COVID-19 hits migrants, refugees especially hard, review shows

Migrants, refugees, and internally displaced people have an 84% higher COVID-19 infection rate and a 46% higher COVID death rate than the general population, a new systematic review and meta-analysis in EClinicalMedicine reveals.

“Even in the advanced stages of the pandemic, migrants faced higher infection risks and disproportionately suffered from the consequences of COVID-19 disease, including deaths,” the study authors wrote.

Complicated exacerbating factors

For the analysis, researchers from Germany, Sweden, and the Philippines combined data from 65 studies published by September 2023 that included more than 53 million people in 22 nations.

They found that, compared to non-migrants, migrants have an 84% higher risk of SARS-CoV-2 infection (relative risk [RR], 1.84; 95% confidence interval [CI], 1.44 to 2.35), about the same risk for hospitalization (RR, 1.10; 95% CI, 0.91 to 1.33), a 23% higher risk of intensive care unit admission (RR = 1.23; 95% CI, 0.99 to 1.52), and a 46% higher risk of COVID-related death overall (RR = 1.46; 95% CI, 0.95 to 2.26). In contrast, once hospitalized, their risk of death is 44% lower (RR = 0.56; 95% CI, 0.42 to 0.76).

Although only 8% of the included studies reported data on vaccination coverage in migrant groups, two thirds of these studies found lower immunization rates among migrants.

The investigators also performed a “qualitative” review of 75 papers to determine compounding factors. It showed that migrants often live in crowded housing, work in essential and high-risk jobs, and lack support from the government. Also, social norms can increase the risk, such as expectations to attend community events.

Several studies described discrepancies between the official health information provided and the actual living conditions of some migrant populations as a source of frustration and alienation.

“At the individual level,” the authors wrote, “the included studies identified unaffordability of personal protective equipment, low health literacy, and language barriers.”

Studies also reported insufficient health information in the appropriate language and distrust in institutions, including public health services. “Several studies described discrepancies between the official health information provided and the actual living conditions of some migrant populations as a source of frustration and alienation, which, in turn, could lead to an overall rejection of pandemic measures,” the authors noted.

Disparities persist throughout pandemic

“Migrants have been at an increased risk of contracting SARS-CoV-2 not only in the early phases, but throughout the entire pandemic,” said principal investigator Professor Kayvan Bozorgmehr, MD, from Bielefeld University in Bielefeld, Germany, in a university news release. 

“Migrants infected with SARS-CoV-2 were not hospitalized more often; but they more often experienced severe course of disease, which resulted in a higher number of admissions to intensive care units. While clinical deaths were lower among migrants—probably due to their younger average age—population-based mortality tended to be higher, especially in high-income countries.”

Bozorgmehr added, “National pandemic plans must adequately consider refugees, migrants and internally displaced persons.”

National pandemic plans must adequately consider refugees, migrants and internally displaced persons.

The analysis shines a spotlight on crucial information gaps. “Our study reveals that health information systems have significant gaps in capturing migration characteristics, which renders migrants invisible in official data,” said first author Maren Hintermeier, a doctoral student at Bielefeld University.

Dr Poonam Dhavan, director of the Migration Health Division at the International Organization for Migration who was not involved in the study, said, “The findings and solutions presented in this report can help policy makers and programme implementers develop strategies and interventions that not only promote equity for migrants, but also lead to better health protection for the entire population.”