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Author Notes:

Dr Heeju Sohn, Email: heeju.sohn@emory.edu

HS acquired funding and access to the restricted data, led the conceptualisation and the analysis and contributed to writing and editing of the manuscript. JKA contributed to the methodology, the literature review and the writing and editing of the manuscript. HS is responsible for the overall content as the guarantor.

Disclosures: None declared.


Research Funding:

This project was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD, grant number R00HD096322).


  • COVID-19
  • public health
  • epidemiology

Geographic variation in COVID-19 vulnerability by legal immigration status in California: a prepandemic cross-sectional study


Journal Title:

BMJ Open


Volume 12, Number 5


Type of Work:

Article | Final Publisher PDF


Objective To quantify COVID-19 vulnerabilities for Californian residents by their legal immigration status and place of residence. Design Secondary data analysis of cross-sectional population-representative survey data. Data All adult respondents in the restricted version of the California Health Interview Survey (2015–2020, n=128 528). Outcome measure Relative Social Vulnerability Indices for COVID-19 by legal immigration status and census region across six domains: socioeconomic vulnerability; demography and disability; minority status and language barriers; high housing density; epidemiological risk; and access to care. Results Undocumented immigrants living in Southern California’s urban areas (Los Angeles, Orange, San Diego-Imperial) have exceptionally high vulnerabilities due to low socioeconomic status, high language barriers, high housing density and low access to care. San Joaquin Valley is home to vulnerable immigrant groups and a US-born population with the highest demographic and epidemiological risk for severe COVID-19. Conclusion Interventions to mitigate public health crises must explicitly consider immigrants’ dual disadvantage from social vulnerability and exclusionary state and federal safety-net policies.

Copyright information:

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/rdf).
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