COVID-19 income of (im)migrants in a valencian hospital: a retrospective longitudinal study of medical records
e202307060
Keywords:
COVID-19, Social Determinants of Health, Hospitalization, Emigrants and immigrantsAbstract
BACKGROUND // Social determinants of health (SDH) refer to the circumstances in which people are born, grow, work, live and age, including the wider set of forces and systems that influence living conditions. SDH produce patterns of disease distribution in societies. There is no reason to believe that this is not the case for COVID-19. The aim of this study was to analyse the time course of hospital admissions for COVID-19 in 2020 among individuals according to their country of origin.
METHODS // A retrospective longitudinal study was conducted using the medical records of individuals hospitalised at the Doctor Peset Hospital in Valencia. The cases were divided into those from a European Union country (community cases) and those from other countries (non-community cases). Differences between groups were analysed using the chi-squared test and Student’s t-test. A multiple logistic regression model was used to examine the association between hospitalisation and mortality. The strength of associations between country of origin and the variables of mortality and hospital admission rate were assessed using Odds Ratio (OR). A significance level of p-value<0.05 was set.
RESULTS // 22.4% of the sample were people of non-Community origin. Of these, 78.3% were from Latin American countries. The mean age of the non-community individuals was approximately seventeen years younger (95% CI 15.2-19.7; p-value<0.01). Within the first six months of the year, 40.2% of community cases and 14.6% of non-community cases were hospitalised. The odds of hospitalisation in the second half of the year were three times higher for non-community cases (OR 3.7; 95% CI 1.9-7.4, p-value<0.01).
CONCLUSIONS // There may have been a higher likelihood of infection among the foreign population during the second half of 2020. The social stratum occupied by migrants may lead to differential exposure, possibly related to the measures implemented to contain the pandemic.
Downloads
References
1. World Health Organization. A conceptual framework for action on the social determinants of health. Genève, Switzerland: World Health Organization; 2010.
2. Kelly MP, Stewart E, Morgan A, Killoran A, Fischer A, Threlfall A, Bonnefoy J. A conceptual framework for public health: NICE’s emerging approach. Public Health. 2009 Jan;123(1):e14-20. doi: https://dx.doi.org/10.1016/j.puhe.2008.10.031
3. Graham H. Social determinants and their unequal distribution: clarifying policy understandings. Milbank Q. 2004;82(1):101-24. doi: https://dx.doi.org/10.1111/j.0887-378x.2004.00303.x
4. Krieger N. Proximal, distal, and the politics of causation: what’s level got to do with it? Am J Public Health. 2008 Feb;98(2):221-30. doi: https://dx.doi.org/10.2105/AJPH.2007.111278
5. Hertzman C. Putting the concept of biological embedding in historical perspective. Proc Natl Acad Sci USA. 2012 Oct 16;109 Suppl 2(Suppl 2):17160-7. doi: https://dx.doi.org/10.1073/pnas.1202203109
6. Mattos Dos Santos R. Isolation, social stress, low socioeconomic status and its relationship to immune response in Covid-19 pandemic context. Brain Behav Immun Health. 2020 Aug;7:100103. doi: https://dx.doi.org/10.1016/j.bbih.2020.100103
7. Marmot M, Friel S, Bell R, Houweling TA, Taylor S; Commission on Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health. Lancet. 2008 Nov 8;372(9650):1661-9. doi: https://dx.doi.org/10.1016/S0140-6736(08)61690-6
8. Alcendor DJ. Racial Disparities-Associated COVID-19 Mortality among Minority Populations in the US. J Clin Med. 2020 Jul 30;9(8):2442. doi: https://dx.doi.org/10.3390/jcm9082442
9. Baqui P, Bica I, Marra V, Ercole A, Van der Schaar M. Ethnic and regional variations in hospital mortality from COVID-19 in Brazil: a cross-sectional observational study. Lancet Glob Health. 2020 Aug;8(8):e1018-e1026. doi: https://dx.doi.org/10.1016/S2214-109X(20)30285-0
10. Webb Hooper M, Nápoles AM, Pérez-Stable EJ. COVID-19 and Racial/Ethnic Disparities. JAMA. 2020 Jun 23;323(24):2466-2467. doi: https://dx.doi.org/10.1001/jama.2020.8598
11. Baah FO, Teitelman AM, Riegel B. Marginalization: Conceptualizing patient vulnerabilities in the framework of social determinants of health-An integrative review. Nurs Inq. 2019 Jan;26(1):e12268. doi: https://dx.doi.org/10.1111/nin.12268
12. Cunningham TJ, Croft JB, Liu Y, Lu H, Eke PI, Giles WH. Vital Signs: Racial Disparities in Age-Specific Mortality Among Blacks or African Americans-United States, 1999-2015. MMWR Morb Mortal Wkly Rep. 2017 May 5;66(17):444-456. doi: https://dx.doi.org/10.15585/mmwr.mm6617e1. Erratum in: MMWR Morb Mortal Wkly Rep. 2017 May 12;66(18):490.
13. Lassale C, Gaye B, Hamer M, Gale CR, Batty GD. Ethnic disparities in hospitalisation for COVID-19 in England: The role of socioeconomic factors, mental health, and inflammatory and pro-inflammatory factors in a community-based cohort study. Brain Behav Immun. 2020 Aug;88:44-49. doi: https://dx.doi.org/10.1016/j.bbi.2020.05.074
14. Pool MS, Agyemang CO, Smalbrugge M. Interventions to improve social determinants of health among elderly ethnic minority groups: a review. Eur J Public Health. 2017 Dec 1;27(6):1048-1054. doi: https://dx.doi.org/10.1093/eurpub/ckx178
15. Soyemi K, Medina-Marino A, Sinkowitz-Cochran R et al. Disparities among 2009 pandemic influenza A (H1N1) hospital admissions: a mixed methods analysis-Illinois, April-December 2009. PLoS One. 2014;9:e84380. doi: https://dx.doi.org/10.1371/journal.pone.0084380
16. Cronología de la respuesta de la OMS a la COVID-19 [Internet]. Who.int. [consultado 19 nov 2021]. Disponible en: https://www.who.int/es/news/item/29-06-2020-covidtimeline
17. Islamoska S, Petersen JH, Benfield T, Norredam M. (2022). Socioeconomic and demographic risk factors in COVID-19 hospitalization among immigrants and ethnic minorities. En European Journal of Public Health (Vol. 32, Número 2, pp. 302-310). doi: https://dx.doi.org/10.1093/eurpub/ckab186
18. Krouse HJ. (2020). COVID-19 and the Widening Gap in Health Inequity. En Otolaryngology-Head and Neck Surgery (United States) (Vol. 163, Número 1, pp. 65-66). doi: https://dx.doi.org/10.1177/0194599820926463
19. Labberton AS, Godøy A, Elgersma IH, Strand BH, Telle K, Arnesen T, Nygård KM, Indseth T. (2022). SARS-CoV-2 infections and hospitalisations among immigrants in Norwaysignificance of occupation, household crowding, education, household income and medical risk: A nationwide register study. En Scandinavian Journal of Public Health (Vol. 50, Número 6, pp. 772-781). doi: https://dx.doi.org/10.1177/14034948221075029
20. Marmot M, Bell R. Fair society, healthy lives. Public Health. 2012 Sep;126 Suppl 1:S4-S10. doi: https://dx.doi.org/10.1016/j.puhe.2012.05.014
21. Carethers JM. Insights into Disparities Observed with COVID-19. J Intern Med. 2020 Nov 8. doi: https://dx.doi.org/10.1111/joim.13199
22. Kalyanaraman Marcello R, Dolle J, Grami S, Adule R, Li Z, Tatem K, Anyaogu C, Ayinla R, Boma N, Brady T, Cosme-Thormann BF, Ford K, Gaither K, Kanter M, Kessler S, Kristal RB, Lieber JJ, Mukherjee V, Rizzo V, Rowell M, Stevens D, Sydney E, Wallach A, Chokshi DA, Davis N. Characteristics and Outcomes of COVID-19 Patients in New York City’s Public Hospital System. PLoS One. 2020 Dec 17;15(12):e0243027. doi: https://dx.doi.org/10.1101/2020.05.29.20086645
23. Bilan N, Dastranji A, Ghalehgolab Behbahani A. Comparison of the spo2/fio2 ratio and the pao2/fio2 ratio in patients with acute lung injury or acute respiratory distress syndrome. J Cardiovasc Thorac Res. 2015;7(1):28-31. doi: https://dx.doi.org/10.15171/jcvtr.2014.06
24. Ritchie H, Mathieu E, Rodés-Guirao L, Appel C, Giattino C, Ortiz-Ospina E et al. Coronavirus Pandemic (COVID-19). Our World in Data [Internet]. 2020 [consultado 19 nov 2021]; Disponible en: https://ourworldindata.org/coronavirus-data
25. Khalatbari-Soltani S, Cumming RC, Delpierre C, Kelly-Irving M. Importance of collecting data on socioeconomic determinants from the early stage of the COVID-19 outbreak onwards. J Epidemiol Community Health. 2020 Aug;74(8):620-623. doi: https://dx.doi.org/10.1136/jech-2020-214297
26. INE. Instituto Nacional de Estadística [Internet]. Ine.es. [consultado 19 nov 2021]. Disponible en: https://www.ine.es/
27. Sistema de Información en Salud Pública (SISP), Direcció General de Salut Pública, Generalitat Valenciana [Internet]. Gva.es. [consultado 19 nov 2021]. Disponible en: http://www.sp.san.gva.es/eolas.jsp?PASARELA_EOLAS_WEBCLIENT_JSP_RECARGA=%23%23MTOEOLAS_URL_ID%23%23arbolActividadesConsultasEjecutar.jsp&Opcion=SANPSSISPEOLAS&Nivel=1&MenuSup=SANMS50000&CodPunto=3416&menuRaizPortal=SANMS50000&Idioma=es&CodPor=121
28. Gustafsson PE, San Sebastian M, Fonseca-Rodriguez O, Fors Connolly AM. Inequitable impact of infection: social gradients in severe COVID-19 outcomes among all confirmed SARS-CoV-2 cases during the first pandemic wave in Sweden. J Epidemiol Community Health. 2021 Sep 15:jech-2021-216778. doi: https://dx.doi.org/10.1136/jech-2021-216778
29. Mackey K, Ayers CK, Kondo KK, Saha S, Advani SM, Young S, Spencer H, Rusek M, Anderson J, Veazie S, Smith M, Kansagara D. Racial and Ethnic Disparities in COVID-19-Related Infections, Hospitalizations, and Deaths: A Systematic Review. Ann Intern Med. 2021 Mar;174(3):362-373. doi: https://dx.doi.org/10.7326/M20-6306
30. Wadhera RK, Wadhera P, Gaba P, Figueroa JF, Joynt Maddox KE, Yeh RW, Shen C. Variation in COVID-19 Hospitalizations and Deaths Across New York City Boroughs. JAMA. 2020 Jun 2;323(21):2192-2195. doi: https://dx.doi.org/10.1001/jama.2020.7197
31. Podewils LJ, Burket TL, Mettenbrink C, Steiner A, Seidel A, Scott K, Cervantes L, Hasnain-Wynia R. Disproportionate Incidence of COVID-19 Infection, Hospitalizations, and Deaths Among Persons Identifying as Hispanic or Latino-Denver, Colorado March-October 2020. MMWR Morb Mortal Wkly Rep. 2020 Dec 4;69(48):1812-1816. doi: https://dx.doi.org/10.15585/mmwr.mm6948a3
32. Gálvez-Iniesta GF. Extranjeros, sin papeles e imprescindibles: Una fotografía de la inmigración irregular en España [Internet]. Porcausa.org. [consultado 19 nov 2021]. Disponible en: https://porcausa.org/wp-content/uploads/2020/07/RetratodelairregularidadporCausa.pdf
33. Wang Z, Zheutlin A, Kao YH, Ayers K, Gross S, Kovatch P, Nirenberg S, Charney A, Nadkarni G, De Freitas JK, O’Reilly P, Just A, Horowitz C, Martin G, Branch A, Glicksberg BS, Charney D, Reich D, Oh WK, Schadt E, Chen R, Li L. Hospitalised COVID-19 patients of the Mount Sinai Health System: a retrospective observational study using the electronic medical records. BMJ Open. 2020 Oct 26;10(10):e040441. doi: https://dx.doi.org/10.1136/bmjopen-2020-040441
34. Dominguez K, Penman-Aguilar A, Chang MH, Moonesinghe R, Castellanos T, Rodriguez-Lainz A, Schieber R; Centers for Disease Control and Prevention (CDC). Vital signs: leading causes of death, prevalence of diseases and risk factors, and use of health services among Hispanics in the United States - 2009-2013. MMWR Morb Mortal Wkly Rep. 2015 May 8;64(17):469-78. Erratum en: MMWR Morb Mortal Wkly Rep. 2015 Oct 16;64(40):1153.
35. BOE-A-2020-3692. Real Decreto 463/2020, de 14 de marzo, por el que se declara el estado de alarma para la gestión de la situación de crisis sanitaria ocasionada por el COVID-19 [Internet]. Boe.es. [consultado 19 nov 2021]. Disponible en: https://www.boe.es/buscar/doc.php?id=BOE-A-2020-3692
36. BOE-A-2020-5767. Real Decreto 555/2020, de 5 de junio, por el que se prorroga el estado de alarma declarado por el Real Decreto 463/2020, de 14 de marzo, por el que se declara el estado de alarma para la gestión de la situación de crisis sanitaria ocasionada por el COVID-19 [Internet]. Boe.es. [consultado 19 nov 2021]. Disponible en: https://www.boe.es/buscar/doc.php?id=BOE-A-2020-5767
37. Fases de desconfinamiento en la Comunidad Valenciana - Conselleria de Sanidad Universal y Salud Pública [Internet]. Gva.es. [consultado 19 nov 2021]. Disponible en: https://coronavirus.san.gva.es/es/consejos-desconfinamiento
38. O’Sullivan TL, Phillips KP. From SARS to pandemic influenza: the framing of high-risk populations. Nat Hazards 2019;98:103-117. doi: https://dx.doi.org/10.1007/s11069-019-03584-6
39. Avance Anuario de Estadísticas 2020. NIPO: 117-20-049-3. Ministerio de Trabajo y Economía Social [Internet]. Gob.es. [consultado 19 nov 2021]. Disponible en: https://www.mites.gob.es/es/estadisticas/anuarios/2020/index.htm
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2023 Ulises López González, Cristina Giménez Lozano, Irene García Bellvis, Ángela Esteban Hurtado, Paulina Cárcamo Ibarra, Ana María Míguez Santillán, Daniel Bautista Rentero
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Usted es libre de:
Compartir — copiar y redistribuir el material en cualquier medio o formato.
La licenciante no puede revocar estas libertades en tanto usted siga los términos de la licencia.
Bajo los siguientes términos:
Atribución — Usted debe dar crédito de manera adecuada , brindar un enlace a la licencia, e indicar si se han realizado cambios. Puede hacerlo en cualquier forma razonable, pero no de forma tal que sugiera que usted o su uso tienen el apoyo de la licenciante.
NoComercial — Usted no puede hacer uso del material con propósitos comerciales.
SinDerivadas — Si remezcla, transforma o crea a partir del material, no podrá distribuir el material modificado.
No hay restricciones adicionales — No puede aplicar términos legales ni medidas tecnológicas que restrinjan legalmente a otras a hacer cualquier uso permitido por la licencia.
Avisos:
No tiene que cumplir con la licencia para elementos del material en el dominio público o cuando su uso esté permitido por una excepción o limitación aplicable.
No se dan garantías. La licencia podría no darle todos los permisos que necesita para el uso que tenga previsto. Por ejemplo, otros derechos como publicidad, privacidad, o derechos morales pueden limitar la forma en que utilice el material.
![¿Cómo evaluar para la RESP? [PARA REVISORES]](https://ojs.sanidad.gob.es/public/site/images/rmartinb/pastilla-revisores-0eaa113abcbc4fc554c7c6c7840ca4c6.jpg)
![¿Cómo recibir avisos sobre nuevos artículos de la RESP? [PARA LECTORES]](https://ojs.sanidad.gob.es/public/site/images/rmartinb/pastilla-lectores-aa689338e95aab07df45b4b0d583188f.jpg)
