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.