Background: The coronavirus disease MESHD (COVID-19) first identified in Wuhan in December 2019 became a pandemic within a few months of its discovery. The impact of COVID-19 is due to both its rapid spread and its severity, but the determinants of severity have not been fully delineated. Objective: Identify factors associated with hospitalization and disease MESHD severity in a racially and ethnically diverse cohort of COVID-19 patients. Methods: We analyzed data from COVID-19 patients diagnosed at the University of Cincinnati health system from March 13, 2020 to May 31, 2020. Severe COVID-19 was defined as admission to intensive care unit or death MESHD. Logistic regression modeling adjusted for covariates was used to identify the factors associated with hospitalization and severe COVID-19. Results: Among the 689 COVID-19 patients included in our study, 29.2% were non-Hispanic White, 25.5% were non-Hispanic Black, 32.5% were Hispanic, and 12.8% were of other race/ethnicity. About 31.3% of patients were hospitalized and 13.2% had severe disease MESHD. In adjusted analyses, the sociodemographic factors associated with hospitalization and/or disease MESHD severity included older age TRANS, non-Hispanic Black or Hispanic race/ethnicity (compared to non-Hispanic White), and smoking. The following comorbidities: diabetes, hypercholesterolemia MESHD hypercholesterolemia HP, asthma MESHD asthma HP, COPD, chronic kidney disease HP kidney disease MESHD, cardiovascular diseases MESHD, osteoarthritis MESHD osteoarthritis HP, and vitamin D deficiency MESHD were associated with hospitalization and/or disease MESHD severity. Hematological disorders such as anemia MESHD anemia HP, coagulation disorders, and thrombocytopenia MESHD thrombocytopenia HP were associated with both hospitalization and disease MESHD severity. Conclusion: This study confirms race and ethnicity as predictors of severe COVID-19. It also finds clinical risk factors for hospitalization and severe COVID-19 not previously identified such a vitamin D deficiency MESHD, hypercholesterolemia MESHD hypercholesterolemia HP, osteoarthritis MESHD osteoarthritis HP, and anemia MESHD anemia HP.