Differences in mortality in Switzerland by citizenship during the first and second COVID-19 waves: Analysis of death statistics

Abstract

BackgroundEarly in the COVID-19 pandemic, it became apparent that members of marginalized populations and immigrants were also at risk of being hospitalized and dying more frequently from COVID-19. To examine how the pandemic affected underserved and marginalized populations, we analyzed data on changes in the number of deaths among people with and without Swiss citizenship during the first and second SARS-CoV-2 waves.MethodWe analyzed the annual number of deaths from the Swiss Federal Statistical Office from 2015 to 2020, and weekly data from January 2020 to May 2021 on deaths of permanent residents with and without Swiss citizenship, and we differentiated the data through subdivision into age groups.ResultsPeople without Swiss citizenship show a higher increase in the number of deaths in 2020 than those who were Swiss citizens. The increase in deaths compared to the previous year was almost twice as high for people without Swiss citizenship (21.8%) as for those with it (11.4%). The breakdown by age group indicates that among people between the ages of 64 and 75, those without Swiss citizenship exhibited an increase in mortality (21.6%) that was four times higher than that for people with Swiss citizenship (4.7%).ConclusionThis study confirms that a highly specialized health care system, as is found in Switzerland, does not sufficiently guarantee that all parts of the population will be equally protected in a health crisis such as COVID-19.

Inequalities in health outcomes of SARS-CoV-2 infection by migration status in Barcelona, Spain

“…The results on the geographical distribution of migrant patients in this study are similar to those of other studies carried out in Spain that show that a higher proportion of migrants come from the Americas Region, specifically from Latin America ( 20–24 , 30 ). This differs from the geographical origin of migrants living in other countries and could be explained by the shared language and historical colonial ties.…”

“…We found that a third of the patients with a SARS-CoV-2 infection who visited our hospital were migrants, which is a higher percentage than the ones reported in other studies ( 21 , 24 , 30 ). It also represents a higher percentage than the one of the migrant populations living in our hospital’s referral area ( 34 ).…”

“…Despite the widespread acknowledgement that migrants are at risk of worse health outcomes ( 16 , 19–24 ), especially during times of crises, lower mortality and SARS-CoV-2 severity can be partially explained by the “healthy migrant effect,” a theory which has been thoroughly discussed in literature ( 4 , 5 , 13 , 30–33 ). As in many other studies, we found that migrants were younger and had less comorbidities than natives, consistent with the abovementioned theory ( 13 , 14 , 19 , 23 , 24 ).…”

“…We could not confirm how long ago a migrant with Spanish nationality had been naturalised. Although we decided to define migration status by the country of birth, instead of the nationality because we believe inequalities and vulnerability do not completely disappear after naturalisation, we do believe that legal status is a factor that should also be explored in migrants ( 30 ).…”

“…We recognise that there are several other characteristics that interact with migration status and that we could not get information on. Data on the country or region of birth does not adequately reflect the extent of structural inequalities or if a patient belongs to an underserved or marginalised community ( 30 ). It was not possible to assume other sociocultural factors related to migration status, such as language barriers, religion, education, or ethnicity.…”