Article Text

Download PDFPDF
Regional deprivation is associated with the distribution of vulnerable asylum seekers: a nationwide small area analysis in Germany
  1. Kayvan Bozorgmehr1,
  2. Oliver Razum2,
  3. Joachim Szecsenyi1,
  4. Werner Maier3,
  5. Christian Stock4,5
  1. 1 Department of General Practice & Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
  2. 2 Department of Epidemiology & International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
  3. 3 Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Neuherberg, Germany
  4. 4 Institute of Medical Biometry and Informatics, University Hospital Heidelberg, Heidelberg, Germany
  5. 5 Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
  1. Correspondence to Kayvan Bozorgmehr, Department of General Practice & Health Services Research, University Hospital Heidelberg, Heidelberg, Marsilius Arkaden, Turm West, 69120 Heidelberg, Germany; kayvan.bozorgmehr{at}


Background Newly arriving asylum seekers in many European Union countries are assigned a place of residence based on administrative quota. This may have important consequences for the exposure to contextual health risks. We assessed the association between regional deprivation and the distribution of asylum seekers in Germany considered as vulnerable (women, children <7 years, persons >64 years) because of their increased health needs.

Methods Using nationally representative data, we analysed the rates of observed to expected numbers of asylum seekers and vulnerable subgroups in Bayesian spatial models. Regional deprivation was measured by the German Index of Multiple Deprivation. The analyses were performed at the district level (N=402) and adjusted for district population size, effects of federal states as well as spatial effects.

Results Of the 224 993 asylum seekers, 38.7% were women, 13.8% children aged <7 years and 19.8% aged >64 years. The adjusted number of asylum seekers (totals and vulnerable subgroups) was higher in more deprived districts (Q3, Q4 and Q5) relative to districts in the lowest deprivation quintile (Q1). The adjusted rate ratios for districts with highest relative to those with lowest deprivation were 1.26 (1.03–1.53) for women, 1.28 (1.04–1.58) for children aged <7 years and 1.50 (1.08–2.08) for older asylum seekers.

Conclusion The adjusted number of vulnerable asylum seekers was higher in districts with medium and highest deprivation compared with districts with lowest deprivation. The disproportionate distribution was highest for older asylum seekers and children <7 years. Vulnerable subgroups tend to be exposed to more deprived places of residence, which may further increase health risks and healthcare needs.

  • deprivation
  • neighbourhood
  • context
  • migration
  • asylum-seekers
  • spatial epidemiology
  • health geography.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors KB: conceived the study, interpreted the results and wrote the first and final draft of the manuscript. OR: contributed to the study design, interpreted the results and critical revision of the manuscript. JS: interpreted the results and critical revision of the manuscript. WM: support using the GIMD, interpreted the results and critical revision of the manuscript. CS: important contributions to the study design, conceived and performed the statistical analysis, interpreted the results and critical revision of the manuscript.

  • Funding The study received no special funding. KB reports grants by the Federal Ministry of Research and Education (BMBF) in the scope of the research programme “Strukturaufbau in der Versorgungsforschung” (grant number: FKZ 01GY1611).

  • Competing interests This study was presented at the European Public Health Conference in Vienna (2016) and was awarded the “Best Abstract Prize” and the “Ferenc Bojan Young Investigator Award”. The authors declare that they have no conflicts of interest.

  • Patient consent The study is based on aggregated data.

  • Provenance and peer review Not commissioned; externally peer reviewed.