Abstract
Aim
Research shows migrant groups have an increased risk of COVID-19 incidence, hospitalization and mortality. Much less is known about how these findings have developed throughout the different stages of the crisis. This study assesses patterns in excess mortality by migrant group during the first three COVID-19 waves in Belgium, while taking sociodemographic and socioeconomic indicators into account.
Subject and methods
Data were derived from an individual-level linkage between the Belgian National Register, the 2011 Belgian census and the tax register. The study population consisted of the legal Belgian population aged 40 years and older (N = 6,004,695). Age-standardized all-cause mortality rates were calculated for the first three COVID waves, and for the same weeks in 2019. Relative mortality differences were studied using Poisson regression. Analyses were stratified by age group, gender and wave.
Results
The heaviest mortality burden fell on the elderly male population, whose mortality patterns also diverged considerably from pre-pandemic times. The largest mortality differences with the Belgian population were observed for elderly Turkish men (> 26% in waves 1–3) and women (~40% in wave 2–3), after controlling for sociodemographic and socioeconomic indicators. While in 2019 some migrant groups experienced a mortality advantage compared to their Belgian peers, this advantage was reduced or turned into a disadvantage during the COVID-crisis.
Conclusion
Significant mortality inequalities were found by migrant group, even after controlling for sociodemographic and socioeconomic background. Mortality patterns varied considerably throughout the three waves under investigation, possibly because of the dynamic nature of the epidemic and the uptake of preventative measures.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data availability
The analyses are based on data from a census-linked mortality follow-up study and cannot be made available due to privacy issues. Researchers can gain full access to the data by submitting an application to the Information Security Committee Belgium. In order to get permission to use data from the Belgian population register linked to census data an authorization request (in Dutch or French) needs to be submitted to the Belgian Data Protection Authority. The authorization request includes an application form and additional forms regarding data security. The necessary forms for the authorization request can be downloaded from the Data Protection Authority website (https://www.dataprotectionauthority.be). Next to information on the applicant and a list of requested data, the authorization request should specify why the data from the population register are necessary, for which time span data will be stored, and who will have access to the data.
Code availability
The codes for the analyses are available upon request (please contact the corresponding author).
References
Aburto JM, Kashyap R, Schöley J et al (2021) Estimating the burden of the COVID-19 pandemic on mortality, life expectancy and lifespan inequality in England and Wales: a population-level analysis. J Epidemiol Community Health 75:735–740. https://doi.org/10.1136/jech-2020-215505
Aldridge RW, Nellums LB, Bartlett S et al (2018) Global patterns of mortality in international migrants: a systematic review and meta-analysis. Lancet 392:2553–2566. https://doi.org/10.1016/S0140-6736(18)32781-8
Altman DG, Bland JM (2003) Statistics notes: interaction revisited: the difference between two estimates. BMJ 326:219–219. https://doi.org/10.1136/bmj.326.7382.219
Aradhya S, Brandén M, Drefahl S et al (2021) Intermarriage and COVID-19 mortality among immigrants. A population-based cohort study from Sweden. BMJ Open 11:e048952. https://doi.org/10.1136/bmjopen-2021-048952
Bambra C, Riordan R, Ford J, Matthews F (2020) The COVID-19 pandemic and health inequalities. J Epidemiol Community Health jech-2020–214401. https://doi.org/10.1136/jech-2020-214401
Bambra C, Lynch J, Smith KE (2021) The Unequal Pandemic, 1st edn. Bristol University Press
Beaney T, Clarke JM, Jain V et al (2020) Excess mortality: the gold standard in measuring the impact of COVID-19 worldwide? J R Soc Med 113:329–334. https://doi.org/10.1177/0141076820956802
Caron RM, Adegboye ARA (2021) COVID-19: a syndemic requiring an integrated approach for marginalized populations. Front Public Health 9:675280. https://doi.org/10.3389/fpubh.2021.675280
Chilunga FP, Stoeldraijer L, Agyemang C et al (2022) Inequalities in COVID-19 deaths by migration background during the first wave, interwave period and second wave of the COVID-19 pandemic: a closed cohort study of 17 million inhabitants of the Netherlands. J Epidemiol Community Health jech-2022–219521. https://doi.org/10.1136/jech-2022-219521
Clouston SAP, Rubin MS, Phelan JC, Link BG (2016) A social history of disease: contextualizing the rise and fall of social inequalities in cause-specific mortality. Demography 53:1631–1656. https://doi.org/10.1007/s13524-016-0495-5
Clouston SAP, Natale G, Link BG (2021) Socioeconomic inequalities in the spread of coronavirus-19 in the United States: a examination of the emergence of social inequalities. Soc Sci Med 268:113554. https://doi.org/10.1016/j.socscimed.2020.113554
Crawshaw AF, Farah Y, Deal A et al (2022) Defining the determinants of vaccine uptake and undervaccination in migrant populations in Europe to improve routine and COVID-19 vaccine uptake: a systematic review. Lancet Infect Dis 22:e254–e266. https://doi.org/10.1016/S1473-3099(22)00066-4
Di Stadio A, Ricci G, Greco A et al (2020) Mortality rate and gender differences in COVID-19 patients dying in Italy: a comparison with other countries. Eur Rev Med Pharmacol Sci 24:4066–4067. https://doi.org/10.26355/eurrev_202004_20980
Díaz González JL, Rusciani R, Spadea T et al (2022) Access to SARS-CoV-2 diagnostic tests: are there barriers for the immigrants in Italy? E P 46:33–40. https://doi.org/10.19191/EP22.4S1.054
Dowd JB, Andriano L, Brazel DM et al (2020) Demographic science aids in understanding the spread and fatality rates of COVID-19. Proc Natl Acad Sci (PNAS) 117:9696–9698. https://doi.org/10.1073/pnas.2004911117
Drefahl S, Wallace M, Mussino E et al (2020) A population-based cohort study of socio-demographic risk factors for COVID-19 deaths in Sweden. Nat Commun 11:5097. https://doi.org/10.1038/s41467-020-18926-3
ECDC (2020) Guidance on infection prevention and control of coronavirus disease (COVID-19) in migrant and refugee reception and detention centres in the EU/EEA and the United Kingdom. Technical report. https://www.ecdc.europa.eu/sites/default/files/documents/COVID-19-guidance-refugee-asylum-seekers-migrants-EU.pdf. Accessed 9 Feb 2023
Gadeyne S, Rodriguez-Loureiro L, Surkyn J, Van Hemelrijck W, Nusselder W, Lusyne P, Vanthomme K (2021) Are we really all in this together? The social patterning of mortality during the first wave of the COVID-19 pandemic in Belgium. Int J Equity Health. 20(1):258. https://doi.org/10.1186/s12939-021-01594-0
Greenaway C, Hargreaves S, Barkati S et al (2020) COVID-19: exposing and addressing health disparities among ethnic minorities and migrants. J Travel Med 27:1–3. https://doi.org/10.1093/jtm/taaa113
Guadagno L (2020) Migrants and the COVID-19 pandemic an initial analysis. International Organization for Migration, Geneva. https://publications.iom.int/books/mrs-no-60-migrants-and-covid-19-pandemic-initial-analysis. Accessed 19 Apr 2023
Hardy OJ, Dubourg D, Bourguignon M et al (2021) A world apart: levels and determinants of excess mortality due to COVID-19 in care homes: the case of the Belgian region of Wallonia during the spring 2020 wave. DemRes 45:1011–1040. https://doi.org/10.4054/DemRes.2021.45.33
Hayward SE, Deal A, Cheng C et al (2021) Clinical outcomes and risk factors for COVID-19 among migrant populations in high-income countries: a systematic review. J Migr Health 3:100041. https://doi.org/10.1016/j.jmh.2021.100041
Holz M, Mayerl J, Andersen H, Maskow B (2022) How does migration background affect COVID-19 vaccination intentions? A complex relationship between general attitudes, religiosity, acculturation and fears of infection. Front Public Health 10:854146. https://doi.org/10.3389/fpubh.2022.854146
Indseth T, Grøsland M, Arnesen T et al (2021) COVID-19 among immigrants in Norway, notified infections, related hospitalizations and associated mortality: a register-based study. Scand J Public Health 49:48–56. https://doi.org/10.1177/1403494820984026
Khanijahani A (2021) Racial, ethnic, and socioeconomic disparities in confirmed COVID-19 cases and deaths in the United States: a county-level analysis as of November 2020. Ethn Health 26:22–35. https://doi.org/10.1080/13557858.2020.1853067
Khanijahani A, Iezadi S, Gholipour K et al (2021) A systematic review of racial/ethnic and socioeconomic disparities in COVID-19. Int J Equity Health 20:248. https://doi.org/10.1186/s12939-021-01582-4
Khlat M, Ghosn W, Guillot M et al (2022) Impact of the COVID-19 crisis on the mortality profiles of the foreign-born In France during the first pandemic wave. Soc Sci Med 115160. https://doi.org/10.1016/j.socscimed.2022.115160
Kjøllesdal MKR, Juarez SP, Aradhya S, Indseth T (2022) Understanding the excess COVID-19 burden among immigrants in Norway. J Public Health fdac033. https://doi.org/10.1093/pubmed/fdac033
Knights F, Carter J, Deal A et al (2021) Impact of COVID-19 on migrants’ access to primary care and implications for vaccine roll-out: a national qualitative study. Br J Gen Pract 71:e583–e595. https://doi.org/10.3399/BJGP.2021.0028
Labberton AS, Godøy A, Elgersma IH et al (2022) SARS-CoV-2 infections and hospitalisations among immigrants in Norway-significance of occupation, household crowding, education, household income and medical risk: a nationwide register study. Scand J Public Health 50:772–781. https://doi.org/10.1177/14034948221075029
Link BG, Phelan J (1995) Social conditions as fundamental causes of disease. J Health Soc Behav Extra Issue 80–94. https://doi.org/10.2307/2626958
Nafilyan V, Islam N, Ayoubkhani D et al (2021a) Ethnicity, household composition and COVID-19 mortality: a national linked data study. J R Soc Med 114:182–211. https://doi.org/10.1177/0141076821999973
Nafilyan V, Islam N, Mathur R et al (2021b) Ethnic differences in COVID-19 mortality during the first two waves of the coronavirus pandemic: a nationwide cohort study of 29 million adults in England. Eur J Epidemiol 36:605–617. https://doi.org/10.1007/s10654-021-00765-1
OECD (2022) What has been the impact of the COVID-19 pandemic on immigrants? An update on recent evidence. Organisation for Economic Co-operation and Development, Paris, France. https://www.oecd-ilibrary.org/social-issues-migration-health/what-has-been-the-impact-of-the-covid-19-pandemic-on-immigrants-an-update-on-recent-evidence_65cfc31c-en. Accessed 10 Feb 2023
Patzina A, Dietrich H (2022) The social gradient in COVID-19 vaccination intentions and the role of solidarity beliefs among adolescents. SSM - Popul Health 17:101054. https://doi.org/10.1016/j.ssmph.2022.101054
Phalet K, Heath A (2010) From ethnic boundaries to ethnic penalties: urban economies and the turkish second generation. Am Behav Sci 53:1824–1850. https://doi.org/10.1177/0002764210368099
Phelan JC, Link BG, Tehranifar P (2010) Social conditions as fundamental causes of health inequalities: theory, evidence, and policy implications. J Health Soc Behav 51:S28–S40. https://doi.org/10.1177/0022146510383498
Ransing R, Ramalho R, de Filippis R et al (2020) Infectious disease outbreak related stigma and discrimination during the COVID-19 pandemic: drivers, facilitators, manifestations, and outcomes across the world. Brain Behav Immun 89:555–558. https://doi.org/10.1016/j.bbi.2020.07.033
Razai MS, Kankam HKN, Majeed A et al (2021) Mitigating ethnic disparities in covid-19 and beyond. BMJ m4921. https://doi.org/10.1136/bmj.m4921
Rostila M, Cederström A, Wallace M et al (2021) Disparities in coronavirus disease 2019 mortality by country of birth in Stockholm, Sweden: a total-population–based cohort study. Am J Epidemiol 190:1510–1518. https://doi.org/10.1093/aje/kwab057
Sciensano (2022) COVID-19 Surveillance. Frequently asked questions. Brussels, Belgium 42. https://covid-19.sciensano.be/sites/default/files/Covid19/COVID-19_FAQ_ENG_final.pdf. Accessed 15 Dec 2022
Sharma G, Volgman AS, Michos ED (2020) Sex differences in mortality from COVID-19 pandemic. JACC Case Reports 2:1407–1410. https://doi.org/10.1016/j.jaccas.2020.04.027
Wallace M, Darlington‐Pollock F (2022) Poor health, low mortality? Paradox found among immigrants in England and Wales. Popul Space Place 28. https://doi.org/10.1002/psp.2360
Vanthomme K, Vandenheede H (2019) Migrant mortality differences in the 2000s in Belgium: interaction with gender and the role of socioeconomic position. Int J Equity Health 18(1):96. https://doi.org/10.1186/s12939-019-0983-5
Vanthomme K, Gadeyne S, Lusyne P, Vandenheede H (2021) A population-based study on mortality among Belgian immigrants during the first COVID-19 wave in Belgium. Can demographic and socioeconomic indicators explain differential mortality? SSM - Popul Health 14:100797. https://doi.org/10.1016/j.ssmph.2021.100797
Wets J (2006) The Turkish community in Austria and Belgium: the challenge of integration. Turk Stud 7:85–100. https://doi.org/10.1080/14683840500520600
Williamson EJ, Walker AJ, Bhaskaran K et al (2020) Factors associated with COVID-19-related death using OpenSAFELY. Nature 584:430–436. https://doi.org/10.1038/s41586-020-2521-4
Yates T, Summerfield A, Razieh C et al (2022) A population-based cohort study of obesity, ethnicity and COVID-19 mortality in 12.6 million adults in England. Nat Commun 13:624. https://doi.org/10.1038/s41467-022-28248-1
Acknowledgements
We are very grateful to Statistics Belgium for preparing the data files and providing essential advice.
Funding
Belgian Science Policy Office (BELSPO) funded this research within the BRAIN-be 2.0 framework supporting pillar 3 Federal societal challenges (grant number B2/202/P3/HELICON). The sponsor did not have a role in conducting the study, the writing of the manuscript, or in the decision to submit it for publication.
Author information
Authors and Affiliations
Contributions
KV: Conceptualization, Methodology, Validation, Formal analysis, Writing of the original draft, Writing—Review & Editing. SG: Conceptualization, Methodology, Validation, Writing of the original draft, Writing—Review & Editing. BD: Conceptualization, Methodology, Validation, Writing—Review & Editing. LVdB: Conceptualization, Methodology, Validation, Formal analysis, Writing of the original draft, Writing—Review & Editing; Visualization. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Ethics approval
This research as well as the data adhere to the ethical code of scientific research in Belgium. All authors have signed the ethical code. See: http://www.belspo.be/belspo/organisation/publ/pub_ostc/Eth_code/ethcode_en.pdf.
Consent to participate
Not applicable.
Consent for publication
Not applicable.
Competing interest
The authors have no competing interests to declare that are relevant to the content of this article.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Vanthomme, K., Gadeyne, S., Devleesschauwer, B. et al. Excess mortality among native Belgians and migrant groups in Belgium during the first three COVID-19 waves: the evolving dynamics of social inequalities. J Public Health (Berl.) (2023). https://doi.org/10.1007/s10389-023-02180-0
Received:
Accepted:
Published:
DOI: https://doi.org/10.1007/s10389-023-02180-0