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Pérez-Muto V, Bertran MJ, Barón-Miras L, Torá-Rocamora I, Gualda-Gea JJ, Vilella A. Inequalities in health outcomes of SARS-CoV-2 infection by migration status in Barcelona, Spain. Front Public Health 2024; 11:1297025. [PMID: 38259790 PMCID: PMC10800692 DOI: 10.3389/fpubh.2023.1297025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/29/2023] [Indexed: 01/24/2024] Open
Abstract
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. Objective The aim of this study is to compare health outcomes associated with SARS-CoV-2 infection between Spanish native and migrant population 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 the following five health outcomes: the presence of symptomatology, hospitalisation, intensive care unit admission, use of mechanical ventilation, and in-hospital 30-day mortality (IHM). Using Spanish natives as a reference, Odds Ratios (OR) with 95% confidence interval (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 < 0.05), but less likely to experience IHM (OR 0.67 [IC95% 0.47-0.93], p < 0.05). Conclusion Characteristics of migrant and native population differ greatly, which could be translated into different needs and health priorities. Native population had higher odds of IHM, but migrants were more likely to present to care symptomatic and to be hospitalised. This could suggest disparities in healthcare access for migrant population. More research on health disparities beyond SARS-CoV-2 in migrant populations is necessary to identify gaps in healthcare access and health literacy.
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Affiliation(s)
- Valeria Pérez-Muto
- Department of Preventive Medicine and Epidemiology, Clinical Institute of Medicine and Dermatology (ICMiD), Hospital Clínic, Barcelona, Spain
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Maria Jesús Bertran
- Department of Preventive Medicine and Epidemiology, Clinical Institute of Medicine and Dermatology (ICMiD), Hospital Clínic, Barcelona, Spain
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Lourdes Barón-Miras
- Department of Preventive Medicine and Epidemiology, Clinical Institute of Medicine and Dermatology (ICMiD), Hospital Clínic, Barcelona, Spain
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Isabel Torá-Rocamora
- Department of Preventive Medicine and Epidemiology, Clinical Institute of Medicine and Dermatology (ICMiD), Hospital Clínic, Barcelona, Spain
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Juan José Gualda-Gea
- Department of Preventive Medicine and Epidemiology, Clinical Institute of Medicine and Dermatology (ICMiD), Hospital Clínic, Barcelona, Spain
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Anna Vilella
- Department of Preventive Medicine and Epidemiology, Clinical Institute of Medicine and Dermatology (ICMiD), Hospital Clínic, Barcelona, Spain
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
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Irizar P, Pan D, Kapadia D, Bécares L, Sze S, Taylor H, Amele S, Kibuchi E, Divall P, Gray LJ, Nellums LB, Katikireddi SV, Pareek M. Ethnic inequalities in COVID-19 infection, hospitalisation, intensive care admission, and death: a global systematic review and meta-analysis of over 200 million study participants. EClinicalMedicine 2023; 57:101877. [PMID: 36969795 PMCID: PMC9986034 DOI: 10.1016/j.eclinm.2023.101877] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 02/02/2023] [Accepted: 02/02/2023] [Indexed: 03/08/2023] Open
Abstract
Background COVID-19 has exacerbated existing ethnic inequalities in health. Little is known about whether inequalities in severe disease and deaths, observed globally among minoritised ethnic groups, relates to greater infection risk, poorer prognosis, or both. We analysed global data on COVID-19 clinical outcomes examining inequalities between people from minoritised ethnic groups compared to the ethnic majority group. Methods Databases (MEDLINE, EMBASE, EMCARE, CINAHL, Cochrane Library) were searched from 1st December 2019 to 3rd October 2022, for studies reporting original clinical data for COVID-19 outcomes disaggregated by ethnicity: infection, hospitalisation, intensive care unit (ICU) admission, and mortality. We assessed inequalities in incidence and prognosis using random-effects meta-analyses, with Grading of Recommendations Assessment, Development, and Evaluation (GRADE) use to assess certainty of findings. Meta-regressions explored the impact of region and time-frame (vaccine roll-out) on heterogeneity. PROSPERO: CRD42021284981. Findings 77 studies comprising over 200,000,000 participants were included. Compared with White majority populations, we observed an increased risk of testing positive for infection for people from Black (adjusted Risk Ratio [aRR]:1.78, 95% CI:1.59-1.99, I2 = 99.1), South Asian (aRR:3.00, 95% CI:1.59-5.66, I2 = 99.1), Mixed (aRR:1.64, 95% CI:1.02-1.67, I2 = 93.2) and Other ethnic groups (aRR:1.36, 95% CI:1.01-1.82, I2 = 85.6). Black, Hispanic, and South Asian people were more likely to be seropositive. Among population-based studies, Black and Hispanic ethnic groups and Indigenous peoples had an increased risk of hospitalisation; Black, Hispanic, South Asian, East Asian and Mixed ethnic groups and Indigenous peoples had an increased risk of ICU admission. Mortality risk was increased for Hispanic, Mixed, and Indigenous groups. Smaller differences were seen for prognosis following infection. Following hospitalisation, South Asian, East Asian, Black and Mixed ethnic groups had an increased risk of ICU admission, and mortality risk was greater in Mixed ethnic groups. Certainty of evidence ranged from very low to moderate. Interpretation Our study suggests that systematic ethnic inequalities in COVID-19 health outcomes exist, with large differences in exposure risk and some differences in prognosis following hospitalisation. Response and recovery interventions must focus on tackling drivers of ethnic inequalities which increase exposure risk and vulnerabilities to severe disease, including structural racism and racial discrimination. Funding ESRC:ES/W000849/1.
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Affiliation(s)
- Patricia Irizar
- School of Social Sciences, University of Manchester, United Kingdom
| | - Daniel Pan
- Department of Respiratory Sciences, University of Leicester, United Kingdom
- Department of Infection and HIV Medicine, University Hospitals Leicester NHS Trust, United Kingdom
- Li Ka Shing Centre for Health Information and Discovery, Oxford Big Data Institute, University of Oxford, United Kingdom
- NIHR Leicester Biomedical Research Centre, United Kingdom
| | - Dharmi Kapadia
- School of Social Sciences, University of Manchester, United Kingdom
| | - Laia Bécares
- Department of Global Health and Social Medicine, King's College London, United Kingdom
| | - Shirley Sze
- Department of Cardiovascular Sciences, University of Leicester, United Kingdom
| | - Harry Taylor
- School of Social Sciences, University of Manchester, United Kingdom
| | - Sarah Amele
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, United Kingdom
| | - Eliud Kibuchi
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, United Kingdom
| | - Pip Divall
- University Hospitals of Leicester, Education Centre Library, Glenfield Hospital and Leicester Royal Infirmary, United Kingdom
| | - Laura J Gray
- Department of Health Sciences, University of Leicester, United Kingdom
| | - Laura B Nellums
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, United Kingdom
| | | | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester, United Kingdom
- Department of Infection and HIV Medicine, University Hospitals Leicester NHS Trust, United Kingdom
- NIHR Leicester Biomedical Research Centre, United Kingdom
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Abarca-Zabalía J, González-Jiménez A, Calle-Rubio M, López-Pastor AR, Fariña T, Ramos-Acosta C, Anguita E, Urcelay E, Espino-Paisán L. Alterations in the immune system persist after one year of convalescence in severe COVID-19 patients. Front Immunol 2023; 14:1127352. [PMID: 36860856 PMCID: PMC9969554 DOI: 10.3389/fimmu.2023.1127352] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 01/25/2023] [Indexed: 02/16/2023] Open
Abstract
Introduction Severe COVID-19 originates a myriad of alterations in the immune system during active disease, especially in the T and NK cell compartments, but several studies in the last year have unveiled some alterations that persist in convalescence. Although most of the studies follow the participants for a short recovery time, studies following patients up to three or six months still find alterations. We aimed at evaluating changes in the NK, T and B cell compartments after severe COVID-19 in participants with a median recovery time of eleven months. Methods Eighteen convalescent of severe COVID-19 (CSC), 14 convalescent of mild COVID-19 (CMC) and nine controls were recruited. NKG2A, NKG2C, NKG2D and the activating receptor NKp44 were evaluated in NKbright, NKdim and NKT subpopulations. In addition, CD3 and CD19 were measured and a basic biochemistry with IL-6 levels was obtained. Results CSC participants showed lower NKbright/NKdim ratio, higher NKp44 expression in NKbright subpopulations, higher levels of serum IL-6, lower levels of NKG2A+ T lymphocytes and a trend to a lower expression of CD19 in B lymphocytes compared to controls. CMC participants showed no significant alterations in the immune system compared to controls. Conclusions These results are concordant with previous studies, which find alterations in CSC weeks or months after resolution of the symptoms, and point to the possibility of these alterations lasting one year or more after COVID-19 resolution.
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Affiliation(s)
- Judith Abarca-Zabalía
- Laboratorio de Investigación en Genética de Enfermedades Complejas, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Adela González-Jiménez
- Laboratorio de Investigación en Genética de Enfermedades Complejas, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Myriam Calle-Rubio
- Department of Pneumology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Andrea R. López-Pastor
- Laboratorio de Investigación en Genética de Enfermedades Complejas, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain,*Correspondence: Andrea R. López-Pastor,
| | - Tomás Fariña
- Intensive Care Unit, Hospital Clínico San Carlos, Madrid, Spain
| | - Carlos Ramos-Acosta
- Department of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain,Hematology Department, Instituto de Medicina de Laboratorio, Instituto de Investigación Sanitaria San Carlos (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Eduardo Anguita
- Department of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain,Hematology Department, Instituto de Medicina de Laboratorio, Instituto de Investigación Sanitaria San Carlos (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Elena Urcelay
- Laboratorio de Investigación en Genética de Enfermedades Complejas, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Laura Espino-Paisán
- Laboratorio de Investigación en Genética de Enfermedades Complejas, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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Ramos-Rincon JM, Cobos-Palacios L, López-Sampalo A, Ricci M, Rubio-Rivas M, Martos-Pérez F, Lalueza-Blanco A, Moragón-Ledesma S, Fonseca-Aizpuru EM, García-García GM, Beato-Perez JL, Josa-Laorden C, Arnalich-Fernández F, Molinos-Castro S, Torres-Peña JD, Artero A, Vargas-Núñez JA, Mendez-Bailon M, Loureiro-Amigo J, Hernández-Garrido MS, Peris-García J, López-Reboiro ML, Barón-Franco B, Casas-Rojo JM, Gómez-Huelgas R. Ethnicity and Clinical Outcomes in Patients Hospitalized for COVID-19 in Spain: Results from the Multicenter SEMI-COVID-19 Registry. J Clin Med 2022; 11:1949. [PMID: 35407557 PMCID: PMC8999367 DOI: 10.3390/jcm11071949] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/26/2022] [Accepted: 03/28/2022] [Indexed: 02/05/2023] Open
Abstract
(1) Background: This work aims to analyze clinical outcomes according to ethnic groups in patients hospitalized for COVID-19 in Spain. (2) Methods: This nationwide, retrospective, multicenter, observational study analyzed hospitalized patients with confirmed COVID-19 in 150 Spanish hospitals (SEMI-COVID-19 Registry) from 1 March 2020 to 31 December 2021. Clinical outcomes were assessed according to ethnicity (Latin Americans, Sub-Saharan Africans, Asians, North Africans, Europeans). The outcomes were in-hospital mortality (IHM), intensive care unit (ICU) admission, and the use of invasive mechanical ventilation (IMV). Associations between ethnic groups and clinical outcomes adjusted for patient characteristics and baseline Charlson Comorbidity Index values and wave were evaluated using logistic regression. (3) Results: Of 23,953 patients (median age 69.5 years, 42.9% women), 7.0% were Latin American, 1.2% were North African, 0.5% were Asian, 0.5% were Sub-Saharan African, and 89.7% were European. Ethnic minority patients were significantly younger than European patients (median (IQR) age 49.1 (40.5−58.9) to 57.1 (44.1−67.1) vs. 71.5 (59.5−81.4) years, p < 0.001). The unadjusted IHM was higher in European (21.6%) versus North African (11.4%), Asian (10.9%), Latin American (7.1%), and Sub-Saharan African (3.2%) patients. After further adjustment, the IHM was lower in Sub-Saharan African (OR 0.28 (0.10−0.79), p = 0.017) versus European patients, while ICU admission rates were higher in Latin American and North African versus European patients (OR (95%CI) 1.37 (1.17−1.60), p < 0.001) and (OR (95%CI) 1.74 (1.26−2.41), p < 0.001). Moreover, Latin American patients were 39% more likely than European patients to use IMV (OR (95%CI) 1.43 (1.21−1.71), p < 0.001). (4) Conclusion: The adjusted IHM was similar in all groups except for Sub-Saharan Africans, who had lower IHM. Latin American patients were admitted to the ICU and required IMV more often.
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Affiliation(s)
| | - Lidia Cobos-Palacios
- Internal Medicine Department, Regional University Hospital of Málaga, Biomedical Research Institute of Málaga (IBIMA), 29010 Malaga, Spain; (L.C.-P.); (A.L.-S.); (M.R.); (R.G.-H.)
- Medicine Department, University of Málaga, 29010 Malaga, Spain
| | - Almudena López-Sampalo
- Internal Medicine Department, Regional University Hospital of Málaga, Biomedical Research Institute of Málaga (IBIMA), 29010 Malaga, Spain; (L.C.-P.); (A.L.-S.); (M.R.); (R.G.-H.)
- Medicine Department, University of Málaga, 29010 Malaga, Spain
| | - Michele Ricci
- Internal Medicine Department, Regional University Hospital of Málaga, Biomedical Research Institute of Málaga (IBIMA), 29010 Malaga, Spain; (L.C.-P.); (A.L.-S.); (M.R.); (R.G.-H.)
- Medicine Department, University of Málaga, 29010 Malaga, Spain
| | - Manuel Rubio-Rivas
- Department of Internal Medicine, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain;
| | | | | | - Sergio Moragón-Ledesma
- Internal Medicine Department, Gregorio Marañón General University Hospital, 28007 Madrid, Spain;
| | | | | | - Jose-Luis Beato-Perez
- Internal Medicine Department, Albacete University Hospital Complex, 02006 Albacete, Spain;
| | | | | | - Sonia Molinos-Castro
- Internal Medicine Department, Santiago de Compostela Clinic Hospital, 15706 Santiago de Compostela, Spain;
| | - José-David Torres-Peña
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, 14004 Cordoba, Spain;
- Spain CIBER Fisiopatologia de la Obesidad y la Nutricion, Carlos III Health Institute, 28029 Madrid, Spain
| | - Arturo Artero
- Internal Medicine Department, Doctor Peset University Hospital, 46017 Valencia, Spain;
| | - Juan-Antonio Vargas-Núñez
- Internal Medicine Department, Puerta de Hierro University Hospital, Instituto de Investigación Sanitaria Puerta de Hierro—Segovia de Arana, 28222 Madrid, Spain;
| | | | - Jose Loureiro-Amigo
- Internal Medicine Department, Moisès Broggi Hospital, 08970 Sant Joan Despí, Spain;
| | | | - Jorge Peris-García
- Internal Medicine Department, de Sant Joan d’Alacant University Clínic Hospital, 03550 Alicante, Spain;
| | | | - Bosco Barón-Franco
- Internal Medicine Department, University Hospital Virgen del Rocío, 41013 Sevilla, Spain;
| | - Jose-Manuel Casas-Rojo
- Internal Medicine Department, Infanta Cristina University Hospital, Parla, 28981 Madrid, Spain;
| | - Ricardo Gómez-Huelgas
- Internal Medicine Department, Regional University Hospital of Málaga, Biomedical Research Institute of Málaga (IBIMA), 29010 Malaga, Spain; (L.C.-P.); (A.L.-S.); (M.R.); (R.G.-H.)
- Medicine Department, University of Málaga, 29010 Malaga, Spain
- Spain CIBER Fisiopatologia de la Obesidad y la Nutricion, Carlos III Health Institute, 28029 Madrid, Spain
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