Refugees, internally displaced persons and migrants were exposed to significantly higher health risks during the Covid-19 pandemic than other population groups. A new study shows a 84 per cent higher risk of infection and a 46 per cent higher mortality rate among migrants compared to the general population. The findings are the result of extensive research led by Bielefeld University and realised in cooperation with the UN Migration Agency IOM and researchers from Heidelberg University Hospital and the Swedish universities of Uppsala and Umeå. The analysis, published in eClinicalMedicine as part of The Lancet Discovery Science, includes data from more than 53 million people, including both migrants and natives from 22 countries.
According to the study, systemic barriers often lead to poorer health outcomes for migrants. These include crowded living conditions, precarious working conditions and limited access to healthcare and social security.
Migrants persistently at higher risk
'Migrants have been at an increased risk of contracting SARS-CoV-2 not only in the early phases, but throughout the entire pandemic,' says the principal investigator Professor Dr Kayvan Bozorgmehr from Bielefeld University. '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.'
The authors conclude from the results of the study that health and social policies need to be more inclusive. 'National pandemic plans must adequately consider refugees, migrants and internally displaced persons,' says Bozorgmehr.
Gaps in health information systems impede accurate assessments
The study includes results from 370 empirical reports from 17,088 datasets worldwide, up to September 2023. It includes a meta-analysis of more than 53 million participants, considering studies on Covid-19 infection risk, hospitalisations, ICU admissions, mortality and vaccination rates among migrants.
'Our study reveals that health information systems have significant gaps in capturing migration characteristics, which renders migrants invisible in official data,' says Maren Hintermeier, first author of the study and doctoral student at Bielefeld University. The authors conclude that the lack of health information has impeded the accurate evaluation of health inequalities among migrants, and measures to reduce them. This was particularly evident in the case of inequalities in immunisation . Although only eight per cent of the included studies reported data on vaccination coverage in migrant groups, two-thirds of these studies found lower immunisation rates among migrants compared to non-migrants.
UN Migration Agency IOM emphasises the importance of the study results
'This global study demonstrates the impact of pandemics on migrants worldwide. It also points to effective strategies to better protect public health by including migrants in regional, national and global responses,' says Dr Poonam Dhavan, the Director of the Migration Health Division at the International Organization for Migration (IOM), the UN Migration Agency. '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. These lessons must not be forgotten in future health emergencies.'
The study was coordinated by the Rapid Review Response Unit (RRRUn) at the School of Public Health at Bielefeld University. This unit systematically collects and analyses evidence on health determinants and population-based interventions. The aim is to support evidence-based decisions in the healthcare system.
Published by 'eClinicalMedicine'
The study was published in the scientific journal 'eClinicalMedicine'. The magazine is part of The Lancet Discovery Science, a suite of open access journals, and focuses on clinical research and practice, from diagnosis and treatment to prevention and health promotion. According to the data service provider Clarivate, eClinicalMedicine is ranked 12th out of 325 journals in the 'General and Internal Medicine' category, with an impact factor of 9.6 (2023).
Original publication:
Maren Hintermeier, Nora Gottlieb, Sven Rohleder, Jan Oppenberg, Mazen Baroudi, Sweetmavourneen Pernitez-Agan, Janice Lopez, Sergio Flores, Amir Mohsenpour, Kolitha Wickramage, Kayvan Bozorgmehr: COVID-19 among migrants, refugees, and internally displaced persons: systematic review, meta-analysis and qualitative synthesis of the global empirical literature. The Lancet eClinicalMedicine, https://doi.org/10.1016/j.eclinm.2024.102698, published on 10 July 2024.
