As global deaths from COVID-19 continue to rise, the world’s governments, institutions, and agencies are still working toward an understanding of who is most at risk of death. In this study, data on all recorded COVID-19 deaths in Sweden up to May 7, 2020 are linked to high-quality and accurate individual-level background data from administrative registers of the total population. By means of individual-level survival analysis we demonstrate that being male, having less individual income, lower education, not being married all independently predict a higher risk of death from COVID-19 and from all other causes of death. Being an immigrant from a low- or middle-income country predicts higher risk of death from COVID-19 but not for all other causes of death. The main message of this work is that the interaction of the virus causing COVID-19 and its social environment exerts an unequal burden on the most disadvantaged members of society.

Background Housing characteristics and neighbourhood context are considered risk factors for COVID-19 mortality among older adults. The aim of this study was to investigate how individual-level housing and neighbourhood characteristics are associated with COVID-19 mortality in older adults. Methods For this population-based, observational study, we used data from the cause-of-death register held by the Swedish National Board of Health and Welfare to identify recorded COVID-19 mortality and mortality from other causes among individuals (aged ≥70 years) in Stockholm county, Sweden, between March 12 and May 8, 2020. This information was linked to population-register data from December, 2019, including socioeconomic, demographic, and residential characteristics. We ran Cox proportional hazards regressions for the risk of dying from COVID-19 and from all other causes. The independent variables were area (m 2 ) per individual in the household, the age structure of the household, type of housing, confirmed cases of COVID-19 in the borough, and neighbourhood population density. All models were adjusted for individual age, sex, country of birth, income, and education. Findings Of 279 961 individuals identified to be aged 70 years or older on March 12, 2020, and residing in Stockholm in December, 2019, 274 712 met the eligibility criteria and were included in the study population. Between March 12 and May 8, 2020, 3386 deaths occurred, of which 1301 were reported as COVID-19 deaths. In fully adjusted models, household and neighbourhood characteristics were independently associated with COVID-19 mortality among older adults. Compared with living in a household with individuals aged 66 years or older, living with someone of working age (<66 years) was associated with increased COVID-19 mortality (hazard ratio 1·6; 95% CI 1·3–2·0). Living in a care home was associated with an increased risk of COVID-19 mortality (4·1; 3·5–4·9) compared with living in independent housing. Living in neighbourhoods with the highest population density (≥5000 individuals per km 2 ) was associated with higher COVID-19 mortality (1·7; 1·1–2·4) compared with living in the least densely populated neighbourhoods (0 to <150 individuals per km 2 ). Interpretation Close exposure to working-age household members and neighbours is associated with increased COVID-19 mortality among older adults. Similarly, living in a care home is associated with increased mortality, potentially through exposure to visitors and care workers, but also due to poor underlying health among care-home residents. These factors should be considered when developing strategies to protect this group. Funding Swedish Research Council for Health, Working Life and Welfare (FORTE), Swedish Foundation for Humanities and Social Sciences.

No study to date has assessed the role of occupations in workers' COVID-19 mortality when adjusted for compositional differences or assessed secondary risks of occupations for cohabiting elderly. Public health responses can be better targeted if we know whether and how work contexts contribute to mortality differentials or whether traditional risk factors operate independently of occupational exposure to coronavirus.

Repeat immigrants differ in terms of income trajectories, and may differ in terms of other outcomes as well. Furthermore, this study underlines that Swedish registers provide a reliable data source to analyze groups which are unidentifiable in other data sources.

This paper focuses on the residential resettlement decisions of a sample of immigrants from Iran and Turkey living in Sweden between 1968 and 2001. Using the Swedish Longitudinal Immigrant database, we are able to link unique pre-and post-migration data to understand whether region of origin is a better predictor of internal migration decisions than is country of origin, the more often used measure in existing research. More specifically, we test whether living in municipalities with a high number of individuals from the same country of origin is a similar phenomenon as a high number of individuals from the same region of origin. This is relevant, as large immigrant groups come from ethnically, religiously, and linguistically heterogeneous countries of origin where regional characteristics differ according to aforementioned aspects from that of the mainstream population. We indeed find that individuals are less likely to relocate from municipalities in which there is a large presence of other immigrants from the same region of origin. Instead, individuals residing in areas with a large number of individuals from their country of origin are observed with an elevated probability of resettlement.

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.

Background Advanced maternal age at birth is considered a risk factor for adverse birth outcomes. A recent study applying a sibling design has shown, however, that the association might be confounded by unobserved maternal characteristics. Methods Using total population register data on all live singleton births during the period 1999–2012 in Denmark (N = 580 133; 90% population coverage), Norway (N = 540 890) and Sweden (N = 941 403) and from 2001–2014 in Finland (N = 568 026), we test whether advanced maternal age at birth independently increases the risk of low birthweight (LBW) (&lt;2500 g) and pre-term birth (&lt;37 weeks gestation). We estimated within-family models to reduce confounding by unobserved maternal characteristics shared by siblings using three model specifications: Model 0 examines the bivariate association; Model 1 adjusts for parity and sex; Model 2 for parity, sex and birth year. Results The main results (Model 1) show an increased risk in LBW and pre-term delivery with increasing maternal ages. For example, compared with maternal ages of 26–27 years, maternal ages of 38–39 years display a 2.2, 0.9, 2.1 and 2.4 percentage point increase in the risk of LBW in Denmark, Finland, Norway and Sweden, respectively. The same patterns hold for pre-term delivery. Conclusions Advanced maternal age is independently associated with higher risk of poor perinatal health outcomes even after adjusting for all observed and unobserved factors shared between siblings.

Background We aim to use intermarriage as a measure to disentangle the role of exposure to virus, susceptibility and care in differences in burden of COVID-19, by comparing rates of COVID-19 infections between immigrants married to a native and to another immigrant. Methods Using data from the Norwegian emergency preparedness, register participants (N=2 312 836) were linked with their registered partner and categorized based on own and partner’s country of birth. From logistic regressions, odds ratios (OR) of COVID-19 infection (15 June 2020–01 June 2021) and related hospitalization were calculated adjusted for age, sex, municipality, medical risk, occupation, household income, education and crowded housing. Results Immigrants were at increased risk of COVID-19 and related hospitalization regardless of their partners being immigrant or not, but immigrants married to a Norwegian-born had lower risk than other immigrants. Compared with intramarried Norwegian-born, odds of COVID-19 infection was higher among persons in couples with one Norwegian-born and one immigrant from Europe/USA/Canada/Oceania (OR 1.42–1.46) or Africa/Asia/Latin-America (OR 1.91–2.01). Odds of infection among intramarried immigrants from Africa/Asia/Latin-America was 4.92. For hospitalization, the corresponding odds were slightly higher. Conclusion Our study suggests that the excess burden of COVID-19 among immigrants is explained by differences in exposure and care rather than susceptibility.