To what extent did mortality from COVID-19 in England and Wales differ for migrants compared to non-migrants in 2020 and 2021? A descriptive, observational study

Abstract

Seventeen percent of people living in the UK are migrants. In high-income countries, migrants have been shown to have better all-cause mortality but worse mortality for some specific causes such as infectious diseases. This observational study aims to quantify the extent to which mortality from coronavirus disease 2019 (COVID-19) differed between migrants and non-migrants for the population of England and Wales, 2020-2021. We use Official National Statistics data to compare mortality from COVID-19 in 2020 and 2021 by country/region of birth, expressed as the standardized mortality ratio with those born in England and Wales as the reference population. Migrants from 17 of 19 countries/regions examined had higher mortality from COVID-19 than non-migrants. The highest mortality was those born in Bangladesh (females SMR = 3.39, 95% CIs 3.09-3.71; males 4.41, 95% CIs 4.09-4.75); Pakistan (females 2.73, 95% CIs 2.59-2.89; males 3.02, 95% CIs 2.89-3.14); and the Caribbean (females 2.03, 95% CIs 1.87-2.20; males 2.48, 95% CIs 2.37-2.60). Migrants born in Antarctica and Oceania (females 0.54, 95% CI 0.42-0.40; males 0.71, 95% CI 0.51-0.88), and North and Central America (females 0.95, 95% CI 0.80-1.11; males 0.85, 95% CI 0.72-0.99) had lower mortality than non-migrants. Most migrant populations had higher mortality from COVID-19 than non-migrants in England and Wales. Policy-makers must work to integrate migration status into routine data collection to inform future research and understand the causes of the inequalities seen.

Figure 1.

Population of migrants in England and Wales in millions, in descending order from highest to lower number (total persons, bottom axis, denoted by black dot) and deaths from COVID-19 (total persons, top axis, denoted by red triangle) by country/region of birth, excluding those born in England and Wales, 2020–2021.

Figure 2.

Forest plot showing SMR for COVID-19, population of England and and Wales, 2020–2021, by country/region of birth (top panel females, bottom panel males) with 95% confidence intervals. The vertical black line shows the SMR for female reference population is females born in England and Wales (SMR = 1); and male reference population is males born in England and Wales (SMR = 1).

Figure 3.

Choropleths showing SMR from COVID-19 for resident population of England and Wales from COVID-19, 2020–2021, by country or region of birth, for all ages for females. Countries/regions shaded red have higher SMRs than the reference population, and blue lower SMRs than the reference population. The darkness of the shade indicates how much higher (reds) or lower (blues) the SMRs are from the reference population, with darker shades indicating greater differences. The UK is combined for the purposes of the visualization and shaded grey as the reference population.

Figure 4.

Choropleths showing SMR from COVID-19 for resident population of England and Wales from COVID-19, 2020–2021, by country or region of birth, for all ages for males. Countries/regions shaded red have higher SMRs than the reference population, and blue lower SMRs than the reference population. The darkness of the shade indicates how much higher (reds) or lower (blues) the SMRs are from the reference population, with darker shades indicating greater differences. The UK is combined for the purposes of the visualization and shaded grey as the reference population.