in COVID-19 outcomes will likely require a comprehensive approach that incorporates strategies that target both individual-specific and group contextual factors.

Original languageEnglish (US)
Pages (from-to)1653-1668
Number of pages16
JournalJournal of Racial and Ethnic Health Disparities
Issue number4
StatePublished - Aug 2023


  • Asian
  • COVID-19
  • Diabetes mellitus
  • Racial health disparities
  • Risk factors

ASJC Scopus subject areas

  • Health(social science)
  • Public Health, Environmental and Occupational Health
  • Anthropology
  • Health Policy
  • Sociology and Political Science


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