Hraiech Sami, Pauly Vanessa, Orleans Véronica, Auquier Pascal, Azoulay Elie, Roch Antoine, Boyer Laurent, Papazian Laurent
Service de Médecine Intensive - Réanimation, AP-HM, Hôpital Nord, Marseille, France.
Faculté de medecine, Centre d'Etudes et de Recherches sur les Services de Santé et qualite de vie EA 3279, Aix-Marseille Université, 13005, Marseille, France.
Ann Intensive Care. 2023 Oct 6;13(1):99. doi: 10.1186/s13613-023-01197-8.
Before the Coronavirus Disease 2019 (COVID-19) pandemic in France, undocumented migrants had a higher risk than general population for being admitted to the intensive care unit (ICU) because of acute respiratory failure or severe infection. Specific data concerning the impact of COVID-19 on undocumented migrants in France are lacking. We aimed to analyze the mortality and respiratory severity of COVID-19 in this specific population. We retrospectively included all undocumented adult migrants admitted in French ICUs from March 2020 through April 2021 using the French nationwide hospital information system (Programme de Médicalisation des Systèmes d'Information). We focused on admissions related to COVID-19. Undocumented migrants were compared to the general population, first in crude analysis, then after matching on age, severity and main comorbidities. The primary outcome was the ICU mortality from COVID-19. Secondary objectives were the incidence of acute respiratory distress syndrome (ARDS), the need for mechanical ventilation (MV), the duration of MV, ICU and hospital stay.
During the study period, the rate of ICU admission among patients hospitalized for COVID-19 was higher for undocumented migrants than for general population (463/1627 (28.5%) vs. 81 813/344 001 (23.8%); p < 0.001). Although ICU mortality was comparable after matching (14.3% for general population vs. 13.3% for undocumented migrants; p = 0.50), the incidence of ARDS was higher among undocumented migrants (odds ratio, confidence interval (OR (CI)) 1.25 (1.06-1.48); p = 0.01). Undocumented migrants needed more frequently invasive MV (OR (CI) 1.2 (1.01-1.42); p = 0.04 than general population. There were no differences between groups concerning duration of MV, ICU and hospital length of stay.
During the first waves of COVID-19 in France, undocumented migrants had a mortality similar to the general population but a higher risk for ICU admission and for developing an ARDS. These results highlight the need for reinforcing prevention and improving primary healthcare access for people in irregular situation.
在法国2019冠状病毒病（COVID-19）大流行之前，无证移民因急性呼吸衰竭或严重感染入住重症监护病房（ICU）的风险高于普通人群。目前缺乏关于COVID-19对法国无证移民影响的具体数据。我们旨在分析这一特定人群中COVID-19的死亡率和呼吸严重程度。我们使用法国全国医院信息系统（信息系统医疗化计划），回顾性纳入了2020年3月至2021年4月期间入住法国ICU的所有成年无证移民。我们重点关注与COVID-19相关的入院情况。首先在粗分析中，然后在按年龄、严重程度和主要合并症进行匹配后，将无证移民与普通人群进行比较。主要结局是COVID-19导致的ICU死亡率。次要目标是急性呼吸窘迫综合征（ARDS）的发生率、机械通气（MV）的需求、MV的持续时间、ICU和住院时间。
在研究期间，因COVID-19住院的患者中，无证移民入住ICU的比例高于普通人群（463/1627（28.5%）对81813/344001（23.8%）；p<0.001）。尽管匹配后ICU死亡率相当（普通人群为14.3%，无证移民为13.3%；p=0.50），但无证移民中ARDS的发生率更高（优势比，置信区间（OR（CI））1.25（1.06-1.48）；p=0.01）。无证移民比普通人群更频繁地需要有创MV（OR（CI）1.2（1.01-1.42）；p=0.04）。两组在MV持续时间、ICU和住院时间方面没有差异。
在法国COVID-19的第一波疫情期间，无证移民的死亡率与普通人群相似，但入住ICU和发生ARDS的风险更高。这些结果凸显了加强预防以及改善非正规处境人群获得初级医疗保健服务的必要性。
