Association between first language and SARS-CoV-2 infection rates, hospitalization, intensive care admissions and death in Finland: a population-based observational cohort study

Abstract

Objectives Motivated by reports of increased risk of coronavirus disease 2019 (COVID-19) in ethnic minorities of high-income countries, we explored whether patients with a foreign first language are at an increased risk of COVID-19 infections, more serious presentations, or worse outcomes. Methods In a retrospective observational population-based quality registry study covering a population of 1.7 million, we studied the incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), admissions to specialist healthcare and the intensive care unit (ICU), and all-cause case fatality in different language groups between 27th February and 3rd August 2020 in Southern Finland. A first language other than Finnish, Swedish or Sámi served as a surrogate marker for a foreign ethnic background. Results In total, 124 240 individuals were tested, and among the 118 300 (95%) whose first language could be determined, 4005 (3.4%) were COVID-19-positive, 623 (0.5%) were admitted to specialized hospitals, and 147 (0.1%) were admitted to the ICU; 254 (0.2%) died. Those with a foreign first language had lower testing rates (348, 95%CI 340–355 versus 758, 95%CI 753–762 per 10 000, p < 0.0001), higher incidence (36, 95%CI 33–38 versus 22, 95%CI 21–23 per 10 000, p < 0.0001), and higher positivity rates (103, 95%CI 96–109 versus 29, 95%CI 28–30 per 1000, p < 0.0001). There was no significant difference in ICU admissions, disease severity at ICU admission, or ICU outcomes. Case fatality by 90 days was 7.7% in domestic cases and 1.2% in those with a foreign first language, explained by demographics (age- and sex-adjusted HR 0.49, 95%CI 0.21–1.15). Conclusions The population with a foreign first language was at an increased risk for testing positive for SARS-CoV-2, but when hospitalized they had outcomes similar to those in the native, domestic language population. This suggests that special attention should be paid to the prevention and control of infectious diseases among language minorities.

Spatiotemporal clustering patterns and sociodemographic determinants of COVID-19 (SARS-CoV-2) infections in Helsinki, Finland

“…In general, median income of inhabitants and a high number of foreign citizens were the best predictors of variation in COVID-19 infection data, followed by a low level of education and a relatively high number of unemployed in postal code areas ( Table 4 ). Our findings are in line with previous socioeconomic studies in Finland, which found that COVID-19 infections were most common in adults with low incomes and a low level of education (Helsinki GSE, 2021), and one out of every four coronavirus infections in Finland has been diagnosed among foreign citizens ( Holmerg et al, 2022 ; THL, 2020). Furthermore, health authorities in Helsinki region announced in 2020 that high number of COVID-19 infections had been detected among the foreign population in the metropolitan area ( Rantavaara, 2020 ).…”

Tobacco use and risk of COVID-19 infection in the Finnish general population

“…We adjusted for covariates that we considered a priori that causally precede the exposure and are associated with the outcome 27 . Evidence shows clear associations with sociodemographic factors and COVID-19 incidence in Finland and other settings 28 – 30 . Tobacco use is also associated with demographic and social factors, including social capital and social participation 31 .…”

Association of sociodemographic characteristics with self-perceived access to COVID-19 information and adherence to preventive measures among migrant origin and general populations in Finland: a cross-sectional study

“…It is possible that these groups over-reported adherence to preventive measures due to social desirability. However, persons originating from the Middle East and Africa also had the highest incidence of COVID-19 in Finland, 30 therefore it is possible that these groups were more motivated to follow recommendations due to higher perceived risk of COVID-19 infection. Women reported adherence to preventive measures more often than men both in the general and migrant origin populations, which is in consistency with previous studies.…”