Factors associated with SARS-CoV-2 infections among migrants in Germany

Abstract

Background International research shows increased risks for SARS-CoV-2 infection and severe disease progression in people with migration history. In Germany, data on this topic is scarce. Aim of this contribution is to examine the association between migrant status and risk of SARS-CoV-2 infection and discuss potential explanatory mechanisms. Methods We analysed data from the German COVID-19 Snapshot Monitoring online-survey and performed hierarchical multiple regression models to calculate probabilities for a self-reported SARS-CoV-2 infection. Main predictor variable was the migrant status; besides, the association with gender, age, education, household size, household language (German vs. other), and occupation in the health sector was analysed. Results Of 45,858 participants, 3.5% reported a current or previous infection with SARS-CoV-2, 16% reported own or parental history of migration. The probability of reporting an infection was 3.95 percentage points higher among migrants. The effect of different characteristics on self-reported SARS-CoV-2 infection varied. Higher probabilities were shown for individuals living in bigger households and those not speaking German at home. Stepwise integration decreased the observed association with migrant status. When adding an interaction term of migrant status and occupation in the health sector, the probability to report an infection was 11.5 percentage points higher for migrants working in the health sector. Conclusions People with migration history, health sector employees and particular migrant health workers are at a higher risk of SARS-CoV-2 infection. However, the migrant status itself does not determine the risk of infection, but the living and working conditions. Therefore, targeted and multilingual prevention measures are needed that consider living and working conditions. Key messages • Higher SARS-CoV-2 infection risks are not solely determined by migrant status, but were shown for health care workers, people living in bigger households and those not speaking German at home. • As not the migrant status determines infection risks, multilingual and targeted prevention measures considering the living and working conditions of people are necessary.

Migrant healthcare workers during COVID-19: bringing an intersectional health system-related approach into pandemic protection. A German case study

“…In Sweden, data illustrated the strongest disadvantage for HCWs from EU countries other than Sweden (66). German research looked more generally at migrant HCWs and revealed some disadvantages (45, 51, 52), but no coherent pattern could be identified.…”

“…The Canadian and Swedish studies and a few reports of international associations considered migrant HCWs more explicitly (67, 77). In Germany, we found overall three studies with some information on migrant HCWs (45, 51, 52), but one was only marginally related to HCWs and another one not specifically concerned with the situation during the COVID-19 pandemic.…”

“…Regarding the substance of inequalities, the scarcity of knowledge is even more serious. More than two third of the studies included in our analysis were concerned with just two major thematic areas: vaccination coverage and attitudes/hesitancy (55, 56, 57, 59, 60, 64), and infection and fear/risk of infection (51, 52, 53, 62, 63, 65). Disadvantages and discrimination were reported for all countries and both topics, except for one study in the UK that specifically investigated the persistence of vaccine hesitancy and did not identify significant differences related to an ethnic group (55).…”

“…In healthcare, professional and organisational settings are interconnected and inequalities created in one area may be reinforced in another. This was described, next to Brazil (17, 63) for Canada (65), Germany (45, 51, 52) and the UK (53, 54, 58, 61). For instance, disadvantages caused by lower PPE protection were strongest for lower status groups, e.g., hospital support worker (63), community healthcare workers (17), and HCWs working in residency care/long-term care (65).…”

“…Records with marginal information on our topic, as well as study protocols and mere opinion papers and editorials without substantive empirical data were also excluded. Finally, 19 articles were selected for the thematic analysis (17, 45, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67).…”