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

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.