key: cord-0849537-3meam7va
authors: Melchior, Maria; Desgrées du Loû, Annabel; Gosselin, Anne; Datta, Geetanjali D.; Carabali, Mabel; Merckx, Joanna; Kaufman, Jay S.
title: Migrant status, ethnicity and COVID-19: More accurate European data are greatly needed
date: 2020-10-23
journal: Clin Microbiol Infect
DOI: 10.1016/j.cmi.2020.10.014
sha: de469083b7ee13b9a1ee646579e66d5718e8e5e9
doc_id: 849537
cord_uid: 3meam7va

nan

belonging to migrant or ethnic minority groups have been reported in several countries, including the 28 US, the UK, Sweden, Brazil, Spain, and South Africa. In particular, racialized populations tend to have 29 less access to testing, higher rates of severe disease, higher mortality rates, and worse sequalae 30 when they survive the infection (1) (2) (3) (4) (5) . The interacting social, behavioral and biological pathways 31 underlying these disparities are doubtlessly complex, but the hierarchy of social advantage in 32 racialized societies drives health status, exposure, housing, employment and access to healthcare, 33 and undoubtedly plays the dominant role (6) . 34

Yet, with the notable exception of the United Kingdom, European countries do not report COVID-19 35 statistics according to migrant status or ethnicity (i.e. individuals' country of origin, nationality or 36 membership of an ethnic minority group), faced with the complexity of collecting and using such 37 information for public health purposes (7). To exemplify the issues at stake and suggest a way 38 forward, we wish to take the case of France, which has a substantial immigrant population and is to 39 date amongst the European countries hardest hit by the COVID-19 epidemic. 40

In France, immigrants make up 10% of the population and descendants of immigrants 12% 41 (https://www.insee.fr/fr/statistiques/4238373?sommaire=4238781#:~:text=En%202018%2C%207%2 42

C5%20millions,le%20m%C3%AAme%20pays%20d'origine.), with recent immigrants most frequently 43 originating from an African country (47%). Data show that compared to the native population, 44 persons who are foreign-born had on average double the rates of all-cause mortality between March 45 and April 2020, some of which were due to COVID-19, however that exact proportion is not known 46 (8). Specifically, while mortality increased by 22% among the native-born, it rose by 54% among individuals born in North Africa, 91% among those born in Asia, and 114% among those born in Sub-48 Saharan Africa. This trend is also reflected in geographic inequalities in mortality, with a 118% systems that are the fundamental drivers of the disparities. However data on health disparities can 109 also be misinterpreted, as when observed differences are mistakenly attributed to genetic makeup 110 (6). There is therefore need not only to collect data making it possible to observe and monitor 111 disparities, but also accompany such data collection and analysis with thoughtful interpretation. One 112 way of moving in that direction without doing wrong is most likely to get members of migrant and 113 ethnic minority groups directly involved in research which pertains to their health. Data should also 114 not only measure components late in the pathways of disease, morbidity and mortality, but capture 115 upstream disparities in exposure and mechanisms contributing to vulnerability, which include social 116 determinants of health and disease. 117

In France, the production of national mortality statistics according to immigration status during the 118 COVID-19 epidemic is a first step towards a broader discussion about the necessity to measure and 119 address inequalities in health between migrants -first, second, and third generation-and the majority 120 population . More generally, in Europe, further progress will necessarily require deliberate 121 consideration of discrimination with regard to health and health care, clarification of terms and 122 indicators (migrant status, ethnicity) to help physicians and public health professionals understand 123 how to interpret disparities based on social mechanisms of action and without falling into the 124 'genetic trap'. The COVID-19 epidemic may be an opportunity for a renewed public discussion about 125 the relevance of collecting and analyzing data on migrant status and ethnicity and health in Europe, 126 and a time to move forward with regard to politically and socially acceptable indicators to be used in 127 public health research and surveillance.

Black-White risk 139 differentials in COVID-19 (SARS-COV2) transmission, mortality and case fatality in the United States: 140 translational epidemiologic perspective and challenges

Stora skillnader i överdödlighet våren 2020 utifrån 143

excess mortality in March-May 2020 by country of birth in

Ethnic and regional variations in hospital 146 mortality from COVID-19 in Brazil: a cross-sectional observational study

españoles e inmigrantes en un área sanitaria de Madrid [COVID-19 in Spanish and immigrant patients 150 in a sanitary district of Madrid

Younger ages at risk of 152

Covid-19 mortality in communities of color

Measuring and analyzing "race", racism, and racial discrimination

Social Epidemiology

The failure of the importation of ethno-racial statistics in Europe: debates and 157 controversies. Ethnic and Racial Studies

Une hausse des décès deux fois plus importante pour les personnes nées 159

étranger que pour celles nées en France en mars-avril 2020. [An increase in mortality two times 160 higher among persons born abroad than among those born in France

La surmortalité durant l'épidémie de Covid-19 dans 163 les départements franciliens

The fierce urgency of now: closing 167 glaring gaps in US surveillance data on COVID-19