Disparities in Coronavirus Disease 2019 Mortality by Country of Birth in Stockholm, Sweden: A Total-Population–Based Cohort Study

Rostila, Mikael; Cederström, Agneta; Wallace, Matthew; Brandén, Maria; Malmberg, Bo; Andersson, Gunnar

doi:10.1093/aje/kwab057

Cited by 77 publications

(88 citation statements)

References 25 publications

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“…Our findings are particularly important to interpret in the light of robust disparities in mortality by country of birth in the total population of Sweden 17 and Stockholm Region. 18 These are studies with different target populations but comparable to our study when it comes to data sources, measures and context. Interestingly, while we were unable to find any lower survival among immigrants with COVID-19, which corresponds to results of a US study also covering a long time period, 25 supplementary analyses restricting the analyses to deaths captured by the aforementioned Swedish studies indeed showed higher death rate among immigrants from LICs.…”

Section: Discussionsupporting

confidence: 57%

“… 11 13–16 Population-based studies on individual-level data remains rare. Two register-based total population studies of Sweden 17 and the capital region of Stockholm 18 have shown higher COVID-19 mortality among groups with lower income, shorter education and particularly those born in low-income (LIC) and middle-income countries (MIC). These findings support earlier Swedish ecological research reporting excess COVID-19 mortality in disadvantaged neighbourhoods.…”

Section: Introductionmentioning

confidence: 99%

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Inequitable impact of infection: social gradients in severe COVID-19 outcomes among all confirmed SARS-CoV-2 cases during the first pandemic wave in Sweden

Gustafsson

Sebastián

Fonseca-Rodríguez

et al. 2021

J Epidemiol Community Health

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BackgroundThe backdrop of the ubiquitous social inequalities has increasingly come into foreground in research on the COVID-19 pandemic, but the lack of high-quality population-based studies limits our understanding of the inequitable outcomes of the disease. The present study seeks to estimate social gradients in COVID-19 hospitalisations, intensive care admissions and death by education, income and country of birth, while taking into account disparities in comorbidities.MethodsWe used a register-based retrospective open cohort design enrolling all 74 659 confirmed SARS-CoV-2-positive cases aged >25 years in Sweden during the first wave of the pandemic (until 14 September 2020). Information was retrieved from multiple registers and linked by the unique Swedish personal identity number concerning COVID-19 case identification; COVID-19 hospitalisations, intensive care admissions and death; comorbidities as measured by the Charlson Comorbidity Index; and sociodemographic information. Social gradients were estimated by the Relative Index of Inequality (RII) using Cox regression.ResultsAdjusted analyses showed significant social gradients in COVID-19 hospitalisation, intensive care admission, across education, income and country of birth, which were unaffected by adjustment for comorbidities. Education and country of birth gradients were stronger for hospitalisation and intensive care admissions but small to non-existent for death. In contrast, income gradients were consistent across all three COVID-19 outcomes.ConclusionSocial gradients in severe COVID-19 outcomes are widespread in Sweden, but appear to be unrelated to pre-existing health disparities. Inequitable outcomes of SARS-CoV-2 infection may therefore be at least partially avoidable and could rely on equitable management of confirmed COVID-19 cases.

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Section: Discussionsupporting

confidence: 57%

Section: Introductionmentioning

confidence: 99%

Inequitable impact of infection: social gradients in severe COVID-19 outcomes among all confirmed SARS-CoV-2 cases during the first pandemic wave in Sweden

Gustafsson

Sebastián

Fonseca-Rodríguez

et al. 2021

J Epidemiol Community Health

View full text Add to dashboard Cite

show abstract

“…The heterogenous effects of COVID-19 are no more evident than in the United States. Heterogeneity has also been observed by socioeconomic status (SES) and structural racism in the UK, Canada, and Sweden [6] , [7] , [8] . In the United States, there is heterogeneity between different states, with higher prevalence and worse outcomes in states with larger proportions of Black and Hispanic persons [9] .…”

Section: Introductionmentioning

confidence: 99%

The effect of race, socioeconomic status, and comorbidity on patients afflicted with COVID 19: A Local Perspective

Mankowski

Al‐Qurayshi

Souza

et al. 2021

Annals of Epidemiology

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Purpose: The aim of this study is to further examine the associations of race, socioeconomic factors, and comorbidity with COVID-19 health outcomes. Methods: This is a retrospective cohort study of 309 PCR confirmed COVID-19 positive adults who presented to Tulane Medical Center in New Orleans, LA, from March 9 to May 29, 2020. The primary outcomes investigated were need for invasive mechanical ventilation (IMV) and in-hospital mortality. A multivariate analysis was performed to determine socioeconomic and medical risk factors for IMV and in-hospital mortality. Results: Compared to white patients, Black patients were more likely to present younger, female, obese, unemployed, and underinsured. However, when controlled for common risk factors, Black and white patients had similar risk for IMV and mortality. Increased age (≥65 years), obesity, and increased comorbidity were associated with increased risk for IMV and mortality. Conclusions: Race and socioeconomic factors may increase risk for COVID-19 infection but did not affect health outcomes within the hospital setting. Therefore, the higher rates of COVID-19 infection and mortality in vulnerable populations may be better explained by lower socioeconomic status, with subsequent higher comorbidity, in these populations. Community health initiatives should be prioritized in response to the COVID-19 pandemic.

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“…International evidence has shown that immigrants and ethnic minorities are disproportionately at risk of severe COVID-19 complications and death. [1][2][3][4][5][6][7][8][9][10][11][12][13] In the context of an ongoing pandemic, an effort to understand the causes for why some groups are more affected is a public health priority. [14][15][16][17] Among these groups, excess mortality has been suggested to be the result of differential exposure (eg, high-risk occupations or overcrowded accommodation), susceptibility (eg, pre-existing conditions) and language barriers and access to healthcare.…”

mentioning

confidence: 99%

Intermarriage and COVID-19 mortality among immigrants. A population-based cohort study from Sweden

et al. 2021

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ObjectivesTo evaluate the role of language proficiency and institutional awareness in explaining excess COVID-19 mortality among immigrants.DesignCohort study with follow-up between 12 March 2020 and 23 February 2021.SettingSwedish register-based study on all residents in Sweden.Participants3 963 356 Swedish residents in co-residential unions who were 30 years of age or older and alive on 12 March 2020 and living in Sweden in December 2019.Outcome measuresCox regression models were conducted to assess the association between different constellations of immigrant-native couples (proxy for language proficiency and institutional awareness) and COVID-19 mortality and all other causes of deaths (2019 and 2020). Models were adjusted for relevant confounders.ResultsCompared with Swedish-Swedish couples (1.18 deaths per thousand person-years), both immigrants partnered with another immigrant and a native showed excess mortality for COVID-19 (HR 1.43; 95% CI 1.29 to 1.58 and HR 1.24; 95% CI 1.10 to 1.40, respectively), which translates to 1.37 and 1.28 deaths per thousand person-years. Moreover, similar results are found for natives partnered with an immigrant (HR 1.15; 95% CI 1.02 to 1.29), which translates to 1.29 deaths per thousand person-years. Further analysis shows that immigrants from both high-income and low-income and middle-income countries (LMIC) experience excess mortality also when partnered with a Swede. However, having a Swedish-born partner is only partially protective against COVID-19 mortality among immigrants from LMIC origins.ConclusionsLanguage barriers and/or poor institutional awareness are not major drivers for the excess mortality from COVID-19 among immigrants. Rather, our study provides suggestive evidence that excess mortality among immigrants is explained by differential exposure to the virus.

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Disparities in Coronavirus Disease 2019 Mortality by Country of Birth in Stockholm, Sweden: A Total-Population–Based Cohort Study

Cited by 77 publications

References 25 publications

Inequitable impact of infection: social gradients in severe COVID-19 outcomes among all confirmed SARS-CoV-2 cases during the first pandemic wave in Sweden

Inequitable impact of infection: social gradients in severe COVID-19 outcomes among all confirmed SARS-CoV-2 cases during the first pandemic wave in Sweden

The effect of race, socioeconomic status, and comorbidity on patients afflicted with COVID 19: A Local Perspective

Intermarriage and COVID-19 mortality among immigrants. A population-based cohort study from Sweden

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