Disparities among Racially/Ethnically Marginalized Groups in the COVID-19 Pandemic Persist Regardless of Statewide Shelter-in-Place Policies: An Analysis from Northern California.

To measure COVID-19 disparities among racial/ethnically marginalized groups in hospitalization and ICU (Intensive Care Unit)-transfer pre/post implementation of the California statewide shelter-in-place (SIP) policy. A retrospective cohort study was conducted at a healthcare system in California. COVID-19 patients from 1/1/20-8/31/20 were identified from electronic health records. We examined hospitalizations and ICU transfers by race/ethnicity and pandemic period using logistic regression. Among 16,520 people with COVID-19 (mean [SD] age, 46.6 [18.4] years; 54.2% women); during the Post-SIP period, patients were on average younger and a larger proportion were Hispanic. In adjusted models, odds of hospitalization were 20% lower post-SIP compared to SIP, yet all non-White groups had higher odds (ORs 1.6-2.1) compared to Non-Hispanic White, regardless of period. Among hospitalized patients, odds of ICU transfer were 33% lower post-SIP versus SIP. Hispanic and Asian patients had higher odds compared to Non-Hispanic. Disparities in hospitalization persisted while ICU risk became more pronounced for Asian and Hispanic patients in post-SIP. Policy makers should consider ways to proactively address inequities in risk when considering future population-level policy interventions for public health crises.