Asian residents in the Bay Area were more likely to be hospitalized with COVID-19 in 2020 than any other racial or ethnic group, and the heightened risk cannot be fully explained by socioeconomic factors or medical conditions, according to newly published research.
Asians were the only racial or ethnic group among those included in the study — Asian, Black, Hispanic and white residents — for whom factors such as age, income, health insurance status and medical co-morbidities did not fully explain the higher risk of hospitalization, the study published Tuesday in the Journal of Racial and Ethnic Health Disparities found.
Hispanic and Black residents’ higher risk for testing positive and being hospitalized was largely tied to socioeconomic status and health issues such as smoking and diabetes, according to the study, which was co-authored by a UCSF researcher. Conversely, such factors did not fully account for Asians’ higher risk for hospitalization, suggesting other things at play. It’s not clear, though, what those are.
“What is interesting is that even when we count for all socioeconomic factors and health profile, just being Asian alone still conferred excess risk for having severe COVID,” said the study’s co-author, UCSF ophthalmologist Dr. David Hwang. “We don’t fully understand the reasons for that.”
Asians have a high rate of diabetes, one of the biggest risk factors for severe COVID outcomes, and diabetes is more frequently undiagnosed and more severe in Asians than it is in other groups. This is in part because Asians tend to have diabetes at lower body weights or body mass index than other groups. However, higher rates of diabetes alone does not explain why Asians had higher COVID hospitalization rates, the study said.
Hwang said there are a few potential explanations that warrant further study. For one, 2020 saw anti-Asian violence become more rampant, which potentially deterred many Asian residents from seeking medical care for COVID until it became so severe they needed hospitalization, Hwang said.
Language barriers could be another reason. Numerous Asian languages are spoken by Bay Area residents, and many Asians could have found it difficult to get medical care in their own language or dialect, Hwang said.
The study builds on previous research published in March in the same journal. That study found that Asian patients in the Bay Area who tested positive for the virus had the highest hospitalization rates of any group — 11.5%, compared to 9.3% for Black patients, 6.9% for Hispanic patients and 5.4% for white patients. The study published Tuesday seeks to explain why these differences occur. Both studies were co-authored by Hwang and Wendy K. Tam Cho, a professor of political science and Asian American studies at the University of Illinois.
The earlier study, conducted January to December 2020, analyzed health records for 130,000 UCSF patients from the nine Bay Area counties, and also found that Asians had a higher COVID mortality rate than any other group. It also corroborated what many national studies have found — that Black and Hispanic residents were more likely to test positive for the virus.
The findings on the higher COVID hospitalization and death rates among Asian residents stand out because most well-publicized national studies have found that Asians had lower rates of infection, hospitalization and death compared to other groups throughout much of the pandemic.
The differences in national studies and the local study could be attributed in part to the Bay Area’s uniquely large and diverse population. The region has one of the highest concentrations of Asian and Asian American residents in the country. Nationally, Asians make up a much smaller percentage of the population. And there is greater socioeconomic diversity among Asians in the Bay Area — Asians are evenly distributed across the income spectrum, with about a third being very low-income and a third being high-income, according to the more recent of the two local studies.
“Our patient population being in a multi-ethnic community allows us to draw conclusions about groups that in other communities are not considered large enough to draw statistically relevant inferences,” Hwang said. “The fact that we have pluralistic society with a larger set of Asians is very different.”
Hwang said the findings underscore the importance of understanding differences within the diverse Asian population so the health care system can tailor programs to address disparities.
“Being Asian is a very heterogeneous group of many different cultures and backgrounds and origins,” he said. “It’s not homogeneous. But understanding those differences and having more attention to studying the health needs in Asians is something that’s an opportunity for our health care system and our researchers to put more of a spotlight on.”
Catherine Ho (she/her) is a San Francisco Chronicle staff writer. Email: cho@sfchronicle.com Twitter: @Cat_Ho
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July 19, 2022 at 07:03PM
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Study: Asian residents more likely to be hospitalized with COVID than others in Bay Area - San Francisco Chronicle
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