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

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.

Social differences in COVID-19 vaccination rates–Findings from a German nationwide study

Background

The COVID-19 vaccination aims to prevent the transmission of the novel coronavirus (SARS-CoV-2) as well as to reduce severe courses of the disease and deaths. But various studies indicate social differences in willingness to be vaccinated. This study aims to examine the influence of different social determinants on COVID-19 vaccination in Germany.

Methods

The analyses are based on data from the sixth follow-up survey of the German Health Update (GEDA 2021), a nationwide cross-sectional telephone survey of the adult population living in Germany. COVID-19 vaccination rates are analyzed considering age, education, income, urban-rural residence and migration background. Poisson regressions were used to examine associations of each social determinant with COVID-19 vaccination rates. Adjustments were made for age, sex, (education) and date of participation.

Results

Overall, the rate of COVID-19 vaccination for the survey period was 86.7%, with significant differences in vaccination rate by social determinants. The vaccination rate increases significantly with age (94.2% for over 60-year-olds), higher level of education (91.5%) or income (93.0%). In addition, people living in rural areas in Germany (83.5%) and people with an own migration experience (79.1%) had a significantly lower vaccination rate. An age-differentiated analysis also showed the social differences in COVID-19 vaccination rate are significantly lower among those over 60-years old.

Conclusions

The results suggest social differences in COVID-19 vaccination especially in younger age groups. This should be considered when designing targeted measures to overcome potential barriers to vaccination. However, a large number of other factors affecting vaccination behavior must be taken into account like structural barriers, confidence in decision-makers, the safety of vaccination, and a sense of responsibility towards the community.

Key messages

• Sociodemographic and socioeconomic determinants affect COVID-19 vaccination rates.

• The social differences in COVID-19 vaccination are lower among those over 60-years old.

Do family characteristics explain a social gradient in overweight in early childhood?

Background

Children's overweight is associated with many factors, including their living situation, in particular their family's socioeconomic position (SEP) and family characteristics. Research on the extent to which family characteristics account for a social gradient in overweight in early life is scarce. This study evaluated whether family characteristics explain SEP differences in the risk of overweight in early childhood.

Methods

The study used baseline data of 3-6 year-old children (n = 1,116) from the intervention ‘Ene mene fit’ conducted at kindergartens in Baden-Württemberg, Germany. Data included overweight (body mass index > 90 percentile) and parents’ reports on their education and family characteristics associated with overweight (child consumes: sweets in front of TV, soft drinks; family joined time: outdoor, breakfast, sports; cooking; child sets table; role model). Model-based single mediation analyses decomposed the total effect of highest parental education on overweight into direct (unmediated) and indirect (mediated) effects (OR, 95% CI).

Results

Girls and boys with low parental education had higher odds for overweight than children with high/medium education. Among boys, low education influenced the risk of overweight via indirect effects of i. ‘sweets consumption in front of TV’ (OR = 1.31, 1.05-1.59) and ii. ‘no joined sports’ (OR = 1.14, 1.00-1.44). The direct effect of low education only remained significant when ‘no joined sports’ was considered (OR = 2.19, 1.11-5.19). Among girls, family characteristics measured here did not explain SEP differences in overweight.

Conclusions

The family characteristics ‘sweets consumption in front of TV’ and ‘no joined sports’ contribute to inequalities in overweight among boys, but not among girls. Therefore, more gender-sensitive research is needed to identify family risk and protective characteristics that explain health inequalities among both boys and girls.

Perceived discrimination and mental health among adolescents in Germany

Background

The association between perceived discrimination and mental health in adolescents has been widely documented. Aim of this contribution is to show how the relationship between mental health and perceived discrimination at school, work or job training differs depending on socio-economic or migration-related determinants.

Methods

The present analyses was conducted with data from German Health Interview and Examination Survey for Children and Adolescents (KiGGS) wave 2 (2014 - 2017). Weighted linear regression analyses were conducted to explore the association between perceived discrimination at school, work or job training and behavioral problems in adolescents (14-17 years). Also, we examined the extent to which the association is moderated by the parents’ income, education as well as the language spoken at home.

Results

Of all young people, 25.5 % reported perceived discrimination at school, work or job training. Behavioral problems were reported more frequently in adolescents with discrimination experience (12.5 % vs. 3.23 %). Multivariate analyses showed that the coefficients of the association between perceived discrimination and behavioral problems differed by parents’ level of education (low 4.07 (2.39-5.74)/high 2.47 (1.29-3.65)), income (low 3.61 (2.06-5.16)/high 0.35 (-1.81-2.51)), or language spoken at home (German 2.02 (0.33-3.70)/ Other 3.48 (-0.27-7.23)).

Conclusions

A large proportion of adolescents experienced discrimination, with this being reported more frequently among young people with behavioral problems. Parents’ income and education as well as the language spoken at home are relevant for this context. To ensure that health inequalities are not exacerbated by discrimination, targeted prevention measures are needed in these settings. These should address not only the individual needs of young people, but also the underlying conditions and thus aim to promote health equity in the long term, especially in already disadvantaged groups.

Key messages

Socioeconomic position and self-rated health among adolescents: the mediating role of the family

Background

Although health inequalities in adolescence are well documented, the underlying mechanisms remain unclear. Few studies have examined the role of the family in explaining adolescents’ health inequalities. The study aimed to explore whether the association between socioeconomic position and self-rated health (SRH) was mediated by familial determinants.

Methods

Using data from wave 2 of the KiGGS study (1,838 female and 1,718 male 11- to 17-year-olds), linear regression analyses were conducted to decompose the total effects of parents’ education, occupation, income, socioeconomic position index, and adolescents’ subjective social status on SRH into direct effects and indirect effects through familial determinants (family cohesion, parenting styles, parental well-being, stress, obesity, smoking and sporting activity).

Results

A significant total effect of all socioeconomic position indicators on SRH was found, except for income in male adolescents. In female adolescents, more than 70% of the total effects of each socioeconomic position indicator were explained by familial mediators, whereas no significant direct effects remained. The most important mediator was parental well-being, followed by family cohesion, parental smoking and sporting activity. In male adolescents, the associations of parental education, the socioeconomic position index and subjective social status with SRH were also mediated by familial determinants (family cohesion, parental smoking and obesity). However, a significant direct effect of subjective social status remained.

Conclusions

The family appears to play an important role in explaining health inequalities, particularly in female adolescents. Reducing health inequalities in adolescence requires policy interventions, community-based strategies, as well as programs to improve parenting and family functioning.

Strategies to recruit people with selected nationalities for the interview survey GEDA Fokus

Background

People with migration history (PMH) are underrepresented within health monitoring at Robert Koch Institute (RKI). To better describe the health status of PHM, the RKI is currently conducting the health interview survey GEDA Fokus with different migrant groups. Aim of this contribution is to present which sub-groups in this sequential mixed-mode survey design are reached by which mode.

Methods

People aged 18-70 years with Croatian (hr), Italian (it), Polish (pl), Syrian (sy) or Turkish (tr) nationality were drawn out of 99 residents’ registration offices all over Germany (N = 33,436). Study persons were invited sequentially to participate online (saq-web), paper-based(saq-paper) and in person (CAPI) or by telephone (CATI) in Arabic, Croatian, German, Italian, Polish or Turkish. Saq-web was available in German only or bilingual. Data collection took place from November 2021 to April 2022. Per nationality, 1,200 participants were recruited.

Results

As of 25th of April, 6,197 people took part, most often per saq-web (49%), which was less often used among participants aged ≥ 50 years (35% vs. 56%). Pl participants used saq-web most often in German only (55%), sy participants most often used the bilingual version (77%). Saq-paper was more often used by participants aged ≥ 50 years (41% vs. 22%) and less often by tr (21%) and sy (24%) participants. Participants with it nationality most often took part on their own initiative (saq) (92%), while tr (33%) and pl (28%) participants were recruited via personal contact (CAPI/ CATI) more often.

Conclusions

Preliminary results show that offering multiple modes of administration helps to reach different sub-groups. Personal contact contributes to reach those not directly taking part on their own initiative. The opportunity to utilize the bilingual version of the questionnaire was well accepted, especially among those with presumably shorter duration of residence in Germany.

Key messages

The impact of perceived discrimination on subjective health among adolescents

Background

Interpersonal discrimination (disc.) plays an important role for physical and mental health, througoutthe life-course and in particular during adolescence. People can experience disc., e.g. due to their physical appearance or language preferences independently of having a migration background (mb, official statistical category in Germany). Aim of this contribution is to analyse the impact of perceived disc. on subjective health and its relation to mb.

Methods

Using data from from German Health Interview and Examination Survey for Children and Adolescents (KiGGS) wave 2 (2014 - 2017), we analysed by logistic regression the impact of a) overall perceived disc. (≥ one indication of “sometimes” across eight dimensions), b) perceived disc. related to origin, skin colour, accent, language, dialect and c) one- and two-sided mb (one or both parents with own mb) on subjective health among adolescents aged 14 to 17 years.

Results

Among 3,558 adolescents, 21% perceived disc. in at least one of overall eight dimensions, 11% reported disc. related to their origin, skin colour or language. A one-sided mb was measured for 8,4% of participants, a two-sided mb for 20%. Perceiving overall disc. (OR = 3.29) and disc. related to origin, skin colour or language (OR = 1.91) was associated with reporting a (very) bad subjective health. Mb had no impact. Effects remain after controlling for gender, age and socioeconomic position of parents (overall disc. aOR=2.99; disc. related to origin, skin colour or language aOR=1.65).

Conclusions

Perceived disc. is associated with worse subjective health among adolescents, whereas no association with mb is observed. Epidemiological analyses solely focussing on one statistical category such as mb are insufficient as they do not consider those affected by discrimination but are not captured by mb. Differentiated analyses are necessary to elucidate explanatory mechanisms and protective factors.

Key messages

The influence of social support on subjective health among people with selected citizenships

Background

Social support as a psychosocial resource has a significant impact on health. However, data on the association between social support and subjective health among people with a migration history is scarce. The aim of this analysis was to examine this association among a sample of people with selected citizenships in consideration of socio-demographic and migration-related factors.

Methods

Data from the project “Improving Health Monitoring in Migrant Populations (IMIRA)” was used, including people with Croatian, Polish, Romanian, Syrian, and Turkish citizenship. Descriptive and logistic regression analyses were conducted to analyse the effect of socio-demographic (gender, age, socio-economic status (SES)) and migration-related factors (length of residence, residence status, German language proficiency) on the association between social support and subjective health (very good/good).

Results

A total of 60.8% of participants with a low level of social support, indicated good subjective health in comparison to 78.8% among those who reported strong support. Participants with a length of residence of over 20 years (aOR=0,29) and (very) poor German language proficiency (aOR=0,39) were less likely to report good health. A high SES had the strongest impact on good subjective health (aOR=5,42).

Conclusions

Overall, the results confirm the findings for the general population in a sample of people with selected citizenships. The fact that people with a migration history more often face structural and health related barriers and that the existence of resources is helpful in overcoming these, a differentiated consideration of the relationship between social support and subjective health seems necessary in order to establish targeted prevention measures.

Key messages

• Among people with selected citizenships, good social support has a positive impact on subjective health.

• Results remain consistent when considering socio-economic and migration-related factors.