Impact of COVID-19 pandemic on incident diagnosis patterns in German refugee centres: quasi-experimental study, 2018-2023

Abstract

The COVID-19 pandemic may have affected morbidity patterns of residents in refugee centres, but empirical evidence is scarce. We utilised linked data from a health surveillance network in German refugee centres, employing a quasi-experimental design to examine the effects of the COVID-19 pandemic on newly diagnosed medical conditions. These diagnoses were coded in on-site healthcare facilities for refugee patients. Our analysis encompasses the timeframe from October 2018 to April 2023 and includes individual-level data for 109,175 refugees. This data resulted in 76,289 patient-months across 21 refugee centres, with a total occupancy of 144,012 person-months. We employed segmented regression analyses, adjusting for time trends, socio-demographic factors, centre occupancy, and centre-specific characteristics, to evaluate the COVID-19 pandemic's impact on incident diagnosis patterns among refugees. The COVID-19 pandemic significantly altered diagnosis patterns among refugees in German centres. Notably, incidents of injuries, mental disorders, psychotherapeutic drug prescriptions, and genitourinary diseases rose, while respiratory diseases decreased, later rebounding. An 88% increase in injury-related diagnoses suggests heightened violence experiences during flight or in centres. Mental disorder diagnoses and psychotherapeutic drug prescriptions rose by 73% and 95%, reflecting pandemic-related stressors in refugee centres, highlighting the pandemic's multifaceted impact on refugee health.