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COVID-19 among migrants, refugees, and internally displaced persons: systematic review, meta-analysis and qualitative synthesis of the global empirical literature.

EClinicalMedicine

August 2024

Section Health Equity Studies & Migration, Department of Primary Care and Health Services Research, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, Heidelberg 69120, Germany.

Background: Evidence amounted early that migrants, who are often side-lined in pandemic response or preparedness plans, are disproportionately affected by the COVID-19 pandemic and its consequences. However, synthesised evidence that quantifies the magnitude of inequalities in infection risk, disease outcomes, consequences of pandemic measures or that explains the underlying mechanisms is lacking.

Methods: We conducted a systematic review searching 25 databases and grey literature (12/2019 to 09/2023) and considered empirical articles covering migrants, refugees, asylum-seekers, and internally displaced persons reporting COVID-19 cases, hospitalisation, ICU admission, mortality, COVID-19 vaccination rates or health consequences of pandemic measures.

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In one of the earliest reports from China during COVID-19, it was noted that over 20% of patients hospitalized with the disease had significant elevations of troponin, a marker of myocardial tissue damage, that put them at a higher risk. In a hypothesis-independent whole exome sequencing (WES) study in hospitalized COVID-19 patients of diverse ancestry, we observed putative enrichment in pathogenic variants in genes known to be involved in the pathogenesis of cardiomyopathy. This observation led us to hypothesize that the observed high morbidity and mortality in these patients might be due to the presence of rare genetic factors that had previously been silent but became relevant as a consequence of the severe stress inflicted by an infection with SARS-CoV-2.

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Aims: While COVID-19 no longer presents a global health emergency, the indirect (non-infection) impacts of the pandemic may exacerbate health inequalities in years to come. We examined the socio-economic distribution of the impacts of the pandemic on the psychosocial and economic well-being of children, young people and their families.

Methods: The CoRonavIruS Health Impact Survey (CRISIS) was conducted in seven existing longitudinal cohorts, together involving n = 3072 participants aged 0-19 years.

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Worldwide, mortality was strongly affected by the COVID-19 pandemic, both directly through COVID-19 deaths and indirectly through changes in other causes of death. Here, we examine the impact of the pandemic on COVID-19 and non-COVID-19 mortality in 24 countries: Australia, Austria, Brazil, Bulgaria, Canada, Chile, Croatia, Czechia, Denmark, England and Wales, Hungary, Japan, Latvia, Lithuania, The Netherlands, Northern Ireland, Poland, Russia, Scotland, South Korea, Spain, Sweden, Switzerland, and the United States. Using demographic decomposition methods, we compare age- and cause-specific contributions to changes in female and male life expectancy at birth in 2019-2020, 2020-2021, and 2021-2022 with those before the COVID-19 pandemic (2015-2019).

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COVID-19 was initially identified as a respiratory system disorder, but it has been reported to interact with and influence the cardiovascular system, in addition to many other body systems. Although COVID-19-associated cardiovascular (CV) complications are common, resulting in high acute phase mortality and a large number of morbidities in the chronic phase, thus severely impacting patients' quality of life and health outcomes, yet clinical, cellular, and molecular biological factors underlying the pathophysiology of cardiovascular complications associated with COVID-19 are poorly understood. This review investigates putative underlying clinical factors as well as cellular and molecular biological mechanisms by which COVID-19 leads to acute CV complications, including state-of-the-art genomic sequencing-based findings, and assessing the long-term CV consequences of COVID-19, aiming to shed light on developing strategies for differential diagnosis, risk prognostic stratification, prevention, and clinical management of CV sequels in COVID-19 patients.

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