# Impact of the COVID-19 pandemic on incident diagnoses in German refugee centres 2018 to 2023

## TL;DR

The study shows how the COVID-19 pandemic changed the types of health issues diagnosed in German refugee centers, with increases in mental health and injury-related diagnoses.

## Contribution

This study provides empirical evidence on how the pandemic altered diagnosis patterns in refugee populations using a quasi-experimental design.

## Key findings

- Incidents of injuries, mental disorders, and psychotherapeutic drug prescriptions increased during the pandemic.
- Respiratory disease diagnoses decreased initially but later rebounded.
- The pandemic's impact on refugee health included heightened stressors and potential violence exposure.

## Abstract

The COVID-19 pandemic may have affected morbidity patterns of residents in refugee centres, but empirical evidence is scarce. We utilised linked data from a health surveillance network in refugee centres of three German federal states, employing a quasi-experimental design to examine the effects of the COVID-19 pandemic on newly diagnosed medical conditions. Doctors coded routine diagnoses on-site in healthcare facilities for refugee patients. Our analysis encompasses the timeframe from October 2018 to April 2023 and includes individual-level data for 109,175 refugees. This data resulted in 76,289 patient-months across 21 refugee centres, with a total occupancy of 144,012 person-months. Here, we employ segmented regression analyses, adjusting for time trends, socio-demographic factors, occupancy, and centre characteristics, to evaluate the COVID-19 pandemic’s impact on incident diagnosis patterns among refugees. We show how the COVID-19 pandemic altered diagnosis patterns among refugees in German centres. Notably, incidents of injuries, mental disorders, psychotherapeutic drug prescriptions, and genitourinary diseases rose, while respiratory diseases decreased, later rebounding. An increase in injury-related diagnoses suggests heightened violence experiences during flight or in centres. Mental disorder diagnoses and psychotherapeutic drug prescriptions rose, reflecting pandemic-related stressors and the pandemic’s multifaceted impact on refugee health.

Refugee populations have been at high risk of COVID-19 but the impacts of the pandemic on healthcare-seeking and diagnosis of other conditions are not well described. Here, the authors use data from a network of refugee centres in Germany to explore impacts of the COVID-19 pandemic on incident diagnosis patterns.