Birthplace Implications of COVID-19 Mortality in Utah 2020–2023: A Cross-sectional Study

The purpose of this population-based study is to examine the impact of COVID-19 and its long-term outcomes on US-born and people born outside the US in the state of Utah. Using the Utah Population Database, people born outside the US who were Utah residents alive on January 2020 were matched to US born Utah residents by age and sex. Demographics were compared using Chi-square test, and we examined COVID-19 outcomes using a conditional logistic regression model adjusting for race, ethnicity, Charlson Comorbidity Index, and socioeconomic factors. The final analysis included 475,582 individuals. Among US-born patients, 76.4% were non-Hispanic White and 9% were Hispanic/Latino. Among foreign-born individuals, 18.2% were non-Hispanic White and 50.1% were Hispanic/Latino origin. People born outside the US were less likely to be admitted to an ICU with a COVID diagnosis compared to those born in the US [OR = 0.85, 95% CI: 0.76-0.94]. In comparison to US-born individuals, Utah residents born outside the US had a 21% lower likelihood of all-cause mortality compared to US-born Utah residents [OR = 0.79, (0.74, 0.84)]. This is the first complete state-based analysis of Utah residents' COVID-19 outcomes and demonstrates the migrant mortality advantage that has been previously described in literature.