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

BACKGROUND: Migrants are a vulnerable population at risk of worse health outcomes due to legal status, language barriers, and socioeconomic and cultural factors. Considering the conflicting literature on the subject, it is important to further explore the extent and nature of these inequalities. AIM: To compare health outcomes associated with SARS-CoV-2 infection between migrant population and Spanish natives living in Barcelona. METHODS: Observational retrospective cohort study including all adult cases of SARS-CoV-2 infection who visited a tertiary hospital in Barcelona between the 1st March 2020 and the 31st March 2022. We established five health outcomes: the presence of symptomatology, hospitalisation, intensive care unit (ICU) admission, use of mechanical ventilation (MV), and in-hospital 30-day mortality (IHM). Using Spanish natives as a reference, Odds Ratios (OR) with 95% CI were calculated for migrants by multivariate logistic regression and adjusted by sociodemographic and clinical factors. RESULTS: Of 11,589 patients (46.8% females), 3,914 were born outside of Spain, although 34.8% of them had legal citizenship. Most migrants were born in the Americas Region (20.3%), followed by other countries in Europe (17.2%). Migrants were younger than natives (median 43 [IQR 33-55] years vs 65 [49-78] years) and had a higher socioeconomic privation index, less comorbidities, and fewer vaccine doses. Adjusted models showed migrants were more likely to report SARS-CoV-2 symptomatology with an adjusted OR of 1.36 (95%CI 1.20-1.54), and more likely to be hospitalised (OR 1.11 [IC95% 1.00-1.23], p = 0.043), but less likely to experience IHM (OR 0.67 [IC95% 0.47-0.93], p = 0.02). CONCLUSIONS: Native population had higher odds of IHM, but migrants were more likely to be hospitalised. Although migrants tend to be younger and healthier, more of them presented to the hospital symptomatic. These results could suggest disparities in healthcare access for migrant population. KEY MESSAGES: • Characteristics of immigrant and native population differ greatly, which could be translated into different needs and health priorities. • More research on health disparities beyond COVID-19 in migrant populations is necessary to identify gaps in healthcare access and health literacy.