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Wanigaratne S, Shah B, Stukel TA, Lu H, Den Otter-Moore S, Shetty J, Saunders N, Gandhi S, Guttmann A. COVID-19 hospitalization, mortality and pre-mature mortality by a history of immigration in Ontario, Canada: a population-based cohort study. LANCET REGIONAL HEALTH. AMERICAS 2024; 34:100762. [PMID: 38779655 PMCID: PMC11109005 DOI: 10.1016/j.lana.2024.100762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 04/19/2024] [Accepted: 04/23/2024] [Indexed: 05/25/2024]
Abstract
Background Immigrants in high-income countries experienced inequities in COVID-19 severe outcomes. We examined hospitalization and death throughout the pandemic, and change during the vaccine era, in Ontario, Canada. Methods We conducted a population-based study using linked immigration and health data, following two cohorts for 20 months from January 1, 2020 (pre-vaccine) and September 1, 2021 (vaccine era). We used multivariable Poisson generalized estimating equation regression to estimate adjusted rate ratios (aRR) with 95% confidence intervals (CI), accounting for age, sex and co-morbidities. We calculated age-standardized years of life lost (ASYRs) rates by immigrant category. Findings Of 11,692,387 community-dwelling adults in the pre-vaccine era cohort and 11,878,304 community-dwelling adults in the vaccine era cohort, 21.6% and 21.4% of adults in each era respectively were immigrants. Females accounted for 57.9% and 57.8% of sponsored family, and 68.4% and 67.6% of economic caregivers, in each era respectively. Compared to other Ontarians in the pre-vaccine era cohort, hospitalization rates were highest for refugees (aRR [95% CI] 3.41 [3.39-3.44]) and caregivers (3.13 [3.07-3.18]), followed by sponsored family and other economic immigrants. Compared to other Ontarians, aRRs were highest for immigrants from Central America (5.00 [4.92-5.09]), parts of South Asia (3.95 [3.89-4.01]) and Jamaica (3.56 [3.51-3.61]) with East Asians having lower aRRs. Mortality aRRs were similar to hospitalization aRRs. In the vaccine era, all aRRs were attenuated and most were similar to or lower than other Ontarians, with refugees and a few regions maintaining higher rates. In the pre-vaccine era ASYRs were higher for all immigrant groups. ASYRs dropped in the vaccine era with only refugees continuing to have higher rates. Interpretation Immigrants, particularly refugees, experienced greater premature mortality. aRRs for most immigrant groups dropped substantially after high vaccine coverage was achieved. Vaccine outreach and improvements in the social determinants of health are needed. Funding Canadian Institutes of Health Research, Canada Research Chairs Program.
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Affiliation(s)
- Susitha Wanigaratne
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
| | - Baiju Shah
- ICES, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Therese A. Stukel
- ICES, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Canada
| | | | | | - Janavi Shetty
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
| | - Natasha Saunders
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Canada
- Department of Paediatrics, University of Toronto, Toronto, Canada
| | | | - Astrid Guttmann
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Canada
- Department of Paediatrics, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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2
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Wong J, Lao C, Dino G, Donyaei R, Lui R, Huynh J. Vaccine Hesitancy among Immigrants: A Narrative Review of Challenges, Opportunities, and Lessons Learned. Vaccines (Basel) 2024; 12:445. [PMID: 38793696 PMCID: PMC11126062 DOI: 10.3390/vaccines12050445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 05/26/2024] Open
Abstract
(1) Background: Vaccination reluctance is a major worldwide public health concern as it poses threats of disease outbreaks and strains on healthcare systems. While some studies have examined vaccine uptake within specific countries, few provide an overview of the barriers and trends among migrant groups. To fill this knowledge gap, this narrative review analyzes immunization patterns and vaccine hesitancy among immigrant populations. (2) Methods: Four researchers independently evaluated the quality and bias risk of the 18 identified articles using validated critical appraisal tools. (3) Results: Most studies focused on vaccine hesitancy among migrants in the United States and Canada, with a higher COVID-19 vaccine reluctance than native-born residents. Contributing factors to this hesitancy include demographics, cultural views, obstacles to healthcare access, financial hardship, and distrust in health policies. Additionally, immigrants in North America and Europe face unfair vaccine challenges due to misinformation, safety concerns, personal perspectives, language barriers, immigration status, and restricted healthcare access. (4) Conclusions: Tailored vaccine education programs and outreach campaigns sensitive to immigrants' diversity should be developed to address this issue. It is also important to investigate community-specific obstacles and assess the long-term sustainability of current efforts to promote vaccination among marginalized migrant groups. Further research into global immunization disparities among immigrant populations is crucial.
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Affiliation(s)
- Jason Wong
- College of Pharmacy, Western University of Health Sciences, 309 E. Second St., Pomona, CA 91766, USA; (C.L.); (G.D.); (R.D.); (R.L.); (J.H.)
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3
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Alves IB, Panunzi S, Silva AC, Loesch RBR, Pereira SCR, Martins MRO. Have immigrant children been left behind in COVID-19 testing rates? - A quantitative study in the Lisbon metropolitan area between march 2020 and may 2023. Front Public Health 2024; 12:1286829. [PMID: 38532979 PMCID: PMC10963449 DOI: 10.3389/fpubh.2024.1286829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 02/16/2024] [Indexed: 03/28/2024] Open
Abstract
Immigrant children often encounter additional barriers in accessing health care than their peers. However, there is a lack of evidence globally regarding how migrant status may have affected access to COVID-19 testing during the pandemic. This study aimed to analyze migrant status as a determinant of COVID-19 testing rates among children in the Lisbon metropolitan area, Portugal. This cross-sequential study included 722 children aged 2-8 years (47% non-immigrants; 53% immigrants). We collected data from a national surveillance system on laboratory-confirmed COVID-19 tests conducted between March 2020 and May 2023 and assessed whether children were ever tested for COVID-19 and testing frequency. We employed robust and standard Poisson regression models to estimate Adjusted Prevalence Ratios and Relative Risks with 95% confidence intervals. A total of 637 tests were performed. Immigrant children had lower testing rates (53% vs. 48%) and fewer tests per child (median: 2 vs. 3). Moreover, they were 17% less likely to be ever tested (PR = 0.83, 95% CI: 0.76-0.89) and performed 26% fewer tests (RR = 0.74, 95% CI: 0.67-0.82) compared to non-immigrant children. Caregiver's age, education, employment status, child's birth weight, and perceived health status were associated factors. Our findings suggest that the COVID-19 pandemic has left immigrant children somewhat behind. We conclude that specific interventions targeting vulnerable populations, such as immigrant children, are needed in future health crises.
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Affiliation(s)
- Iolanda B. Alves
- Global Health and Tropical Medicine (GHTM), Institute of Hygiene and Tropical Medicine (IHMT), NOVA University of Lisbon, Lisbon, Portugal
| | - Silvia Panunzi
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - António C. Silva
- Public Health Department, Regional Health Administration of Lisbon and Tagus Valley, Ministry of Health, Lisbon, Portugal
- AJPAS-Associação de Intervenção Comunitária, Desenvolvimento Social e de Saúde, Amadora, Portugal
| | - Regina B. R. Loesch
- Global Health and Tropical Medicine (GHTM), Institute of Hygiene and Tropical Medicine (IHMT), NOVA University of Lisbon, Lisbon, Portugal
| | - Sofia C. R. Pereira
- Amadora Primary Care Health Centre’s Group, Regional Health Administration of Lisbon and Tagus Valley, Ministry of Health, Lisbon, Portugal
| | - M. Rosário O. Martins
- Global Health and Tropical Medicine (GHTM), Institute of Hygiene and Tropical Medicine (IHMT), NOVA University of Lisbon, Lisbon, Portugal
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4
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Fong WLE, Nguyen VG, Burns R, Boukari Y, Beale S, Braithwaite I, Byrne TE, Geismar C, Fragaszy E, Hoskins S, Kovar J, Navaratnam AMD, Oskrochi Y, Patel P, Tweed S, Yavlinsky A, Hayward AC, Aldridge RW. The incidence of COVID-19-related hospitalisation in migrants in the UK: Findings from the Virus Watch prospective community cohort study. J Migr Health 2024; 9:100218. [PMID: 38559897 PMCID: PMC10978526 DOI: 10.1016/j.jmh.2024.100218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 08/11/2023] [Accepted: 02/26/2024] [Indexed: 04/04/2024] Open
Abstract
Background Migrants in the United Kingdom (UK) may be at higher risk of SARS-CoV-2 exposure; however, little is known about their risk of COVID-19-related hospitalisation during waves 1-3 of the pandemic. Methods We analysed secondary care data linked to Virus Watch study data for adults and estimated COVID-19-related hospitalisation incidence rates by migration status. To estimate the total effect of migration status on COVID-19 hospitalisation rates, we ran mixed-effect Poisson regression for wave 1 (01/03/2020-31/08/2020; wildtype), and mixed-effect negative binomial regressions for waves 2 (01/09/2020-31/05/2021; Alpha) and 3 (01/06/2020-31/11/2021; Delta). Results of all models were then meta-analysed. Results Of 30,276 adults in the analyses, 26,492 (87.5 %) were UK-born and 3,784 (12.5 %) were migrants. COVID-19-related hospitalisation incidence rates for UK-born and migrant individuals across waves 1-3 were 2.7 [95 % CI 2.2-3.2], and 4.6 [3.1-6.7] per 1,000 person-years, respectively. Pooled incidence rate ratios across waves suggested increased rate of COVID-19-related hospitalisation in migrants compared to UK-born individuals in unadjusted 1.68 [1.08-2.60] and adjusted analyses 1.35 [0.71-2.60]. Conclusion Our findings suggest migration populations in the UK have excess risk of COVID-19-related hospitalisations and underscore the need for more equitable interventions particularly aimed at COVID-19 vaccination uptake among migrants.
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Affiliation(s)
- Wing Lam Erica Fong
- Institute of Health Informatics, University College London, London NW1 2DA, UK
| | - Vincent G Nguyen
- Institute of Health Informatics, University College London, London NW1 2DA, UK
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
- Department of Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Rachel Burns
- Institute of Health Informatics, University College London, London NW1 2DA, UK
| | - Yamina Boukari
- Institute of Health Informatics, University College London, London NW1 2DA, UK
| | - Sarah Beale
- Institute of Health Informatics, University College London, London NW1 2DA, UK
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
| | - Isobel Braithwaite
- Institute of Health Informatics, University College London, London NW1 2DA, UK
| | - Thomas E Byrne
- Institute of Health Informatics, University College London, London NW1 2DA, UK
| | - Cyril Geismar
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
- Department of Infectious Disease Epidemiology, MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Ellen Fragaszy
- Institute of Health Informatics, University College London, London NW1 2DA, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Susan Hoskins
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
| | - Jana Kovar
- Institute of Health Informatics, University College London, London NW1 2DA, UK
| | - Annalan MD Navaratnam
- Institute of Health Informatics, University College London, London NW1 2DA, UK
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
| | - Youssof Oskrochi
- Institute of Health Informatics, University College London, London NW1 2DA, UK
| | - Parth Patel
- Institute of Health Informatics, University College London, London NW1 2DA, UK
| | - Sam Tweed
- Institute of Health Informatics, University College London, London NW1 2DA, UK
| | - Alexei Yavlinsky
- Institute of Health Informatics, University College London, London NW1 2DA, UK
| | - Andrew C Hayward
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
| | - Robert W Aldridge
- Institute of Health Informatics, University College London, London NW1 2DA, UK
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5
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Contoli B, Tosti ME, Asta F, Minardi V, Marchetti G, Casigliani V, Scarso S, Declich S, Masocco M. Exploring COVID-19 Vaccination Willingness in Italy: A Focus on Resident Foreigners and Italians Using Data from PASSI and PASSI d'Argento Surveillance Systems. Vaccines (Basel) 2024; 12:124. [PMID: 38400108 PMCID: PMC10893094 DOI: 10.3390/vaccines12020124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/17/2024] [Accepted: 01/22/2024] [Indexed: 02/25/2024] Open
Abstract
(1) The COVID-19 pandemic exacerbated health disparities, both between foreign and autochthonous populations. Italy was one of the European countries that was the most affected by the COVID-19 pandemic; however, only limited data are available on vaccine willingness. This study aims to assess the propensity of foreign and autochthonous populations residing in Italy to be vaccinated and the relative associated factors. (2) Data were collected and analysed from the two Italian surveillance systems, PASSI and PASSI d'Argento, in the period of August 2020-December 2021. The data include those of the Italian resident adult population over 18 years old. A multinomial logistic regression model, stratified by citizenship, was used to assess the associations of sociodemographic, health, and COVID-19 experience variables with vaccination attitudes. (3) This study encompassed 19,681 eligible subjects. Considering the willingness to be vaccinated, foreign residents were significantly less certain to get vaccinated (49.4% vs. 60.7% among Italians). Sociodemographic characteristics, economic difficulties, and trust in local health units emerged as factors that were significantly associated with vaccine acceptance. Having received the seasonal flu vaccine was identified as a predictor of COVID-19 vaccine acceptance among foreign and Italian residents. (4) This study underscores the significance of tailoring interventions to address vaccine hesitancy based on the diverse characteristics of foreign and Italian residents. This research offers practical insights for public health strategies, highlighting the importance of tailored educational campaigns, improved communication, and nuanced interventions to enhance vaccine acceptance and uptake within both populations.
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Affiliation(s)
- Benedetta Contoli
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità, 00161 Rome, Italy; (B.C.); (V.M.); (M.M.)
| | - Maria Elena Tosti
- National Centre for Global Health, Istituto Superiore di Sanità, 00161 Rome, Italy; (M.E.T.); (G.M.); (S.S.); (S.D.)
| | - Federica Asta
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità, 00161 Rome, Italy; (B.C.); (V.M.); (M.M.)
| | - Valentina Minardi
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità, 00161 Rome, Italy; (B.C.); (V.M.); (M.M.)
| | - Giulia Marchetti
- National Centre for Global Health, Istituto Superiore di Sanità, 00161 Rome, Italy; (M.E.T.); (G.M.); (S.S.); (S.D.)
| | - Virginia Casigliani
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy;
| | - Salvatore Scarso
- National Centre for Global Health, Istituto Superiore di Sanità, 00161 Rome, Italy; (M.E.T.); (G.M.); (S.S.); (S.D.)
- Department of Public Health and Infectious Diseases, Sapienza Università di Roma, 00185 Rome, Italy
| | - Silvia Declich
- National Centre for Global Health, Istituto Superiore di Sanità, 00161 Rome, Italy; (M.E.T.); (G.M.); (S.S.); (S.D.)
| | - Maria Masocco
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità, 00161 Rome, Italy; (B.C.); (V.M.); (M.M.)
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Mikolai J, Dorey P, Keenan K, Kulu H. Spatial patterns of COVID-19 and non-COVID-19 mortality across waves of infection in England, Wales, and Scotland. Soc Sci Med 2023; 338:116330. [PMID: 37907058 DOI: 10.1016/j.socscimed.2023.116330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 09/12/2023] [Accepted: 10/10/2023] [Indexed: 11/02/2023]
Abstract
Recent studies have established the key individual-level risk factors of COVID-19 mortality such as age, gender, ethnicity, and socio-economic status. However, the spread of infectious diseases is a spatial and temporal process implying that COVID-19 mortality and its determinants may vary sub-nationally and over time. We investigate the spatial patterns of age-standardised death rates due to COVID-19 and their correlates across local authority districts in England, Wales, and Scotland across three waves of infection. Using a Spatial Durbin model, we explore within- and between-country variation and account for spatial dependency. Areas with a higher share of ethnic minorities and higher levels of deprivation had higher rates of COVID-19 mortality. However, the share of ethnic minorities and population density in an area were more important predictors of COVID-19 mortality in earlier waves of the pandemic than in later waves, whereas area-level deprivation has become a more important predictor over time. Second, during the first wave of the pandemic, population density had a significant spillover effect on COVID-19 mortality, indicating that the pandemic spread from big cities to neighbouring areas. Third, after accounting for differences in ethnic composition, deprivation, and population density, initial cross-country differences in COVID-19 mortality almost disappeared. COVID-19 mortality remained higher in Scotland than in England and Wales in the third wave when COVID-19 mortality was relatively low in all three countries. Interpreting these results in the context of higher overall (long-term) non-COVID-19 mortality in Scotland suggests that Scotland may have performed better than expected during the first two waves. Our study highlights that accounting for both spatial and temporal factors is essential for understanding social and demographic risk factors of mortality during pandemics.
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Affiliation(s)
- Júlia Mikolai
- ESRC Centre for Population Change, United Kingdom; University of St Andrews, United Kingdom.
| | | | - Katherine Keenan
- ESRC Centre for Population Change, United Kingdom; University of St Andrews, United Kingdom
| | - Hill Kulu
- ESRC Centre for Population Change, United Kingdom; University of St Andrews, United Kingdom
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Cacciani L, Cesaroni G, Calandrini E, Davoli M, Agabiti N. Covid-19 vaccination among migrants in Rome, Italy. Sci Rep 2023; 13:20890. [PMID: 38017018 PMCID: PMC10684578 DOI: 10.1038/s41598-023-48273-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/24/2023] [Indexed: 11/30/2023] Open
Abstract
Migrants may be susceptible to vaccine barriers and hesitancy. We evaluated the association between migrant status, as measured by the citizenship from a High Migratory Pressure Country (HMPC), and COVID-19 vaccination uptake in the resident population in Rome, Italy. We also investigated sex differences. We followed participants for vaccination against COVID-19 in 2021. We calculated crude- and adjusted-vaccination rates and Cox hazard ratios of vaccination for migrants compared to Italians. Among migrants from HMPCs, we estimated HRs for females compared to males, stratifying by geographical area of origin. Models were adjusted for age and deprivation index and stratified by infection history. In 2021, among 1,731,832 18-64-year-olds, migrants were 55% less likely to uptake at least one COVID-19 vaccine dose than their Italian counterpart. Past SARS-CoV-2 infection reduced the difference between migrants and Italians to 27%. Among migrants from HMPCs, we observed a slight excess of vaccination uptake among females compared to males. Focusing on geographical areas, we observed that only females from central-western Asia were 9% less likely to uptake vaccination than males. Health communication strategies oriented to migrants and considering their different languages, cultures, and health literacy should be adopted for prevention before emergencies.
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Affiliation(s)
- Laura Cacciani
- Department of Epidemiology of the Regional Health Service of Lazio, Asl Roma 1, Rome, Italy.
| | - Giulia Cesaroni
- Department of Epidemiology of the Regional Health Service of Lazio, Asl Roma 1, Rome, Italy
| | - Enrico Calandrini
- Department of Epidemiology of the Regional Health Service of Lazio, Asl Roma 1, Rome, Italy
| | - Marina Davoli
- Department of Epidemiology of the Regional Health Service of Lazio, Asl Roma 1, Rome, Italy
| | - Nera Agabiti
- Department of Epidemiology of the Regional Health Service of Lazio, Asl Roma 1, Rome, Italy
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Rosso A, Rinaldi A, Coluzzi D, Perrelli F, Napoli PA, Flacco ME, Manzoli L, De Angelis G. Developing a Strategy for COVID-19 Control Among Hard-to-Reach Migrant Communities: The Experience of Roma 2 Local Health Authority. Int J Public Health 2023; 68:1605766. [PMID: 38024208 PMCID: PMC10664708 DOI: 10.3389/ijph.2023.1605766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Roma 2 Local Health Authority (ASL) developed a strategy to control the COVID-19 epidemic in Hard-to-reach (HTR) migrant communities, addressing both the containment of clusters in informal settlements and access to COVID-19 vaccination. The strategy was based on a strong collaboration of different services across the ASL and with Non-Governmental Organizations (NGOs). NGOs were involved in the active surveillance, reporting of COVID-19 suspected cases to the ASL and information to the communities. Health interventions (e.g., COVID-19 tests, contact tracing, vaccination) were offered in outreach in HTR communities' life places. From April 2020 to February 2021, 15 outbreaks were controlled, for a total of over 4,500 persons reached, and 265 COVID-19 cases identified. From July to November 2021, vaccinations were offered in outreach or with dedicated sessions, reaching 1,398 people. This intervention model may lay the foundations for the design of public health strategies, not only aimed at HTR populations.
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Affiliation(s)
- Annalisa Rosso
- Migrants Health Unit, Local Health Authority Rome 2, Rome, Italy
| | | | - Daniele Coluzzi
- Migrants Health Unit, Local Health Authority Rome 2, Rome, Italy
| | | | | | - Maria Elena Flacco
- Department of Environmental and Preventive Sciences, University of Ferrara, Ferrara, Italy
| | - Lamberto Manzoli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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9
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Hraiech S, Pauly V, Orleans V, Auquier P, Azoulay E, Roch A, Boyer L, Papazian L. COVID-19 among undocumented migrants admitted to French intensive care units during the 2020-2021 period: a retrospective nationwide study. Ann Intensive Care 2023; 13:99. [PMID: 37803153 PMCID: PMC10558416 DOI: 10.1186/s13613-023-01197-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/26/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Before the Coronavirus Disease 2019 (COVID-19) pandemic in France, undocumented migrants had a higher risk than general population for being admitted to the intensive care unit (ICU) because of acute respiratory failure or severe infection. Specific data concerning the impact of COVID-19 on undocumented migrants in France are lacking. We aimed to analyze the mortality and respiratory severity of COVID-19 in this specific population. We retrospectively included all undocumented adult migrants admitted in French ICUs from March 2020 through April 2021 using the French nationwide hospital information system (Programme de Médicalisation des Systèmes d'Information). We focused on admissions related to COVID-19. Undocumented migrants were compared to the general population, first in crude analysis, then after matching on age, severity and main comorbidities. The primary outcome was the ICU mortality from COVID-19. Secondary objectives were the incidence of acute respiratory distress syndrome (ARDS), the need for mechanical ventilation (MV), the duration of MV, ICU and hospital stay. RESULTS During the study period, the rate of ICU admission among patients hospitalized for COVID-19 was higher for undocumented migrants than for general population (463/1627 (28.5%) vs. 81 813/344 001 (23.8%); p < 0.001). Although ICU mortality was comparable after matching (14.3% for general population vs. 13.3% for undocumented migrants; p = 0.50), the incidence of ARDS was higher among undocumented migrants (odds ratio, confidence interval (OR (CI)) 1.25 (1.06-1.48); p = 0.01). Undocumented migrants needed more frequently invasive MV (OR (CI) 1.2 (1.01-1.42); p = 0.04 than general population. There were no differences between groups concerning duration of MV, ICU and hospital length of stay. CONCLUSION During the first waves of COVID-19 in France, undocumented migrants had a mortality similar to the general population but a higher risk for ICU admission and for developing an ARDS. These results highlight the need for reinforcing prevention and improving primary healthcare access for people in irregular situation.
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Affiliation(s)
- Sami Hraiech
- Service de Médecine Intensive - Réanimation, AP-HM, Hôpital Nord, Marseille, France.
- Faculté de medecine, Centre d'Etudes et de Recherches sur les Services de Santé et qualite de vie EA 3279, Aix-Marseille Université, 13005, Marseille, France.
| | - Vanessa Pauly
- Faculté de medecine, Centre d'Etudes et de Recherches sur les Services de Santé et qualite de vie EA 3279, Aix-Marseille Université, 13005, Marseille, France
- Départment d'Informatique Médical, AP-HM, Marseille, France
| | - Véronica Orleans
- Faculté de medecine, Centre d'Etudes et de Recherches sur les Services de Santé et qualite de vie EA 3279, Aix-Marseille Université, 13005, Marseille, France
- Départment d'Informatique Médical, AP-HM, Marseille, France
| | - Pascal Auquier
- Faculté de medecine, Centre d'Etudes et de Recherches sur les Services de Santé et qualite de vie EA 3279, Aix-Marseille Université, 13005, Marseille, France
| | - Elie Azoulay
- Service de Médecine Intensive et Réanimation, Hôpital Saint-Louis, AP-HP, Paris, France
| | - Antoine Roch
- Service de Médecine Intensive - Réanimation, AP-HM, Hôpital Nord, Marseille, France
- Faculté de medecine, Centre d'Etudes et de Recherches sur les Services de Santé et qualite de vie EA 3279, Aix-Marseille Université, 13005, Marseille, France
| | - Laurent Boyer
- Faculté de medecine, Centre d'Etudes et de Recherches sur les Services de Santé et qualite de vie EA 3279, Aix-Marseille Université, 13005, Marseille, France
- Départment d'Informatique Médical, AP-HM, Marseille, France
| | - Laurent Papazian
- Faculté de medecine, Centre d'Etudes et de Recherches sur les Services de Santé et qualite de vie EA 3279, Aix-Marseille Université, 13005, Marseille, France
- Centre Hospitalier de Bastia, 20600, Bastia, Corsica, France
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10
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Gaggioli S, Formica G, Manciulli T, Spinicci M, Bartoloni A, Zammarchi L. Extreme disparities in the access to outpatient treatment for COVID-19 observed at a tertiary hospital in Florence, Tuscany, Italy. Public Health 2023; 223:e3-e4. [PMID: 36935316 PMCID: PMC9884617 DOI: 10.1016/j.puhe.2023.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/06/2023] [Accepted: 01/20/2023] [Indexed: 02/03/2023]
Affiliation(s)
- S Gaggioli
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - G Formica
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - T Manciulli
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - M Spinicci
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy; Division of Infectious Diseases, Careggi University Hospital, Florence, Italy
| | - A Bartoloni
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy; Division of Infectious Diseases, Careggi University Hospital, Florence, Italy
| | - L Zammarchi
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy; Division of Infectious Diseases, Careggi University Hospital, Florence, Italy.
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11
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de Dios B, Pérez-Jacoiste A, Lalueza A, Maestro G, García-Reyne A, Lizasoain M, Lumbreras C. Disparities between Latinx migrants and Spanish natives in COVID-19 outcome in Madrid. Pathog Glob Health 2023; 117:590-595. [PMID: 36775987 PMCID: PMC10392248 DOI: 10.1080/20477724.2023.2174295] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
Previous studies have suggested an increased susceptibility of COVID-19 among certain populations. We analyzed whether COVID-19 presentation and mortality differ between Latinx migrants and Spanish natives. METHODS AND MATERIALS COVID-19 patients between 35-64 years old admitted between January 26th-May-5th 2020 were reviewed. Demographics, major comorbidities, symptoms, signs and analytical parameters on admission were recorded. Respiratory failure was defined as PaO2/FiO2 ≤ 200 mmHg, noninvasive or invasive mechanical ventilation requirement at any time during hospitalization. A propensity score (PS) adjustment was created between Latinx and Spanish. A multivariable logistic regression model adjusted by the PS was performed to evaluate the effects of different variables on mortality. RESULTS 894 patients: 425 (47.5%) Latinx and 469 (52.5%) Spanish natives were included. Latinx were younger (50 vs 55 years p < 0.001) and had less comorbidities (29.4% vs 55.0% p < 0.001) than Spanish natives. More often they exhibited fever (22.1% vs 9.8% p = 0.018) and had higher inflammatory markers (PCR) (11.3 mg/dl vs 7.7 mg/dl p < 0.001). Mortality seemed lower among Latinx (4.7% vs 8.7%, p = 0.017). No association was found between ethnicity and mortality. Respiratory failure [OR = 23.978 (CI 95% 9.4-60.1) p < 0.001], LDH [OR (per unitary increment) = 1.002; CI95% (1.000-1.004;p = 0.036] and PCR [OR (per unitary increment) = 1.044 (CI95% 1.06-1.08); p = 0.02] were independently associated to mortality. CONCLUSIONS We were unable to identify significant ethnic disparities between Latinx and Spanish natives in terms of COVID-19 mortality. Universal access to the health care system in Spain may have contributed to a better outcome of Latinx patients. Differences previously described might be a consequence of socioeconomic disparities.
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Affiliation(s)
- Begoña de Dios
- Internal Medicine Service, Hospital Universitario “12 de Octubre”, Madrid, Spain
- 1 Doctoral Student Rey Juan Carlos University, Madrid, Spain
| | | | - Antonio Lalueza
- Internal Medicine Service, Hospital Universitario “12 de Octubre”, Madrid, Spain
| | - Guillermo Maestro
- Internal Medicine Service, Hospital Universitario “12 de Octubre”, Madrid, Spain
| | - Ana García-Reyne
- Internal Medicine Service, Hospital Universitario “12 de Octubre”, Madrid, Spain
| | - Manuel Lizasoain
- Internal Medicine Service, Hospital Universitario “12 de Octubre”, Madrid, Spain
| | - Carlos Lumbreras
- Internal Medicine Service, Hospital Universitario “12 de Octubre”, Madrid, Spain
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12
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Gili A, Caminiti M, Lupi C, Zichichi S, Minicucci I, Pezzotti P, Primieri C, Bietta C, Stracci F. Socio-Economic Factors Associated with Ethnic Disparities in SARS-CoV-2 Infection and Hospitalization. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6521. [PMID: 37569061 PMCID: PMC10418672 DOI: 10.3390/ijerph20156521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/15/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND There is evidence that non-Italians presented higher incidence of infection and worse health outcomes if compared to native populations in the COVID-19 pandemic. The aim of the study was to compare Italian- and non-Italian-born health outcomes, accounting for socio-economic levels. METHODS We analyzed data relative to 906,463 people in Umbria (Italy) from 21 February 2020 to 31 May 2021. We considered the National Deprivation Index, the Urban-Rural Municipalities Index and the Human Development Index (HDI) of the country of birth. We used a multilevel logistic regression model to explore the influence of these factors on SARS-CoV-2 infection and hospitalization rates. Diagnosis in the 48 h preceding admission was an indicator of late diagnosis among hospitalized cases. RESULTS Overall, 54,448 persons tested positive (6%), and 9.7% of them were hospitalized. The risk of hospital admission was higher among non-Italians and was inversely related to the HDI of the country of birth. A diagnosis within 48 h before hospitalization was more frequent among non-Italians and correlated to the HDI level. CONCLUSIONS COVID-19 had unequal health outcomes among the population in Umbria. Reduced access to primary care services in the non-Italian group could explain our findings. Policies on immigrants' access to primary healthcare need to be improved.
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Affiliation(s)
- Alessio Gili
- Public Health Section, Department of Medicine and Surgery, University of Perugia, 06129 Perugia, Italy
| | - Marta Caminiti
- Public Health Section, Department of Medicine and Surgery, University of Perugia, 06129 Perugia, Italy
| | - Chiara Lupi
- Public Health Section, Department of Medicine and Surgery, University of Perugia, 06129 Perugia, Italy
| | - Salvatore Zichichi
- Public Health Section, Department of Medicine and Surgery, University of Perugia, 06129 Perugia, Italy
| | - Ilaria Minicucci
- Public Health Section, Department of Medicine and Surgery, University of Perugia, 06129 Perugia, Italy
| | - Patrizio Pezzotti
- Department of Infectious Diseases, Istituto Superiore di Sanità, 00162 Rome, Italy
| | - Chiara Primieri
- Epidemiology Unit, Department of Preventive Medicine, Local Health Unit 1, 06126 Perugia, Italy
| | - Carla Bietta
- Epidemiology Unit, Department of Preventive Medicine, Local Health Unit 1, 06126 Perugia, Italy
| | - Fabrizio Stracci
- Public Health Section, Department of Medicine and Surgery, University of Perugia, 06129 Perugia, Italy
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13
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Vrabel K, Johnson SU, Ebrahimi OV, Hoffart A. Anxiety and depressive symptoms among migrants during the COVID-19 pandemic in Norway: A two-wave longitudinal study. PSYCHIATRY RESEARCH COMMUNICATIONS 2023; 3:100115. [PMID: 36942153 PMCID: PMC10008811 DOI: 10.1016/j.psycom.2023.100115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/07/2023] [Accepted: 03/08/2023] [Indexed: 03/16/2023]
Abstract
This study was designed to examine the impact of the COVID-19 pandemic on the mental health of migrants living in Norway. We conducted a longitudinal two-waves survey among a sample of 574 migrants and multilevel modelling was used to analyse anxiety, health anxiety and depressive symptoms. Demographic and psychological predictors were investigated. The levels of anxiety, health anxiety and depressive symptoms among migrants decreased from the lockdown (strict social distancing protocols) to phaseout. Reductions in maladaptive coping strategies were related to parallel reductions in anxiety, health anxiety, and depression, and a reduction in loneliness was related to a reduction in depression. The results indicate that the elevated levels of anxiety, health anxiety and depressive symptoms among migrants in the first phase of the pandemic may be temporary.
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Affiliation(s)
- KariAnne Vrabel
- Department of Psychology, University of Oslo, Oslo, Norway
- Modum Bad Psychiatric Hospital, Vikersund, Norway
| | - Sverre Urnes Johnson
- Department of Psychology, University of Oslo, Oslo, Norway
- Modum Bad Psychiatric Hospital, Vikersund, Norway
| | - Omid V Ebrahimi
- Department of Psychology, University of Oslo, Oslo, Norway
- Modum Bad Psychiatric Hospital, Vikersund, Norway
| | - Asle Hoffart
- Department of Psychology, University of Oslo, Oslo, Norway
- Modum Bad Psychiatric Hospital, Vikersund, Norway
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14
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De Rose A, Arezzo MF, Amore M, Cuomo A, De Filippis S, La Pia S, Pasqualini M, Pirani A, Torta R, Fagiolini A. Vulnerabilities in Mental Health due to Covid-19 Pandemic: The Response of the Italian Physicians. SOCIAL INDICATORS RESEARCH 2023; 168:1-18. [PMID: 37362172 PMCID: PMC10227811 DOI: 10.1007/s11205-023-03111-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/03/2023] [Indexed: 06/28/2023]
Abstract
COVID-19 pandemic has exacerbated the pre-existing vulnerabilities and inequalities in societies. In this paper we analyse the categories that have suffered more than others from the pandemic and the restrictions on social life in terms of mental health. We rely on the Serendipity project based on a survey administered between November 2021 and February 2022 to a sample of Italian physicians (n = 1281). The survey aimed to assess the perception of general practitioners, paediatricians, geriatricians, and mental health specialists (psychiatrists, neurologists, child neuropsychiatrists), about changes in the mental health of the population as an effect of the COVID-19 pandemic and the lockdown. The strategies implemented by the doctors interviewed in terms of the intensity of the prevention, emergence, and treatment of mental health interventions, and their association with physicians' characteristics and their opinions on patient vulnerability have been illustrated by means of a multiple correspondence analysis. An overall result of the survey is the consensus of doctors on the worsening of mental health in general population, especially among their patients, due to the pandemic and on the onset of new discomforts. The most exposed individuals to the risk of onset or worsening of mental disorders include women, young people, and patients with psychiatric comorbidity. The paper also illustrates the interventions put in place by the physicians and deemed necessary from a public heath response perspective, that include providing psychoeducation to the general population, improving telehealth services, and increasing financial and human resources for community-based care.
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Affiliation(s)
- Alessandra De Rose
- Department of Methods and Models for Economy, Territory, and Finance, Sapienza University of Rome, Rome, Italy
| | - Maria Felice Arezzo
- Department of Methods and Models for Economy, Territory, and Finance, Sapienza University of Rome, Rome, Italy
| | - Mario Amore
- Department of Neuroscience, Ophthalmology, Genetics and Infant‑Maternal Science, (IRCCS) Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Alessandro Cuomo
- Department of Molecular Medicine, University of Siena, Siena, Italy
| | | | | | - Marta Pasqualini
- Department of Methods and Models for Economy, Territory, and Finance, Sapienza University of Rome, Rome, Italy
| | - Alessandro Pirani
- Center for Cognitive Disorders and Dementia, Health County of Ferrara, Cento, Italy
| | - Riccardo Torta
- Department of Neuroscience, University of Turin, Turin, Italy
| | - Andrea Fagiolini
- Department of Molecular Medicine, University of Siena, Siena, Italy
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15
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Ikram M, Sayagh Y. The Consequences of COVID-19 Disruption on Sustainable Economy in the Top 30 High-Tech Innovative Countries. GLOBAL JOURNAL OF FLEXIBLE SYSTEMS MANAGEMENT 2023; 24:247-269. [PMID: 37101930 PMCID: PMC10068236 DOI: 10.1007/s40171-023-00338-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 03/06/2023] [Indexed: 04/05/2023]
Abstract
This study aims to investigate the effects of the COVID-19 pandemic on the innovation index, Gross Domestic Product (GDP), high technology exports, and human development (HDI) in the world's leading 30 high-tech innovative countries. Using grey relational analysis models, the association between COVID-19 and other economic development indices was investigated. The model selects the country least affected by the pandemic from the top 30 innovative countries through a conservative (maximin) method based on grey association values. Data was collected from World Bank databases and analyzed to compare pre- and post-COVID-19 periods (2019, 2020). The outcomes of this study provide essential recommendations for industries and decision-makers with suitable action plans to preserve economic systems from further harm caused by the global COVID-19 outbreak. The ultimate goal is to boost the innovation index, GDP, high-tech exports, and HDI of high-tech economies and pave the way for a sustainable economy. To the author's knowledge, this is the first study to develop a multidimensional framework to assess COVID-19's impact on the sustainable economy of top 30 high-tech innovative countries, and to conduct a comparative analysis to identify the strong and weak effects of COVID-19 on sustainable economic growth.
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Affiliation(s)
- Muhammad Ikram
- grid.442822.a0000 0004 1789 8654School of Business Administration, Al Akhawayn University in Ifrane, Avenue Hassan II, P.O. Box 104, 53000 Ifrane, Morocco
| | - Youssef Sayagh
- grid.442822.a0000 0004 1789 8654School of Business Administration, Al Akhawayn University in Ifrane, Avenue Hassan II, P.O. Box 104, 53000 Ifrane, Morocco
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16
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Shamloo SE, Cocco VM, Faccini M, Benet-Martínez V, Trifiletti E. Managing the unexpected: Bicultural identity integration during the COVID-19 emergency. INTERNATIONAL JOURNAL OF INTERCULTURAL RELATIONS : IJIR 2023; 93:101781. [PMID: 36845221 PMCID: PMC9943769 DOI: 10.1016/j.ijintrel.2023.101781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 02/13/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
Unexpected and sudden emergency situations such as COVID-19 may render ethnic minorities particularly vulnerable to experiencing negative outcomes. Yet, we put forward that Bicultural Identity Integration (BII) - the degree to which bicultural individuals perceive their cultural identities as compatible and overlapping - may represent a resource in times of emergencies, since it may positively influence, through enhancement of psychological well-being, how bicultural individuals respond in terms of distress and coping strategies. Based on this assumption, the present study aimed at examining the relationship between BII and responses to COVID-19. N = 370 bicultural individuals (mean age = 26.83, SD = 8.74) from different cultural backgrounds were recruited online and completed measures of BII, psychological well-being, COVID-19 distress and coping strategies (positive attitudes, avoidance, social support seeking) during the second wave of the COVID-19 pandemic in Italy. We tested a model in which BII was the predictor, psychological well-being was the mediator and reactions to the COVID-19 emergency (distress, use of coping) were the outcomes. This model was tested against two alternative models. The proposed model showed a better fit to the data compared to the alternative models. In this model, psychological well-being mediated the relationship between BII (harmony) and coping strategies, except social support seeking. These findings highlight the important role played by BII in emergency situations, as it may indirectly, through enhancement of psychological well-being, contribute to enhance biculturals' adaptive reactions in terms of distress as well as affect coping strategies during highly stressful events.
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Affiliation(s)
- Soraya Elizabeth Shamloo
- Faculty of Medicine, University of Modena and Reggio Emila, Viale A. Allegri 9, 42121 Reggio Emilia, Italy
| | - Veronica Margherita Cocco
- Department of Humanities, Social Sciences and Cultural Industries, University of Parma, Borgo Carissimi, 10, 43121 Parma, Italy
| | - Martina Faccini
- Department of Human Sciences, University of Verona, via San Francesco 22, 35127 Verona, Italy
| | - Verónica Benet-Martínez
- Department of Political and Social Sciences, ICREA & Pompeu Fabra University, Ramon Trias Fargas, 25-27, 08005 Barcelona, Spain
| | - Elena Trifiletti
- Department of Human Sciences, University of Verona, via San Francesco 22, 35127 Verona, Italy
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17
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Irizar P, Pan D, Kapadia D, Bécares L, Sze S, Taylor H, Amele S, Kibuchi E, Divall P, Gray LJ, Nellums LB, Katikireddi SV, Pareek M. Ethnic inequalities in COVID-19 infection, hospitalisation, intensive care admission, and death: a global systematic review and meta-analysis of over 200 million study participants. EClinicalMedicine 2023; 57:101877. [PMID: 36969795 PMCID: PMC9986034 DOI: 10.1016/j.eclinm.2023.101877] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 02/02/2023] [Accepted: 02/02/2023] [Indexed: 03/08/2023] Open
Abstract
Background COVID-19 has exacerbated existing ethnic inequalities in health. Little is known about whether inequalities in severe disease and deaths, observed globally among minoritised ethnic groups, relates to greater infection risk, poorer prognosis, or both. We analysed global data on COVID-19 clinical outcomes examining inequalities between people from minoritised ethnic groups compared to the ethnic majority group. Methods Databases (MEDLINE, EMBASE, EMCARE, CINAHL, Cochrane Library) were searched from 1st December 2019 to 3rd October 2022, for studies reporting original clinical data for COVID-19 outcomes disaggregated by ethnicity: infection, hospitalisation, intensive care unit (ICU) admission, and mortality. We assessed inequalities in incidence and prognosis using random-effects meta-analyses, with Grading of Recommendations Assessment, Development, and Evaluation (GRADE) use to assess certainty of findings. Meta-regressions explored the impact of region and time-frame (vaccine roll-out) on heterogeneity. PROSPERO: CRD42021284981. Findings 77 studies comprising over 200,000,000 participants were included. Compared with White majority populations, we observed an increased risk of testing positive for infection for people from Black (adjusted Risk Ratio [aRR]:1.78, 95% CI:1.59-1.99, I2 = 99.1), South Asian (aRR:3.00, 95% CI:1.59-5.66, I2 = 99.1), Mixed (aRR:1.64, 95% CI:1.02-1.67, I2 = 93.2) and Other ethnic groups (aRR:1.36, 95% CI:1.01-1.82, I2 = 85.6). Black, Hispanic, and South Asian people were more likely to be seropositive. Among population-based studies, Black and Hispanic ethnic groups and Indigenous peoples had an increased risk of hospitalisation; Black, Hispanic, South Asian, East Asian and Mixed ethnic groups and Indigenous peoples had an increased risk of ICU admission. Mortality risk was increased for Hispanic, Mixed, and Indigenous groups. Smaller differences were seen for prognosis following infection. Following hospitalisation, South Asian, East Asian, Black and Mixed ethnic groups had an increased risk of ICU admission, and mortality risk was greater in Mixed ethnic groups. Certainty of evidence ranged from very low to moderate. Interpretation Our study suggests that systematic ethnic inequalities in COVID-19 health outcomes exist, with large differences in exposure risk and some differences in prognosis following hospitalisation. Response and recovery interventions must focus on tackling drivers of ethnic inequalities which increase exposure risk and vulnerabilities to severe disease, including structural racism and racial discrimination. Funding ESRC:ES/W000849/1.
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Affiliation(s)
- Patricia Irizar
- School of Social Sciences, University of Manchester, United Kingdom
| | - Daniel Pan
- Department of Respiratory Sciences, University of Leicester, United Kingdom
- Department of Infection and HIV Medicine, University Hospitals Leicester NHS Trust, United Kingdom
- Li Ka Shing Centre for Health Information and Discovery, Oxford Big Data Institute, University of Oxford, United Kingdom
- NIHR Leicester Biomedical Research Centre, United Kingdom
| | - Dharmi Kapadia
- School of Social Sciences, University of Manchester, United Kingdom
| | - Laia Bécares
- Department of Global Health and Social Medicine, King's College London, United Kingdom
| | - Shirley Sze
- Department of Cardiovascular Sciences, University of Leicester, United Kingdom
| | - Harry Taylor
- School of Social Sciences, University of Manchester, United Kingdom
| | - Sarah Amele
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, United Kingdom
| | - Eliud Kibuchi
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, United Kingdom
| | - Pip Divall
- University Hospitals of Leicester, Education Centre Library, Glenfield Hospital and Leicester Royal Infirmary, United Kingdom
| | - Laura J Gray
- Department of Health Sciences, University of Leicester, United Kingdom
| | - Laura B Nellums
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, United Kingdom
| | | | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester, United Kingdom
- Department of Infection and HIV Medicine, University Hospitals Leicester NHS Trust, United Kingdom
- NIHR Leicester Biomedical Research Centre, United Kingdom
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18
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Mazzalai E, Giannini D, Tosti ME, D’Angelo F, Declich S, Jaljaa A, Caminada S, Turatto F, De Marchi C, Gatta A, Angelozzi A, Marchetti G, Pizzarelli S, Marceca M. Risk of Covid-19 Severe Outcomes and Mortality in Migrants and Ethnic Minorities Compared to the General Population in the European WHO Region: a Systematic Review. JOURNAL OF INTERNATIONAL MIGRATION AND INTEGRATION 2023; 24:1-31. [PMID: 36647529 PMCID: PMC9833641 DOI: 10.1007/s12134-023-01007-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2022] [Indexed: 01/13/2023]
Abstract
The Covid-19 pandemic has had a major impact on migrants and ethnic minorities (MEMs). Socio-economic factors and legal, administrative and language barriers are among the reasons for this increased susceptibility. The aim of the study is to investigate the impact of Covid-19 on MEMs compared to the general population in terms of serious outcomes. We conducted a systematic review collecting studies on the impact of Covid-19 on MEMs compared to the general population in the WHO European Region regarding hospitalisation, intensive care unit (ICU) admission and mortality, published between 01/01/2020 and 19/03/2021. Nine researchers were involved in selection, study quality assessment and data extraction. Of the 82 studies included, 15 of the 16 regarding hospitalisation for Covid-19 reported an increased risk for MEMs compared to the white and/or native population and 22 out of the 28 studies focusing on the ICU admission rates found an increased risk for MEMs. Among the 65 studies on mortality, 43 report a higher risk for MEMs. An increased risk of adverse outcomes was reported for MEMs. Social determinants of health are among the main factors involved in the genesis of health inequalities: a disadvantaged socio-economic status, a framework of structural racism and asymmetric access to healthcare are linked to increased susceptibility to the consequences of Covid-19. These findings underline the need for policymakers to consider the socio-economic barriers when designing prevention plans. Supplementary Information The online version contains supplementary material available at 10.1007/s12134-023-01007-x.
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Affiliation(s)
- Elena Mazzalai
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Dara Giannini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
- Italian Society of Migration Medicine (SIMM), Rome, Italy
| | - Maria Elena Tosti
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Franca D’Angelo
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Silvia Declich
- Italian Society of Migration Medicine (SIMM), Rome, Italy
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Anissa Jaljaa
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Susanna Caminada
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
- Italian Society of Migration Medicine (SIMM), Rome, Italy
| | - Federica Turatto
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Chiara De Marchi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Angela Gatta
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Aurora Angelozzi
- Department for Organisational Development, Local Health Unit Roma 1, Rome, Italy
| | - Giulia Marchetti
- Italian Society of Migration Medicine (SIMM), Rome, Italy
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Scilla Pizzarelli
- Knowledge Unit, Documentation and Library, Istituto Superiore di Sanità, Rome, Italy
| | - Maurizio Marceca
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
- Italian Society of Migration Medicine (SIMM), Rome, Italy
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19
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P PMM, Degli Antoni M, Formenti B, Viola F, Castelli F, Amadasi S, Quiros-Roldan E. Characteristics of the population with mild COVID-19 symptoms eligible for early treatment attended in a single center in Northern Italy. J Infect Public Health 2022; 16:104-106. [PMCID: PMC9724552 DOI: 10.1016/j.jiph.2022.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 11/08/2022] [Accepted: 11/20/2022] [Indexed: 12/12/2022] Open
Abstract
After more than two years from the first COVID-19 detected case in Brescia, Northern Italy, monoclonal antibodies and antiviral therapy aimed at early treatment of mild COVID-19 in patients at risk of progression and of hospitalization has been approved in Italy. Here we report the characteristics of the population eligible for the COVID-19 early treatments at our COVID-19 Early Therapy Unit of the Infectious Diseases Department of the ASST Spedali Civili of Brescia, with the aim to evaluate the characteristics of the foreign and native groups. Up to March the 31st, 2022, a total of 559 patients were referred to our Unit for COVID-19 early treatment, where 7.6% were foreigners, a group significantly younger than natives (p<0.05). Particular differences are noticed between the native and the foreign population, where people aged > 65 years old were significantly more frequent among italians (39.7% vs 16.3%, p<0.01), while primary or acquired immunodeficiencies were more frequent in foreigners (55.8% vs 38.9%, p=0.03). Substantial differences are noted between native and foreign populations, where 14% and 26% (p<0.05) respectively have never been vaccinated for COVID-19. Overall, 71% of the referred patients received an early treatment for mild COVID-19, with no differences between the two groups. Overall, on day 28 after treatment, 23 (4%) patients had been hospitalized due to COVID-19 related complications and four died (0,7%), no one was foreigner. In conclusion, while the treatment offered for mild COVID-19 appears to be rather uniform between the native and the foreign populations, some differences, especially in preventive vaccination COVID-19, must be taken into account.
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Affiliation(s)
- Paola Magro Magro P
- U.O. Malattie Infettive, ASST Spedali Civili di Brescia e Università degli Studi di Brescia,Corresponding author
| | - M Degli Antoni
- U.O. Malattie Infettive, ASST Spedali Civili di Brescia e Università degli Studi di Brescia
| | - B Formenti
- Cattedra UNESCO “Formazione e rinforzo delle risorse umane per lo sviluppo sanitario nei Paesi a risorse limitate”, Università degli Studi di Brescia, Italia
| | - F Viola
- U.O. Malattie Infettive, ASST Spedali Civili di Brescia e Università degli Studi di Brescia
| | - F Castelli
- U.O. Malattie Infettive, ASST Spedali Civili di Brescia e Università degli Studi di Brescia,Cattedra UNESCO “Formazione e rinforzo delle risorse umane per lo sviluppo sanitario nei Paesi a risorse limitate”, Università degli Studi di Brescia, Italia
| | - S Amadasi
- U.O. Malattie Infettive, ASST Spedali Civili di Brescia e Università degli Studi di Brescia
| | - E Quiros-Roldan
- U.O. Malattie Infettive, ASST Spedali Civili di Brescia e Università degli Studi di Brescia
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20
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Immordino P, Graci D, Casuccio A, Restivo V, Mazzucco W. COVID-19 Vaccination in Migrants and Refugees: Lessons Learnt and Good Practices. Vaccines (Basel) 2022; 10:vaccines10111965. [PMID: 36423059 PMCID: PMC9692740 DOI: 10.3390/vaccines10111965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/24/2022] [Accepted: 11/11/2022] [Indexed: 11/22/2022] Open
Abstract
The COVID-19 pandemic has exacerbated inequalities between low- and high-income countries. Within the latter, a greater impact is seen in the poorest and most vulnerable people, including refugees, asylum seekers, and migrants. They all may experience poor access to quality healthcare or have suboptimal health-seeking behavior, distrust of governments, or fear of detention and deportation if seeking healthcare. Some refugees and migrants may face multiple barriers to vaccination and access to health systems that are relevant to the administration of COVID-19 vaccines, despite the growing inclusion of these populations in public health policies. Several good practices have emerged to ensure the inclusion of these populations in vaccination and healthcare for COVID-19 globally. However, inequalities persist between high-income and low-/middle-income populations. The inequalities in COVID-19 vaccination reflect the already existing ones in common health services worldwide. Further efforts are necessary to reduce such disparities, to protect the vulnerable, and, by extension, the general population. The initiatives organized, both at global and local levels, to support vaccination campaigns represent a notable example of how complex multilevel structures, such as health systems, as well as limited resource health services, can successfully face, even during a health emergency, the challenges related to global health issues.
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21
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Passos-Castilho AM, Labbé AC, Barkati S, Luong ML, Dagher O, Maynard N, Tutt-Guérette MA, Kierans J, Rousseau C, Benedetti A, Azoulay L, Greenaway C. Outcomes of hospitalized COVID-19 patients in Canada: impact of ethnicity, migration status and country of birth. J Travel Med 2022; 29:6567954. [PMID: 35417000 PMCID: PMC9047205 DOI: 10.1093/jtm/taac041] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ethnoracial groups in high-income countries have a 2-fold higher risk of SARS-CoV-2 infection, associated hospitalizations, and mortality than Whites. Migrants are an ethnoracial subset that may have worse COVID-19 outcomes due to additional barriers accessing care, but there are limited data on in-hospital outcomes. We aimed to disaggregate and compare COVID-19 associated hospital outcomes by ethnicity, immigrant status and region of birth. METHODS Adults with community-acquired SARS-CoV-2 infection, hospitalized March 1-June 30, 2020, at four hospitals in Montréal, Quebec, Canada, were included. Age, sex, socioeconomic status, comorbidities, migration status, region of birth, self-identified ethnicity [White, Black, Asian, Latino, Middle East/North African], intensive care unit (ICU) admissions and mortality were collected. Adjusted hazard ratios (aHR) for ICU admission and mortality by immigrant status, ethnicity and region of birth adjusted for age, sex, socioeconomic status and comorbidities were estimated using Fine and Gray competing risk models. RESULTS Of 1104 patients (median [IQR] age, 63.0 [51.0-76.0] years; 56% males), 57% were immigrants and 54% were White. Immigrants were slightly younger (62 vs 65 years; p = 0.050), had fewer comorbidities (1.0 vs 1.2; p < 0.001), similar crude ICU admissions rates (33.0% vs 28.2%) and lower mortality (13.3% vs 17.6%; p < 0.001) than Canadian-born. In adjusted models, Blacks (aHR 1.39, 95% confidence interval 1.05-1.83) and Asians (1.64, 1.15-2.34) were at higher risk of ICU admission than Whites, but there was significant heterogeneity within ethnic groups. Asians from Eastern Asia/Pacific (2.15, 1.42-3.24) but not Southern Asia (0.97, 0.49-1.93) and Caribbean Blacks (1.39, 1.02-1.89) but not SSA Blacks (1.37, 0.86-2.18) had a higher risk of ICU admission. Blacks had a higher risk of mortality (aHR 1.56, p = 0.049). CONCLUSIONS Data disaggregated by region of birth identified subgroups of immigrants at increased risk of COVID-19 ICU admission, providing more actionable data for health policymakers to address health inequities.
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Affiliation(s)
- Ana Maria Passos-Castilho
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
| | - Annie-Claude Labbé
- Division of Infectious Diseases, Department of Medicine, Hôpital Maisonneuve-Rosemont, CIUSSS de l'Est-de-l'Île-de-Montréal, Montreal, QC, Canada.,Department of Microbiology, Infectiology and Immunology, Université de Montréal, Montreal, QC, Canada
| | - Sapha Barkati
- Division of Infectious Diseases, Department of Medicine, McGill University Health Center (MUHC), McGill University, Montreal, QC, Canada.,Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Department of Medicine, McGill University, Montreal, QC, Canada
| | - Me-Linh Luong
- Department of Microbiology, Infectiology and Immunology, Université de Montréal, Montreal, QC, Canada.,Department of Medical Microbiology and Infectiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Olina Dagher
- Department of Biomedical Sciences, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Noémie Maynard
- Department of Medicine, McGill University, Montreal, QC, Canada
| | | | - James Kierans
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
| | - Cecile Rousseau
- Department of Psychiatry, McGill University Health Center, McGill University, Montreal, QC, Canada.,SHERPA University Institute, CIUSSS du Centre-Ouest-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Andrea Benedetti
- SHERPA University Institute, CIUSSS du Centre-Ouest-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Laurent Azoulay
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada.,Departments of Medicine and Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Christina Greenaway
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada.,Department of Medicine, McGill University, Montreal, QC, Canada.,Departments of Medicine and Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.,Division of Infectious Disease, Jewish General Hospital, 3755 Côte St. Catherine Road, Room G-200, Montreal, QC H3T 1E2, Canada
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22
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Nese A. Migrations in Italy and Perceptions of Ethnic Threat. JOURNAL OF INTERNATIONAL MIGRATION AND INTEGRATION 2022; 24:1-30. [PMID: 36159032 PMCID: PMC9483359 DOI: 10.1007/s12134-022-00985-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2022] [Indexed: 11/17/2022]
Abstract
This work investigates anti-immigrant sentiment in Italy and to what extent any "perceived ethnic threat" is influenced by the actual presence of immigrants. Whereas previous studies in the Italian context provide evidence for various social and psychological explanations of anti-immigrant sentiment, this work underlines the role of economic factors focusing on competition theory as main theoretical explanation. The analysis examines microdata obtained from the European Social Survey and from the Labour Force Survey conducted in 2016. In line with the economic perspective, the results suggest that the percentage of unemployed immigrants-rather than just the number of immigrants-significantly increases natives' perceptions of an "ethnic threat."
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Affiliation(s)
- Annamaria Nese
- Department of Economics and Statistics, CELPE, University of Salerno, Via Giovanni Paolo II, 132 - 84084 Fisciano (SA), Italy
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23
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Darwish I, Harrison LB, Passos-Castilho AM, Labbé AC, Barkati S, Luong ML, Kong LY, Tutt-Guérette MA, Kierans J, Rousseau C, Benedetti A, Azoulay L, Greenaway C. In-hospital outcomes of SARS-CoV-2-infected health care workers in the COVID-19 pandemic first wave, Quebec, Canada. PLoS One 2022; 17:e0272953. [PMID: 36001588 PMCID: PMC9401164 DOI: 10.1371/journal.pone.0272953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/28/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Health care workers (HCW), particularly immigrants and ethnic minorities are at increased risk for SARS-CoV-2 infection. Outcomes during a COVID-19 associated hospitalization are not well described among HCW. We aimed to describe the characteristics of HCW admitted with COVID-19 including immigrant status and ethnicity and the associated risk factors for Intensive Care unit (ICU) admission and death.
Methods
Adults with laboratory-confirmed community-acquired COVID-19 hospitalized from March 1 to June 30, 2020, at four tertiary-care hospitals in Montréal, Canada were included. Demographics, comorbidities, occupation, immigration status, country of birth, ethnicity, workplace exposures, and hospital outcomes (ICU admission and death) were obtained through a chart review and phone survey. A Fine and Gray competing risk proportional hazards model was used to estimate the risk of ICU admission among HCW stratified by immigrant status and region of birth.
Results
Among 1104 included persons, 150 (14%) were HCW, with a phone survey participation rate of 68%. HCWs were younger (50 vs 64 years; p<0.001), more likely to be female (61% vs 41%; p<0.001), migrants (68% vs 55%; p<0.01), non-White (65% vs 41%; p<0.001) and healthier (mean Charlson Comorbidity Index of 0.3 vs 1.2; p<0.001) compared to non-HCW. They were as likely to be admitted to the ICU (28% vs 31%; p = 0.40) but were less likely to die (4% vs. 17%; p<0.001). Immigrant HCW accounted for 68% of all HCW cases and, compared to Canadian HCW, were more likely to be personal support workers (PSW) (54% vs. 33%, p<0.01), to be Black (58% vs 4%) and to work in a Residential Care Facility (RCF) (59% vs 33%; p = 0.05). Most HCW believed that they were exposed at work, 55% did not always have access to personal protective equipment (PPE) and 40% did not receive COVID-19-specific Infection Control (IPAC) training.
Conclusion
Immigrant HCW were particularly exposed to COVID-19 infection in the first wave of the pandemic in Quebec. Despite being young and healthy, one third of all HCW required ICU admission, highlighting the importance of preventing workplace transmission through strong infection prevention and control measures, including high COVID-19 vaccination coverage.
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Affiliation(s)
- Ilyse Darwish
- Division of Infectious Diseases, McGill University, Montréal, Quebec, Canada
| | - Luke B. Harrison
- Division of Infectious Diseases, McGill University, Montréal, Quebec, Canada
| | - Ana Maria Passos-Castilho
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montréal, Quebec, Canada
| | - Annie-Claude Labbé
- Department of Medicine & Division of Infectious Diseases, Hôpital Maisonneuve-Rosemont, CIUSSS de l’Est-de-l’Île-de-Montréal, Montréal, Quebec, Canada
- Department of Microbiology, Infectiology and Immunology, Université de Montréal, Montréal, Quebec, Canada
- Département des Laboratoires de Biologie Médicale, Grappe Optilab-CHUM, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, Canada
| | - Sapha Barkati
- Department of Medicine & Division of Infectious Diseases, McGill University Health Center (MUHC), McGill University, Montréal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montréal, Quebec, Canada
- Department of Medicine, McGill University, Montréal, Quebec, Canada
| | - Me-Linh Luong
- Department of Microbiology, Infectiology and Immunology, Université de Montréal, Montréal, Quebec, Canada
- Département des Laboratoires de Biologie Médicale, Grappe Optilab-CHUM, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, Canada
- Department of Medicine & Division of Infectious Diseases CHUM, Montréal, Quebec, Canada
| | - Ling Yuan Kong
- Department of Medicine & Division of Infectious Diseases, Jewish General Hospital, McGill University, Montréal, Quebec, Canada
| | - Marc-Antoine Tutt-Guérette
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montréal, Quebec, Canada
| | - James Kierans
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montréal, Quebec, Canada
| | - Cécile Rousseau
- Department of Psychiatry, McGill University Health Center, McGill University, Montréal, Quebec, Canada
- SHERPA University Institute, CIUSSS du Centre-Ouest-de-l’Île-de-Montréal, Montréal, Quebec, Canada
| | - Andrea Benedetti
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Quebec, Canada
| | - Laurent Azoulay
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montréal, Quebec, Canada
- Department of Medicine, McGill University, Montréal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Quebec, Canada
| | - Christina Greenaway
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montréal, Quebec, Canada
- Department of Medicine, McGill University, Montréal, Quebec, Canada
- Department of Medicine & Division of Infectious Diseases, Jewish General Hospital, McGill University, Montréal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Quebec, Canada
- * E-mail:
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24
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Matlin SA, Smith AC, Merone J, LeVoy M, Shah J, Vanbiervliet F, Vandentorren S, Vearey J, Saso L. The Challenge of Reaching Undocumented Migrants with COVID-19 Vaccination. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19169973. [PMID: 36011606 PMCID: PMC9408401 DOI: 10.3390/ijerph19169973] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/28/2022] [Accepted: 08/04/2022] [Indexed: 05/02/2023]
Abstract
Access to vaccination against a health threat such as that presented by the COVID-19 pandemic is an imperative driven, in principle, by at least three compelling factors: (1) the right to health of all people, irrespective of their status; (2) humanitarian need of undocumented migrants, as well as of others including documented migrants, refugees and displaced people who are sometimes vulnerable and living in precarious situations; and (3) the need to ensure heath security globally and nationally, which in the case of a global pandemic requires operating on the basis that, for vaccination strategies to succeed in fighting a pandemic, the highest possible levels of vaccine uptake are required. Yet some population segments have had limited access to mainstream health systems, both prior to as well as during the COVID-19 pandemic. People with irregular resident status are among those who face extremely high barriers in accessing both preventative and curative health care. This is due to a range of factors that drive exclusion, both on the supply side (e.g., systemic and practical restrictions in service delivery) and the demand side (e.g., in uptake, including due to fears that personal data would be transmitted to immigration authorities). Moreover, undocumented people have often been at increased risk of infection due to their role as "essential workers", including those experiencing higher exposure to the SARS-CoV-2 virus due to frontline occupations while lacking protective equipment. Often, they have also been largely left out of social protection measures granted by governments to their populations during successive lockdowns. This article reviews the factors that serve as supply-side and demand-side barriers to vaccination for undocumented migrants and considers what steps need to be taken to ensure that inclusive approaches operate in practice.
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Affiliation(s)
- Stephen A. Matlin
- Institute of Global Health Innovation, Imperial College London, South Kensington, London SW7 2AZ, UK
- Correspondence: (S.A.M.); (J.M.)
| | - Alyna C. Smith
- Rue du Congrès/Congresstraat 37-41, P.O. Box 5, 1000 Brussels, Belgium
| | - Jessica Merone
- Human Rights Center, University of Padova, Via 8 Febbraio, 2, 35122 Padova, Italy
- Correspondence: (S.A.M.); (J.M.)
| | - Michele LeVoy
- Rue du Congrès/Congresstraat 37-41, P.O. Box 5, 1000 Brussels, Belgium
| | - Jalpa Shah
- Santé Publique France, 12 rue du Val d’Osne, CEDEX, 94415 Saint-Maurice, France
| | | | - Stéphanie Vandentorren
- Santé Publique France, 12 rue du Val d’Osne, CEDEX, 94415 Saint-Maurice, France
- INSERM UMR 1219-Bordeaux Population Health, University of Bordeaux, 33000 Bordeaux, France
| | - Joanna Vearey
- African Centre for Migration & Society (ACMS), University of the Witwatersrand, Johannesburg 2000, South Africa
| | - Luciano Saso
- Department of Physiology and Pharmacology, Sapienza University of Rome, 00185 Rome, Italy
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25
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Differences in the incidence and clinical outcomes of SARS-CoV-2 infection between Italian and non-Italian nationals using routine data. Public Health 2022; 211:136-143. [PMID: 36113199 PMCID: PMC9365864 DOI: 10.1016/j.puhe.2022.07.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 11/23/2022]
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26
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Berrou I, Hamilton K, Cook C, Armour C, Hughes S, Hancock J, Quigg S, Hajinur H, Srivastava S, Kenward C, Ali A, Hobbs L, Milani E, Walsh N. Leaving No One Behind: Interventions and Outcomes of the COVID-19 Vaccine Maximising Uptake Programme. Vaccines (Basel) 2022; 10:vaccines10060840. [PMID: 35746447 PMCID: PMC9227842 DOI: 10.3390/vaccines10060840] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/10/2022] [Accepted: 05/19/2022] [Indexed: 02/06/2023] Open
Abstract
The devastating impact of COVID-19 on individuals and communities has accelerated the development of vaccines and the deployment of ambitious vaccination programmes to reduce the risks of infection, infection transmission and symptom severity. However, many people delay or refuse to get vaccinated against COVID-19, for many complex reasons. Vaccination programmes that are tailored to address individual and communities’ COVID-19 concerns can improve vaccine uptake rates and help achieve the required herd-immunity threshold. The Maximising Uptake Programme has led to the vaccination of 7979 people from February–August 2021 in the South West of England, UK, who are at high risk of severe illness from COVID-19 and/or may not access the COVID-19 vaccines through mass vaccination centres and general practices. These include: people experiencing homelessness; non-English-speaking people; people from minority ethnic groups; refugees and asylum seekers; Gypsy, Roma, Travelers and boat people; and those who are less able to access vaccination centres, such as people with learning difficulties, serious mental illness, drug and alcohol dependence, people with physical and sensory impairment, and people with dementia. Outreach work coupled with a targeted communication and engagement campaign, co-designed with community leaders and influencers, have led to significant engagement and COVID-19 vaccine uptake among the target populations.
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Affiliation(s)
- Ilhem Berrou
- Glenside Campus, School of Health and Social Wellbeing, University of the West of England, Bristol BS16 1DD, UK;
- Correspondence: ; Tel.: +44-11732-84053
| | - Kathryn Hamilton
- South West England Public Health Training Scheme, First Floor, Park House, 1200 Bristol Parkway North, Newbrick Road, Bristol BS34 8YU, UK; (K.H.); (C.C.); (C.A.); (S.S.)
| | - Clare Cook
- South West England Public Health Training Scheme, First Floor, Park House, 1200 Bristol Parkway North, Newbrick Road, Bristol BS34 8YU, UK; (K.H.); (C.C.); (C.A.); (S.S.)
| | - Clare Armour
- South West England Public Health Training Scheme, First Floor, Park House, 1200 Bristol Parkway North, Newbrick Road, Bristol BS34 8YU, UK; (K.H.); (C.C.); (C.A.); (S.S.)
| | - Sian Hughes
- National Health Service (NHS) Bristol, North Somerset and South Gloucestershire CCG, 360 Bristol, Marlborough Street, Bristol BS1 3NX, UK; (S.H.); (J.H.); (S.Q.); (C.K.)
| | - Jude Hancock
- National Health Service (NHS) Bristol, North Somerset and South Gloucestershire CCG, 360 Bristol, Marlborough Street, Bristol BS1 3NX, UK; (S.H.); (J.H.); (S.Q.); (C.K.)
| | - Sally Quigg
- National Health Service (NHS) Bristol, North Somerset and South Gloucestershire CCG, 360 Bristol, Marlborough Street, Bristol BS1 3NX, UK; (S.H.); (J.H.); (S.Q.); (C.K.)
| | - Huda Hajinur
- Caafi Health, Unit 18, The Coach House, 2 Upper York Street, St Paul’s, Bristol BS2 8QN, UK;
| | - Seema Srivastava
- South West England Public Health Training Scheme, First Floor, Park House, 1200 Bristol Parkway North, Newbrick Road, Bristol BS34 8YU, UK; (K.H.); (C.C.); (C.A.); (S.S.)
| | - Charlie Kenward
- National Health Service (NHS) Bristol, North Somerset and South Gloucestershire CCG, 360 Bristol, Marlborough Street, Bristol BS1 3NX, UK; (S.H.); (J.H.); (S.Q.); (C.K.)
| | - Amjid Ali
- NHS Blood and Transplant 500, North Bristol Park, Filton, Bristol BS34 7QH, UK;
| | - Laura Hobbs
- Department of Applied Sciences, Frenchay Campus, University of the West of England, Bristol BS16 1QY, UK; (L.H.); (E.M.)
| | - Elena Milani
- Department of Applied Sciences, Frenchay Campus, University of the West of England, Bristol BS16 1QY, UK; (L.H.); (E.M.)
| | - Nicola Walsh
- Glenside Campus, School of Health and Social Wellbeing, University of the West of England, Bristol BS16 1DD, UK;
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27
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Sacco C, Petrone D, Del Manso M, Mateo-Urdiales A, Fabiani M, Bressi M, Bella A, Pezzotti P, Rota MC, Riccardo F. Risk and protective factors for SARS-CoV-2 reinfections, surveillance data, Italy, August 2021 to March 2022. EURO SURVEILLANCE : BULLETIN EUROPEEN SUR LES MALADIES TRANSMISSIBLES = EUROPEAN COMMUNICABLE DISEASE BULLETIN 2022; 27. [PMID: 35593164 PMCID: PMC9121659 DOI: 10.2807/1560-7917.es.2022.27.20.2200372] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We explored the risk factors associated with SARS-CoV-2 reinfections in Italy between August 2021 and March 2022. Regardless of the prevalent virus variant, being unvaccinated was the most relevant risk factor for reinfection. The risk of reinfection increased almost 18-fold following emergence of the Omicron variant compared with Delta. A severe first SARS-CoV-2 infection and age over 60 years were significant risk factors for severe reinfection.
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Affiliation(s)
- Chiara Sacco
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Daniele Petrone
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Martina Del Manso
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | | | - Massimo Fabiani
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Marco Bressi
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Antonino Bella
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Patrizio Pezzotti
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Maria Cristina Rota
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Flavia Riccardo
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
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- The members of the Italian Integrated Surveillance of COVID-19 study group are acknowledged at the end of the article
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28
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Fano V, Coviello E, Consonni D, Agresta A, Orsini N, Crielesi A, Miglietta AS, Pasqua C, Vairo F, Vivaldi F, De Angelis G, Colaiocco G, Fabiani M. COVID-19 vaccines coverage and effectiveness against SARS-CoV-2 infection among residents in the largest Health Authority of Lazio region (Italy): a population-based cohort study. Expert Rev Vaccines 2022; 21:1147-1157. [PMID: 35584901 DOI: 10.1080/14760584.2022.2080057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The waning of the protective effect of COVID-19 vaccines and timing of booster doses are debated. METHODS Population-based cohort study in the largest Health Authority of Lazio region, Italy, on 946,156 residents aged 12+ (study period: January 1, 2021-January 10, 2022). Vaccine Effectiveness (VE) against any SARS-CoV-2 infection (symptomatic or asymptomatic) was estimated through multivariable negative binomial models using unvaccinated person-time as reference. RESULTS The primary vaccination cycle was completed by 81% of residents; of these, 45% received a booster dose. Vaccine coverages were lower for foreigners, deprived areas, families with children aged 0-11, and households of size 1 or 6+. Overall, VE waned from 71% (95% Confidence Interval (CI) 70-73%) 1 month after the second dose to 43% (CI 41-45%) after 4 months and 24% (CI 21-27%) after 6 months, especially in the elderly aged 70+. We observed a prompt restore of VE 15-19 days after the booster dose (69%, CI 67-70%). CONCLUSIONS Our results showed effectiveness of a booster dose four months after completion of the primary cycle, and support the recommendation of prioritizing elderly and fragile individuals. The lower vaccine coverage among social disadvantaged subgroups suggests the need of targeted communication and interventions.
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Affiliation(s)
| | | | - Dario Consonni
- Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandro Agresta
- Regional Service for Epidemiology, Surveillance and Control of Infectious Diseases, Lazio Region, Italy
| | - Nicola Orsini
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | - Francesco Vairo
- Regional Service for Epidemiology, Surveillance and Control of Infectious Diseases, Lazio Region, Italy
| | | | | | | | - Massimo Fabiani
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
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29
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Epidemiological Characteristics of COVID-19 Cases in Non-Italian Nationals in Sicily: Identifying Vulnerable Groups in the Context of the COVID-19 Pandemic in Sicily, Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095767. [PMID: 35565161 PMCID: PMC9105146 DOI: 10.3390/ijerph19095767] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 02/06/2023]
Abstract
As in other parts of the world, undocumented migrants in Italy suffer worse health status due to their immigration enforcement situation and other vulnerabilities such as precarious illegal jobs, exploitation and abuse or barriers to higher education, with higher prevalence of chronic noncommunicable diseases. The COVID-19 pandemic, as other pandemics, has not affected everyone equally. The undocumented was one of the most affected groups with regard to hospitalization rates and mortality worldwide. Sicily is one of the gates of entrance to Europe for migrants and asylum seekers from Africa and Asia. Herein, we described the epidemiological characteristics of COVID-19 cases in Sicily to compare hospitalization rate and mortality between Italian nationals and foreigners. We extracted data from the integrated national surveillance system established by the Italian National Institute of Health (Istituto Superiore di Sanità, ISS) to collect information on all COVID-19 cases and deaths in Sicily. We found that the hospitalization rates were higher in undocumented foreigners, and they were most likely to present a more severe clinical outcome compared to Italian nationals. Inclusive public health policies should take this population group into consideration to achieve the Health for All goal.
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Ecological Model Explaining the Psychosocial Adaptation to COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095159. [PMID: 35564553 PMCID: PMC9099994 DOI: 10.3390/ijerph19095159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/08/2022] [Accepted: 04/22/2022] [Indexed: 01/27/2023]
Abstract
The main objective of this study is to understand and characterize the adoption of an ecological perspective and the physical, psychological, social, and contextual health factors that may influence the adjustment to and mental health experiences during the COVID-19 pandemic. The study included 5479 participants, of which 3710 were female (67.7%), aged between 18 and 90 years old, with a mean age of 48.57 years (SD = 14.29), were considered three age groups: 21.5% up to 35 years old, 61.8% between 36 and 64 years old, and 16.7% 65 years old or more. The mental health and individual adjustment to the COVID-19 situation are explained by socio-demographic factors, health-related factors, lifestyles, attitudes and behaviors, lockdown experience, and place of residence. A better adaptation and mental health are observed among men, people with a higher educational level, people with lower sadness, nervousness, and burnout, and people whose health situation did not worsen with the pandemic. In terms of lifestyle, a better adaptation is related to a better quality of sleep, fewer nightmares, a higher practice of physical activity, and less consumption of processed foods and sweets. A better adaptation is also associated with lower levels of dependence on alcohol, TV, and SN (social networks) and a more positive experience of the lockdown imposed by the pandemic. Gender and age group differences in the described context were studied. Promoting a better adjustment and improved mental health when dealing with the COVID-19 requires an ecological understanding and multitarget interventions, targeting physical, mental, and social health together with the contextual environment.
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Kumar BN, Hargreaves S, Agyemang C, James RA, Blanchet K, Gruer L. Reducing the impact of the coronavirus on disadvantaged migrants and ethnic minorities. Eur J Public Health 2021; 31:iv9-iv13. [PMID: 34751368 PMCID: PMC8576303 DOI: 10.1093/eurpub/ckab151] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Studies from several countries have shown that the COVID-19 pandemic has disproportionally affected migrants. Many have numerous risk factors making them vulnerable to infection and poor clinical outcome. Policies to mitigate this effect need to take into account public health principles of inclusion, universal health coverage and the right to health. In addition, the migrant health agenda has been compromised by the suspension of asylum processes and resettlement, border closures, increased deportations and lockdown of camps and excessively restrictive public health measures. International organizations including the World Health Organization and the World Bank have recommended measures to actively counter racism, xenophobia and discrimination by systemically including migrants in the COVID-19 pandemic response. Such recommendations include issuing additional support, targeted communication and reducing barriers to accessing health services and information. Some countries have had specific policies and outreach to migrant groups, including facilitating vaccination. Measures and policies targeting migrants should be evaluated, and good models disseminated widely.
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Affiliation(s)
- Bernadette N Kumar
- Norwegian Institute of Public Health, Folkehelseinstituttet, Oslo, Norway
| | - Sally Hargreaves
- Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
| | - Charles Agyemang
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Rosemary A James
- Lancet Migration European Regional Hub, Geneva Centre of Humanitarian Studies, Geneva, Switzerland
| | - Karl Blanchet
- Lancet Migration European Regional Hub, Geneva Centre of Humanitarian Studies, Geneva, Switzerland
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Diaz E, Mamelund SE, Eid J, Aasen HS, Martin Kaarbøe O, Brokstad RJC, Gloppen S, Beyer A, Kumar BN. Learning from the COVID-19 pandemic among migrants: An innovative, system-level, interdisciplinary approach is needed to improve public health. Scand J Public Health 2021; 49:804-808. [PMID: 34058901 PMCID: PMC8521362 DOI: 10.1177/14034948211019795] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/21/2021] [Accepted: 05/03/2021] [Indexed: 11/29/2022]
Abstract
The effects of the COVID-19 pandemic are amplified among socially vulnerable groups, including international migrants, in terms of both disease transmission and outcomes and the consequences of mitigation measures. Migrants are overrepresented in COVID-19 laboratory-confirmed cases, hospital admissions, intensive care treatment and death statistics in all countries with available data. A syndemic approach has been suggested to understand the excess burden in vulnerable populations. However, this has not stopped the unequal burden of disease in Norway. Initially, the disease was mainly imported by Norwegians returning from skiing holidays in the Alps, and the prevalence of infection among migrants in Norway, defined as people born abroad to foreign parents, was low. Later, confirmed cases in migrants increased and have remained stable at 35-50% - more than twice the proportion of the migrant population (15%). To change this pattern, we need to understand the complex mechanisms underlying inequities in health and their relative and multiplying impacts on disease inequalities and to test the effect of counterfactual policies in order to reduce inequalities in disease burden. Yet, the current paradigm in the field of migration and health research, that is, the theories, research methods and explanatory models commonly applied, fail to fully understand the differences in health outcomes between international migrants and the host population. Here, we use the Norwegian situation as a case to explain the need for an innovative, system-level, interdisciplinary approach at a global level.
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Affiliation(s)
- Esperanza Diaz
- Pandemic Centre, University of Bergen, Norway
- Department for Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Norway
- Unit for Migration and Health, Norwegian Institute of Public Health (FHI), Norway
| | | | - Jarle Eid
- Pandemic Centre, University of Bergen, Norway
- Centre for Crisis Psychology, University of Bergen, Norway
| | | | - Oddvar Martin Kaarbøe
- Pandemic Centre, University of Bergen, Norway
- Department for Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Norway
- Faculty of Social Sciences, University of Bergen, Norway
| | | | - Siri Gloppen
- Pandemic Centre, University of Bergen, Norway
- Department of Comparative Politics, Faculty of Social Sciences, University of Bergen, Norway
| | - Anders Beyer
- Pandemic Centre, University of Bergen, Norway
- Faculty of Fine Art, Music and Design, University of Bergen, Norway
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Corrao G, Cantarutti A, Monzio Compagnoni M, Franchi M, Rea F. Change in healthcare during Covid-19 pandemic was assessed through observational designs. J Clin Epidemiol 2021; 142:45-53. [PMID: 34715313 PMCID: PMC8547953 DOI: 10.1016/j.jclinepi.2021.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/16/2021] [Accepted: 10/19/2021] [Indexed: 12/27/2022]
Abstract
Objective Methodological challenges for investigating the changes in healthcare utilization during COVID-19 pandemic must be considered for obtaining unbiased estimates. Study design and setting A population-based study in the Lombardy region (Italy) measured the association between the level of epidemic restrictions (increasing exposure during pre-epidemic, post-lockdown, and lockdown periods) and the recommended healthcare (outcome) for patients with schizophrenia, heart failure, chronic obstructive pulmonary disease, breast cancer, and pregnancy women. Two designs are applied: the self-controlled case series (SCCS) and the usual cohort design. Adjustments for between-patients unmeasured confounders and seasonality of medical services delivering were performed. Results Compared with pre-epidemic, reductions in delivering recommended healthcare during lockdown up to 73% (95% confidence interval: 63%–80%) for timeliness of breast cancer surgery, and up to 20% (16%–23%) for appropriated gynecologic visit during pregnancy were obtained from SCCS and cohort design, respectively. Healthcare provision came back to pre-epidemic levels during the post-lockdown, with the exception of schizophrenic patients for whom the SCCS showed a reduction in continuity of care of 11% (11%–12%). Conclusion Strategies for investigating the changes in healthcare utilization during pandemic must be implemented. Recommendations for taking into account sources of systematic uncertainty are discussed and illustrated by using motivating examples.
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Affiliation(s)
- Giovanni Corrao
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy; Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Anna Cantarutti
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy; Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Matteo Monzio Compagnoni
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy; Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Matteo Franchi
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy; Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Federico Rea
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy; Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
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Hargreaves S, Hayward SE, Noori T, McKee M, Kumar B. COVID-19: counting migrants in. Lancet 2021; 398:211-212. [PMID: 34274061 PMCID: PMC8285119 DOI: 10.1016/s0140-6736(21)01339-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 06/09/2021] [Indexed: 12/22/2022]
Affiliation(s)
- Sally Hargreaves
- Migrant Health Research Group, St George's, University of London, London SW17 0QT, UK.
| | - Sally E Hayward
- Migrant Health Research Group, St George's, University of London, London SW17 0QT, UK; Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Teymur Noori
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Martin McKee
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
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Armocida B, Formenti B, Missoni E, D'Apice C, Marchese V, Calvi M, Castelli F, Ussai S. Challenges in the equitable access to COVID-19 vaccines for migrant populations in Europe. LANCET REGIONAL HEALTH-EUROPE 2021; 6:100147. [PMID: 34124708 PMCID: PMC8179687 DOI: 10.1016/j.lanepe.2021.100147] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Benedetta Armocida
- Institute for Maternal and Child Health - IRCCS “Burlo Garofolo” - Trieste, Italy
| | - Beatrice Formenti
- Saluteglobale.it Associazione di Promozione Sociale, Brescia, Italy
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Italy
- UNESCO Chair “Training and empowering human resources for health development in resource-limited countries” of University of Brescia, Brescia, Italy
- Corresponding author.
| | - Eduardo Missoni
- Saluteglobale.it Associazione di Promozione Sociale, Brescia, Italy
- Center for Research on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy
| | - Clelia D'Apice
- Saluteglobale.it Associazione di Promozione Sociale, Brescia, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Valentina Marchese
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Italy
| | - Marzia Calvi
- Saluteglobale.it Associazione di Promozione Sociale, Brescia, Italy
| | - Francesco Castelli
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Italy
- UNESCO Chair “Training and empowering human resources for health development in resource-limited countries” of University of Brescia, Brescia, Italy
| | - Silvia Ussai
- Saluteglobale.it Associazione di Promozione Sociale, Brescia, Italy
- World Health Organization (WHO), Geneva, Switzerland
- Fondazione “G. Gulotta”, Florence, Italy
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Hayward SE, Deal A, Cheng C, Crawshaw A, Orcutt M, Vandrevala TF, Norredam M, Carballo M, Ciftci Y, Requena-Méndez A, Greenaway C, Carter J, Knights F, Mehrotra A, Seedat F, Bozorgmehr K, Veizis A, Campos-Matos I, Wurie F, McKee M, Kumar B, Hargreaves S. Clinical outcomes and risk factors for COVID-19 among migrant populations in high-income countries: A systematic review. J Migr Health 2021; 3:100041. [PMID: 33903857 PMCID: PMC8061095 DOI: 10.1016/j.jmh.2021.100041] [Citation(s) in RCA: 142] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/07/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Migrants in high-income countries may be at increased risk of COVID-19 due to their health and social circumstances, yet the extent to which they are affected and their predisposing risk factors are not clearly understood. We did a systematic review to assess clinical outcomes of COVID-19 in migrant populations, indirect health and social impacts, and to determine key risk factors. METHODS We did a systematic review following PRISMA guidelines (PROSPERO CRD42020222135). We searched multiple databases to 18/11/2020 for peer-reviewed and grey literature on migrants (foreign-born) and COVID-19 in 82 high-income countries. We used our international networks to source national datasets and grey literature. Data were extracted on primary outcomes (cases, hospitalisations, deaths) and we evaluated secondary outcomes on indirect health and social impacts and risk factors using narrative synthesis. RESULTS 3016 data sources were screened with 158 from 15 countries included in the analysis (35 data sources for primary outcomes: cases [21], hospitalisations [4]; deaths [15]; 123 for secondary outcomes). We found that migrants are at increased risk of infection and are disproportionately represented among COVID-19 cases. Available datasets suggest a similarly disproportionate representation of migrants in reported COVID-19 deaths, as well as increased all-cause mortality in migrants in some countries in 2020. Undocumented migrants, migrant health and care workers, and migrants housed in camps have been especially affected. Migrants experience risk factors including high-risk occupations, overcrowded accommodation, and barriers to healthcare including inadequate information, language barriers, and reduced entitlement. CONCLUSIONS Migrants in high-income countries are at high risk of exposure to, and infection with, COVID-19. These data are of immediate relevance to national public health and policy responses to the pandemic. Robust data on testing uptake and clinical outcomes in migrants, and barriers and facilitators to COVID-19 vaccination, are urgently needed, alongside strengthening engagement with diverse migrant groups.
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Affiliation(s)
- Sally E Hayward
- Institute for Infection and Immunity, St George's University of London, London, UK
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Anna Deal
- Institute for Infection and Immunity, St George's University of London, London, UK
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Cherie Cheng
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - Alison Crawshaw
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - Miriam Orcutt
- Institute for Global Health, University College London, London, UK
| | | | - Marie Norredam
- Danish Research Centre for Migration, Ethnicity and Health, University of Copenhagen; Department of Infectious Diseases at Copenhagen University Hospital, Amager and Hvidovre, Copenhagen, Denmark
| | - Manuel Carballo
- International Centre for Migration, Health, and Development, Geneva, Switzerland
| | | | - Ana Requena-Méndez
- Department of Medicine, Karolinska Insitutet, Solna, Sweden; and Barcelona Insitute for Global Health (ISGlobal), University of Barcelona, Barcelona, Spain
| | | | - Jessica Carter
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - Felicity Knights
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - Anushka Mehrotra
- Institute for Infection and Immunity, St George's University of London, London, UK
| | | | - Kayvan Bozorgmehr
- Department of Population Medicine and Health and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany; Section for Health Equity Studies & Migration, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Ines Campos-Matos
- Public Health England; and UCL Collaborative Centre for Inclusion Health, London, UK
| | - Fatima Wurie
- Public Health England; and UCL Research Department of Epidemiology and Public Health, London, UK
| | - Martin McKee
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Sally Hargreaves
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - on behalf of the ESCMID Study Group for Infections in Travellers and Migrants (ESGITM)
- Institute for Infection and Immunity, St George's University of London, London, UK
- Institute for Global Health, University College London, London, UK
- Faculty of Business and Social Sciences, Kingston University, London, UK
- Danish Research Centre for Migration, Ethnicity and Health, University of Copenhagen; Department of Infectious Diseases at Copenhagen University Hospital, Amager and Hvidovre, Copenhagen, Denmark
- International Centre for Migration, Health, and Development, Geneva, Switzerland
- Doctors of the World UK, London, UK
- Department of Medicine, Karolinska Insitutet, Solna, Sweden; and Barcelona Insitute for Global Health (ISGlobal), University of Barcelona, Barcelona, Spain
- Department of Medicine, McGill University, Montreal, Canada
- Department of Population Medicine and Health and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany; Section for Health Equity Studies & Migration, Heidelberg University Hospital, Heidelberg, Germany
- Medecins Sans Frontieres Greece, Athens, Greece
- Public Health England, London, UK
- Public Health England; and UCL Collaborative Centre for Inclusion Health, London, UK
- Public Health England; and UCL Research Department of Epidemiology and Public Health, London, UK
- Norwegian Institute of Public Health, Oslo, Norway
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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SARS-CoV-2 infection and smoking: What is the association? A brief review. Comput Struct Biotechnol J 2021; 19:1654-1660. [PMID: 33777332 PMCID: PMC7985684 DOI: 10.1016/j.csbj.2021.03.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/12/2021] [Accepted: 03/20/2021] [Indexed: 02/06/2023] Open
Abstract
The link between smoking and the expression of SARS-CoV-2 key entry genes is discussed. Smoking-related cardiac and respiratory diseases are risk factors for COVID-19. The impact of smoking on ACE-2 and TMPRSS2 receptors expression is controversial.
Susceptibility to severe illness from COVID-19 is anticipated to be associated with cigarette smoking as it aggravates the risk of cardiovascular and respiratory illness, including infections. This is particularly important with the advent of a new strain of coronaviruses, the severe acute respiratory syndrome coronavirus (SARS-CoV-2) that has led to the present pandemic, coronavirus disease 2019 (COVID-19). Although, the effects of smoking on COVID-19 are less described and controversial, we presume a link between smoking and COVID-19. Smoking has been shown to enhance the expression of the angiotensin-converting enzyme-2 (ACE-2) and transmembrane serine protease 2 (TMPRSS2) key entry genes utilized by SARS-CoV-2 to infect cells and induce a ‘cytokine storm’, which further increases the severity of COVID-19 clinical course. Nevertheless, the impact of smoking on ACE-2 and TMPRSS2 receptors expression remains paradoxical. Thus, further research is necessary to unravel the association between smoking and COVID-19 and to pursue the development of potential novel therapies that are able to constrain the morbidity and mortality provoked by this infectious disease. Herein we present a brief overview of the current knowledge on the correlation between smoking and the expression of SARS-CoV-2 key entry genes, clinical manifestations, and disease progression.
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Key Words
- ACE2, angiotensin-converting enzyme-2
- ACEIs, Angiotensin‐converting enzyme inhibitors
- ADAM17, ADAM metallopeptidase domain 17
- ALCAM, activated leukocyte cell adhesion molecule
- ARBs, angiotensin receptor blockers
- ARDS, acute respiratory distress syndrome
- Ang, angiotensin
- BatCoV, bat coronavirus
- CLDN7, claudin 7
- COPD, chronic obstructive pulmonary disease
- COVID-19
- COVID-19, coronavirus disease 2019
- CTNNB1, catenin beta 1
- Coronavirus
- ERK, extracellular signal-regulated kinases
- HDAC6, histone deacetylase 6
- HIV-1, human immunodeficiency virus 1
- IFN, Interferons
- IPF, Idiopathic pulmonary fibrosis
- IR, Ionizing radiation
- JNK, c-Jun N-terminal kinase
- Lung disease
- MCN, mucin
- MERS, middle-East respiratory syndrome
- NO, nitric oxide
- Oral disease
- R0, R-nought
- RAS, renin-angiotensin
- RR, relative risk
- SARS-CoV-2
- SARS-CoV-2, severe acute respiratory syndrome coronavirus
- Smoking
- TJP3, tight junction protein 3
- TMPRSS, transmembrane serine protease
- hrsACE2, human recombinant soluble ACE-2
- nAChR, α7 nicotinic acetylcholine receptor
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