Disparities in COVID-19 health outcomes among different sub-immigrant groups in the US - a study based on the spatial Durbin model

Immigrants may be more vulnerable to coronavirus disease 2019 (COVID-19) than other sub-population groups due to their relatively low socioeconomic status. However, no quantitative studies have examined the relationships between immigrants and COVID-19 health outcomes (confirmed cases and related deaths). We first examined the relationship between total immigrants and COVID-19 health outcomes with spatial Durbin models after controlling for demographic, biophysical and socioeconomic variables. We then repeated the same analysis within multiple subimmigrant groups divided by those with original nativity to examine the differential associations with health outcomes. The result showed that the proportion of all immigrants is negatively associated with the number of confirmed cases and related deaths. At the continent and sub-continent level, we consistently found negative relationships between the number of confirmed cases and the proportion of all sub-immigrant groups. However, we observed mixed associations between the proportion of sub-immigrant groups and the number of deaths. Those counties having a higher prevalence of immigrants from Africa [Eastern Africa: -18.6, 95% confidence interval (CI): -38.3~-2.9; Northern Africa: -146.5, 95% CI: -285.5~-20.1; Middle Africa: -622.6, 95% CI: -801.4~- 464.5] and the Americas (Northern America: -90.5, 95% CI: - 106.1~-73.8; Latin America: -6.8, 95% CI: -8.1~-5.2) mostly had a lower number of deaths, whereas those counties having a higher prevalence of immigrants from Asia (Eastern Asia: 21.0, 95% CI: 7.7~36.2; Western Asia: 42.5, 95% CI: 16.9~68.8; South- Central Asia: 26.6, 95% CI: 15.5~36.9) showed a higher number of deaths. Our results partially support that some immigrants, especially those from Asia, are more vulnerable to COVID-19 than other sub-population groups.