BackgroundMigrants, including refugees, asylum seekers, labour migrants, and undocumented migrants, now constitute a considerable proportion of most high-income countries’ populations, including their skilled and unskilled workforces. Migrants may be at increased risk of COVID-19 due to their health and social circumstances, yet the extent to which they are being 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 (cases, hospitalisations, deaths), indirect health and social impacts, and to determine key risk factors.MethodsWe did a systematic review following PRISMA guidelines, registered with PROSPERO (CRD42020222135). We searched databases including PubMed, Global Health, Scopus, CINAHL, and pre-print databases (medRxiv) via the WHO Global Research on COVID-19 database to Nov 18, 2020 for peer-reviewed and grey literature pertaining to migrants (defined as 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 our 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 and labour compounds may have been especially affected. In general, migrants have higher levels of many risk factors and vulnerabilities relevant to COVID-19, including increased exposure to SARS-CoV-2 due to high-risk occupations and overcrowded accommodation, and barriers to health care including inadequate information, language barriers, and reduced entitlement to healthcare coverage related to their immigration status.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 responses to the pandemic and should inform policymaking on strategies for reducing transmission of COVID-19 in this population. 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.
Background Migrants in high-income countries (HICs) may have been disproportionately affected by the COVID-19 pandemic, yet the extent to which they are impacted, and their predisposing risk factors, are not clearly understood. We did a systematic review to assess clinical outcomes, indirect health and social impacts, and key risk factors in migrants. Methods Our systematic review following PRISMA guidelines (PROSPERO CRD42020222135) identified peer-reviewed and grey literature relating to migrants (foreign-born) and COVID-19 in 82 HICs. Primary outcomes were cases, hospitalisations and deaths from COVID-19 involving migrants; secondary outcomes were indirect health and social impacts and risk factors. Results 3016 data sources were screened with 158 from 15 countries included in the analysis. We found migrants are at increased risk of SARS-CoV-2 infection and are over-represented among cases (e.g. constituting 42% of cases in Norway [to 27/4/2020], 26% in Denmark [to 7/9/2020], and 32% in Sweden [to 7/5/2020]); some datasets from Europe show migrants may be over-represented in deaths with 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, with certain nationality groups disproportionately impacted. Migrants experience a range of risk factors for COVID-19, including high-risk occupations, overcrowded accommodation, and barriers to healthcare including inadequate information, language barriers, and reduced entitlement. Conclusions Migrants in HICs are at high risk of COVID-19, with a range of specific risk factors that have not been well-considered in the public health response to date. These data are of immediate relevance to the policy response to the pandemic, with strategies urgently needed to reduce transmission. Migrant populations must also be better considered in national plans for COVID-19 vaccination roll-out. On behalf of ESGITM Key messages Migrants in high-income countries may be disproportionately represented in COVID-19 infections and deaths, with higher levels of many vulnerabilities and risk factors. Migrants must be better included in all aspects of the pandemic response, including vaccination roll-out.
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