SARS-CoV-2 infections and hospitalisations among immigrants in Norway-significance of occupation, household crowding, education, household income and medical risk: a nationwide register study

Abstract

Background: As in other countries, the COVID-19 pandemic has affected Norway’s immigrant population disproportionately, with significantly higher infection rates and hospitalisations. The reasons for this are uncertain. Methods: Through the national emergency preparedness register, BeredtC19, we have studied laboratory-confirmed infections with SARS-CoV-2 and related hospitalisations in the entire Norwegian population, by birth-country background for the period 15 June 2020 to 31 March 2021, excluding the first wave due to limited test capacity and restrictive test criteria. Straightforward linkage of individual-level data allowed adjustment for demographics, socioeconomic factors (occupation, household crowding, education and household income), and underlying medical risk for severe COVID-19 in regression models. Results: The sample comprised 5.49 million persons, of which 0.91 million were born outside of Norway, there were 82,532 confirmed cases and 3088 hospitalisations. Confirmed infections in this period (per 100,000): foreign-born 3140, Norwegian-born with foreign-born parents 4799 and Norwegian-born with Norwegian-born parent(s) 1011. Hospitalisations (per 100,000): foreign-born 147, Norwegian-born with foreign-born parents 47 and Norwegian-born with Norwegian-born parent(s) 37. The addition of socioeconomic and medical factors to the base model (age, sex, municipality of residence) attenuated excess infection rates by 12.0% and hospitalisations by 3.8% among foreign-born, and 10.9% and 46.2%, respectively, among Norwegian-born with foreign parents, compared to Norwegian-born with Norwegian-born parent(s). Conclusions: There were large differences in infection rates and hospitalisations by country background, and these do not appear to be fully explained by socioeconomic and medical factors. Our results may have implications for health policy, including the targeting of mitigation strategies.

Understanding the excess COVID-19 burden among immigrants in Norway

“…Immigrants and Norwegian-born in mixed couples had about the same rates of COVID-19, indicating that the environment these couples share is important for the exposure and likelihood of infection. In line with previous studies, 2 , 11 , 12 socioeconomic factors we were able to adjust for could not explain differences in rates. This point toward other factors related to exposure, such as the local community infrastructure and public transport offers, which may be important to assess in future studies.…”

“…It is reasonable to assume that this will reinforce already high rates. Still, both in the current and in previous papers, 1 , 11 municipality have not explained much of differences in rates between immigrants and nonimmigrants. We adjusted our analyses for crowded housing.…”

“… 19 However, underlying medical risk has not explained high rates of COVID-19-related hospitalizations or mortality among immigrants in previous studies. 8 , 11 Genetic susceptibility to COVID-19 and a severe course of the disease among groups of immigrants have also been proposed, but so far without sufficient empirical support. 20 , 21 …”

The Evaluation of a Social Media Campaign to Increase COVID-19 Testing in Migrant Groups: Cluster Randomized Trial

“…Several migrant groups have been disproportionally affected by COVID-19 in Norway [ 1 , 2 ]. These groups are also considered difficult to reach through traditional communication platforms [ 3 , 4 ].…”

“…In this study, we aimed at assessing whether a targeted social media advertising campaign encouraging selected migrant groups to get tested affected testing behavior (ClinicalTrials.gov NCT04866589; protocol is provided in Multimedia Appendices 1 and 2 ). The intervention described in this paper was an extension of the “Get tested” campaign, which had been launched after the Norwegian Institute of Public Health (NIPH) published findings that indicated higher rates of undetected cases among certain migrant groups compared to the general population; that is, lower test rates, higher test positivity rates, and higher rates of hospitalization [ 1 ]. The “Get tested” campaign was a part of a larger effort directed at the migrant population, which included drop-in testing stations [ 6 ] and dialogue meetings with migrant groups.…”