Migrant and ethnic minorities at higher risk of COVID-19 severe outcomes? A systematic review

Background

The Covid-19 pandemic has had a recognised impact in widening health inequalities, both between and within countries, with a major impact on socially disadvantaged population groups such as Migrants and Ethnic Minorities (MEMs). While there is growing evidence on the matter worldwide, data specific to the WHO European Region is scarce. The issue, however, is pressing, since it is estimated that almost 10% of the population living in the WHO European Region is made up of migrants. 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.

Methods

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. Fourteen researchers were involved in selection, study quality assessment, data extraction and analysis.

Results

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. 82% of the studies were conducted in the UK.

Conclusions

These findings highlight the disproportionate impact of Covid-19 on MEMs population, with an increased risk of all the adverse outcomes taken into consideration. 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 policy-makers to consider the socio-economic barriers when designing health promotion plans.

Key messages

• The combination of disadvantage socioeconomic conditions with COVID-19 transmission characteristics put migrants and ethnic minorities at a higher risk of facing sever health outcomes.

• The amount of evidence on the inequal impact of COVID-19 on migrants and ethnic minorities produced by European countries is poor. This gap must be filled to develop effective health promotion plans.

Perceived health and interaction with healthcare workers of a hard-to-reach group in a Roman suburb

 

Previous studies have showed that people living in Bastogi - a segregated and deprived peripheral area of Rome- have difficulties in accessing and relating to health services. Our aim was to analyze the health perception, health-related behaviors, and the interaction between healthcare professionals and the census population living in Bastogi, compared to the population living in the area of the same local health unit, ASL Roma 1 (hereafter ASL). The PASSI survey (from the Italian Surveillance System) was administered by phone and through door-to-door interviews to a sample of 210 residents of Bastogi. Data were analyzed and compared to the ones of the ASL collected in 2017-2018. Descriptive and univariate analysis were performed with STATA 13. P-values ≤ 0.05 were considered statistically significant. The socio-economic indicators, acknowledged determinants of health inequalities, showed a worse condition for the inhabitants of Bastogi. There was a significantly higher proportion of foreign and unemployed residents in Bastogi, with a lower educational level compared to the ASL. 58.1 % of the Bastogi group claimed their health to be good/very good (ASL: 71.6%; p = 0.000). 56.2% of the respondents from Bastogi were current smokers (ASL: 25.8%; p = 0.000). Risk factors for and prevalence of chronic diseases were significantly higher in Bastogi. The proportion of respondents who stated they had not had any recent contact with health professionals was significantly higher, and mammogram screening uptake was lower (75.3%; ASL: 90.4%; p = 0.001). Despite their lower help-seeking behavior, our study pointed out that the respondents from Bastogi who had had a contact with a health professional reported a higher perceived interest about their health than in the ASL. Further studies are needed to investigate whether this attention is attributable to the higher prevalence of chronic diseases or to the health professional's awareness of vulnerability of a hard-to-reach group.

Key messages

The population from Bastogi is marginalized and hard-to-reach: we found a worse overall self- reported health condition, a worse help-seeking behavior and a lack of reliance on health professionals. The PASSI survey administration has led to a greater involvement of the competent health institution, which resulted in the introduction of a community nurse and a Single Access Point.