Abstract
BackgroundMigrants 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. MethodsWe 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. Results3016 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. ConclusionsMigrants 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.
Highlights
The COVID-19 pandemic has highlighted the vast ethnic, social, economic and cultural diversity that has come to characterise contemporary high-income countries (HICs), and has served as a reminder of the growing rate of population movement between, as well as within, countries and the new public health opportunities and challenges this is presenting
Initial searches of databases and for grey literature identified 3016 records to screen; 158 of which were included in the final analysis (35 for primary outcomes, 123 for secondary outcomes) (Fig. 1)
The average quality appraisal score was 73.6%, with reports included in the primary outcomes having a slightly higher quality score on average than those included in the secondary outcomes (74.9% and 72.9%, respectively)
Summary
The COVID-19 pandemic has highlighted the vast ethnic, social, economic and cultural diversity that has come to characterise contemporary high-income countries (HICs), and has served as a reminder of the growing rate of population movement between, as well as within, countries and the new public health opportunities and challenges this is presenting. Data from several countries have revealed a much greater risk of infection and adverse outcomes from COVID-19 among Black, Asian, and Minority Ethnic [BAME] groups, South/East Asian, Black Americans, Hispanics, Latinos, racialised groups, people of colour, and indigenous groups compared to the native white population in the same countries (Sze and Nevill, 2020) These adverse outcomes are likely the result of a complex interaction of socioeconomic disadvantage influencing exposure to SARS-CoV-2 and underlying health status, that predisposes to severe illness (Public Health England 2020, Mathur et al, 2020), leading to calls to address the root causes of these inequalities and in the future. 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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