Science Update: Foreign-born Minnesotans more likely to die of COVID-19 at a younger age than U.S.-born residents, NIH-funded study suggests

Working-age immigrant men—particularly Latinos—were more likely to die of COVID-19 than their native-born counterparts, according to a study of Minnesota death records funded by the National Institutes of Health. Because COVID-19 data on immigration status is not collected on a national level, the findings provide insights into how COVID-19 mortality trends differ between U.S.- and foreign-born residents.

Most COVID-19 deaths among the state's U.S.-born residents occurred in nursing homes in late 2020. In contrast, deaths among foreign-born Minnesotans occurred outside long-term care facilities and earlier in the pandemic. The difference underscores the need for intervention strategies targeted to immigrant communities, the authors wrote.

The study was conducted by Kimberly M. Horner, doctoral student, and her colleagues at the University of Minnesota. It appears in Population Research and Policy Review. The study was funded in part by the NIH's Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Background

Previous studies have shown that recent immigrants are often healthier than U.S.-born residents and that immigrant health status tends to converge with U.S.-born health the longer an immigrant population has been in the country. Before the pandemic, immigrants typically had better health than U.S.-born residents in nearly all disease categories, except infectious diseases.

However, immigrants also face unique risks for COVID-19. Many reside in multigenerational housing, which can expose more susceptible older individuals to children who may acquire the virus in schools. Those with limited English skills may have difficulty accessing health services and understanding public health recommendations. Many immigrants lack health insurance and access to routine health care. Immigrants are also more likely to work in frontline jobs where social distancing is difficult. Undocumented immigrants may also be reluctant to seek health care because of concerns about their immigration status.

To avoid discouraging immigrants from seeking care, information on country of origin and immigration status is not collected on a federal level and so national statistics on immigrants' COVID-19 status is not available. However, because many state death certificates contain information on immigrant status, studies of state-level COVID-19 mortality rates could provide insights into differences in mortality trends between U.S.-born and foreign-born residents.

In the current study, researchers analyzed death certificates from the Minnesota Department of Health Office of Vital Records from January 1 to December 31, 2020. They also analyzed state-wide population data to estimate the proportions of foreign-born and U.S.-born residents in the state. Minnesota has a total population of 5.6 million people, with nearly 500,000 immigrants.

Results

Nearly 90% of COVID-19 deaths in 2020 were among U.S.-born Minnesotans. However, foreign-born state residents died at a younger average age (just over 72 years) than U.S.-born residents (82 years). Compared to U.S.-born residents and other foreign-born groups, foreign-born Latinos who died from COVID-19 had the lowest average age at death (just over 64 years), highest proportion of male deaths (about 70%) and lowest educational attainment, with more than 60 percent having less than a high school diploma.

Deaths among white U.S.-born and foreign-born residents tended to occur in those over age 65. The Latino foreign-born had a higher proportion of deaths of those in the working age population, ages 20 through 64.

Significance

The researchers concluded that foreign-born Minnesotans experienced higher death rates than native-born residents of the state and that these deaths occurred at a younger age, compared to those born in the United States. These findings could provide insight into how COVID-19 affects immigrants on national level and may lead to programs focused on lowering the risk of the disease among these populations.

Reference

Horner, KM, et al. A first look: disparities in COVID-19 mortality among U.S.-born and foreign-born Minnesota residents. Population Research and Policy Review. 2021. https://doi.org/10.1007/s11113-021-09668-1