High excess mortality in areas with young and socially vulnerable populations during the COVID-19 outbreak in Stockholm Region, Sweden

Abstract

IntroductionWe aimed to describe the distribution of excess mortality (EM) during the first weeks of the COVID-19 outbreak in the Stockholm Region, Sweden, according to age, sex and sociodemographic context.MethodsWeekly all-cause mortality data were obtained from Statistics Sweden for the period 1 January 2015 to 17 May 2020. EM during the first 20 weeks of 2020 was estimated by comparing observed mortality rates with expected mortality rates during the five previous years (N=2 379 792). EM variation by socioeconomic status (tertiles of income, education, Swedish-born, gainful employment) and age distribution (share of 70+-year-old persons) was explored based on Demographic Statistics Area (DeSO) data.ResultsEM was first detected during the week of 23–29 March 2020. During the peak week of the epidemic (6–12 April 2020), an EM of 150% was observed (152% in 80+-year-old women; 183% in 80+-year-old men). During the same week, the highest EM was observed for DeSOs with lowest income (171%), lowest education (162%), lowest share of Swedish-born (178%) and lowest share of gainfully employed residents (174%). EM was further increased in areas with higher versus lower proportion of younger people (magnitude of increase: 1.2–1.7 times depending on socioeconomic measure).ConclusionLiving in areas characterised by lower socioeconomic status and younger populations was linked to excess mortality during the COVID-19 pandemic in the Stockholm Region. These conditions might have facilitated viral spread. Our findings highlight the well-documented vulnerability linked to increasing age and sociodemographic context for COVID-19–related death.

Clinical outcomes and risk factors for COVID-19 among migrant populations in high-income countries: a systematic review

“…Among people born in Sweden, the EU, the Nordic countries or North America, the excess mortality among those >65 was 19% and among the middle aged was 1% (40). In Stockholm during the peak of the epidemic (6 to 12 April 2020), areas with the lowest tercile of share of Swedish-born had 178% excess mortality compared with the previous five years (41).…”

Interaction Effects between COVID-19 Outbreak and Community Income Levels on Excess Mortality among Patients Visiting Emergency Departments

“…Excess mortality during the COVID-19 pandemic was caused not only by deaths directly attributable to COVID-19 but also to deaths indirectly caused by COVID-19 that were due to disruptions in the operation of the existing healthcare system. 2 Patients with acute medical illnesses are reluctant to visit emergency departments (EDs) because of concerns about COVID-19 contamination in hospitals, as well as stay-at-home orders. Patients with severe illness who visit the ED may also experience delays in proper treatment, which are due to a lack of resources resulting from the consumption of many medical resources, such as beds, intensive care units (ICUs) and medical staff, in the course of responding to the COVID-19 outbreak.…”

“…Patients with severe illness who visit the ED may also experience delays in proper treatment, which are due to a lack of resources resulting from the consumption of many medical resources, such as beds, intensive care units (ICUs) and medical staff, in the course of responding to the COVID-19 outbreak. 2 3 4 …”

“… 7 People with lower SEPs at the individual and neighborhood levels have higher mortality rates, which have been consistently reported in patients with various diseases and in special situations such as disasters. 8 9 10 11 12 13 Recent analyses of the excess mortality from COVID-19 have also reported higher excess mortality in the general population with lower income and education levels, 2 4 14 but few attempts have been made in patients with emergency conditions.…”

COVID-19 collateral damage: psychological distress and behavioral changes among older adults during the first outbreak in Stockholm, Sweden

“…While several studies have examined the distribution of COVID-19 mortality among Swedish older adults by sex, socioeconomic and household factors [11][12][13], little is known on the collateral damage of these restrictions. To the best of our knowledge, only one study has examined the mental health consequences of the Swedish strategy on the elderly [14], and no study has looked into other dimensions such as psychological wellbeing and/or behavioral changes.…”