Abstract
BackgroundTo compare differences in the probability of COVID-19-related death between native Italians and immigrants hospitalised with COVID-19.MethodsThis retrospective study of prospectively collected data was conducted at the ASST Fatebenefratelli-Sacco Hospital in Milan, Italy, between 21 February and 31 November 2020. Uni- and multivariable Cox proportional hazard models were used to assess the impact of the patients' origin on the probability of COVID-19-related death.ResultsThe study population consisted of 1,179 COVID-19 patients: 921 Italians (78.1%) and 258 immigrants (21.9%) who came from Latin America (99, 38%), Asia (72, 28%), Africa (50, 19%) and central/eastern Europe (37, 14%). The Italians were significantly older than the immigrants (median age 70 years, interquartile range (IQR) 58–79 vs 51 years, IQR 41–60; p < 0.001), and more frequently had one or more co-morbidities (79.1% vs 53.9%; p < 0.001). Mortality was significantly greater among the Italians than the immigrants as a whole (26.6% vs 12.8%; p < 0.001), and significantly greater among the immigrants from Latin America than among those from Asia, Africa or central/eastern Europe (21% vs 8%, 6% and 8%; p = 0.016). Univariable analysis showed that the risk of COVID-19-related death was lower among the immigrants (hazard ratio [HR] 0.43, 95% confidence interval [CI] 0.30–0.63; p < 0.0001], but the risk of Latin American immigrants did not significantly differ from that of the Italians (HR 0.74, 95% CI 0.47–1.15; p = 0.183). However, after adjusting for potential confounders, multivariable analysis showed that there was no difference in the risk of death between the immigrants and the Italians (adjusted HR [aHR] 1.04, 95% CI 0.70–1.55; p = 0.831), but being of Latin American origin was independently associated with an increased risk of death (aHR 1.95, 95% CI 1.17–3.23; p = 0.010).ConclusionsMortality was lower among the immigrants hospitalised with COVID-19 than among their Italian counterparts, but this difference disappeared after adjusting for confounders. However, the increased risk of death among immigrants of Latin American origin suggests that COVID-19 information and prevention initiatives need to be strengthened in this sub-population.
Highlights
To compare differences in the probability of COVID-19-related death between native Italians and immigrants hospitalised with COVID-19
Giacomelli et al BMC Infectious Diseases (2022) 22:63 among immigrants of Latin American origin suggests that COVID-19 information and prevention initiatives need to be strengthened in this sub-population
An older age and age-related comorbidities are known to be strongly associated with increased COVID-19-related morbidity and mortality [3, 13, 14], and so it is not surprising that in-hospital mortality was greater among the Italians than among the immigrants as a whole or that this difference disappeared after adjusting for the potential confounders of age, biological sex, co-morbidities, and disease severity upon hospital admission
Summary
To compare differences in the probability of COVID-19-related death between native Italians and immigrants hospitalised with COVID-19. The Coronavirus Disease 2019 (COVID-19) pandemic caused by the newly identified severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) started to hit Europe in late February 2020, when there was an abrupt surge in the number of severely and critically ill respiratory patients in northern Italy, Lombardy [1]. The probability that people infected with SARS-CoV-2 will die is one of the most concerning aspects of the COVID-19 pandemic. Observational studies of hospitalised COVID-19 patients found that an older age, a higher co-morbidity burden, obesity, and disease severity upon hospital admission all markedly influenced the risk of death [3]. It has been observed that immigrants are at greater risk of exposure and infection than native populations, probably because they often work in high-risk occupations, live in overcrowded accommodation, and face barriers to healthcare and prevention initiatives [9, 10]. Some studies have found that immigrants with COVID-19 are at increased risk of hospitalisation [9, 10], but it is unclear whether this means that they are at increased risk of COVID-19-related death [11, 12]
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