Clinical outcomes and risk factors for COVID-19 among migrant populations in high-income countries: A systematic review

Sally E Hayward; Anna Deal; Cherie Cheng; Alison Crawshaw; Miriam Orcutt; Tushna F Vandrevala; Marie Norredam; Manuel Carballo; Yusuf Ciftci; Ana Requena-Méndez; Christina Greenaway; Jessica Carter; Felicity Knights; Anushka Mehrotra; Farah Seedat; Kayvan Bozorgmehr; Apostolos Veizis; Ines Campos-Matos; Fatima Wurie; Martin McKee; Bernadette Kumar; Sally Hargreaves; ESCMID Study Group for Infections in Travellers and Migrants (ESGITM)

doi:10.1016/j.jmh.2021.100041

Clinical outcomes and risk factors for COVID-19 among migrant populations in high-income countries: A systematic review

J Migr Health. 2021:3:100041. doi: 10.1016/j.jmh.2021.100041. Epub 2021 Apr 22.

Authors

Sally E Hayward^{1

2}, Anna Deal^{1

2}, Cherie Cheng¹, Alison Crawshaw¹, Miriam Orcutt³, Tushna F Vandrevala⁴, Marie Norredam⁵, Manuel Carballo⁶, Yusuf Ciftci⁷, Ana Requena-Méndez⁸, Christina Greenaway⁹, Jessica Carter¹, Felicity Knights¹, Anushka Mehrotra¹, Farah Seedat¹⁰, Kayvan Bozorgmehr¹¹, Apostolos Veizis¹², Ines Campos-Matos¹³, Fatima Wurie¹⁴, Martin McKee², Bernadette Kumar¹⁵, Sally Hargreaves¹; ESCMID Study Group for Infections in Travellers and Migrants (ESGITM)

Affiliations

¹ Institute for Infection and Immunity, St George's University of London, London, UK.
² Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
³ Institute for Global Health, University College London, London, UK.
⁴ Faculty of Business and Social Sciences, Kingston University, London, UK.
⁵ Danish Research Centre for Migration, Ethnicity and Health, University of Copenhagen; Department of Infectious Diseases at Copenhagen University Hospital, Amager and Hvidovre, Copenhagen, Denmark.
⁶ International Centre for Migration, Health, and Development, Geneva, Switzerland.
⁷ Doctors of the World UK, London, UK.
⁸ Department of Medicine, Karolinska Insitutet, Solna, Sweden; and Barcelona Insitute for Global Health (ISGlobal), University of Barcelona, Barcelona, Spain.
⁹ Department of Medicine, McGill University, Montreal, Canada.
¹⁰ Public Health England, London, UK.
¹¹ Department of Population Medicine and Health and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany; Section for Health Equity Studies & Migration, Heidelberg University Hospital, Heidelberg, Germany.
¹² Medecins Sans Frontieres Greece, Athens, Greece.
¹³ Public Health England; and UCL Collaborative Centre for Inclusion Health, London, UK.
¹⁴ Public Health England; and UCL Research Department of Epidemiology and Public Health, London, UK.
¹⁵ Norwegian Institute of Public Health, Oslo, Norway.

Abstract

Background: Migrants 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.

Methods: We 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.

Results: 3016 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.

Conclusions: Migrants 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.