Inequalities in accessing COVID-19 healthcare for migrants and ethnic minorities: a systematic review

Abstract

Abstract The COVID19 pandemic has had a major impact on lower socioeconomic groups and minorities in terms of risk of SARS-CoV-2 infection, morbidity and mortality. It was defined as a syndemic because of its interaction with pre-existing socioeconomic determinants of health, worsening health outcomes. The study aims to investigate whether Migrants and Ethnic Minority populations (MEMs) faced more inequalities in access to prevention, diagnosis and treatment for COVID19 compared to the native population in the WHO European region. We conducted a systematic review searching the following databases: Medline, Embase, Biosis, Scisearch, Esbiobase. Quantitative and quali-quantitative studies on MEMs’ access to healthcare for COVID19 in the WHO European Region published from January 2020 to February 2022 were eligible. A total of 19 studies were included, around 65% of the studies were conducted in UK. Most studies (11) investigated vaccine hesitancy, five were about vaccine execution, three on access to information and to testing for COVID19. All studies reported greater vaccine hesitancy among the target population compared to white ethnicity and all of those investigating vaccination uptake pointed out that MEMs had lower odds of being vaccinated; finally, MEMs population resulted to face more difficulties in accessing COVID19 information and testing. These findings highlight the inequalities MEMs population faced accessing healthcare services for COVID19. Social determinants of health are one of the main factors involved in the genesis of health inequalities: a framework of structural racism leading to lower trust in government choices, together with a disadvantaged socio-economic status, determined inequalities in accessing healthcare services and health information. Our study underlines the need for policymakers to prioritize strategies for building trust and engage MEMs, and to overcome the socio-economic barriers when designing health promotion programs. Key messages • MEMs population faced higher barriers to the access to vaccination, turned out to be more vaccine hesitant and faced more difficulties in access to Covid-19 information and testing. • The study underlines the need of finding strategies for building trust and engage ethnic minorities, and to overcome the socio-economic barriers when designing health promotion programs.