Disparities in COVID-19 deaths 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

Preliminary evidence points to higher morbidity and mortality of COVID-19 in certain racial and ethnic groups but population-based studies using micro-level data are so far lacking. A register-based cohort including all adults living in Stockholm, Sweden (n=1,778,670) between January 31(st) (date of first confirmed case of COVID-19) and May 4(th) 2020 was utilized. Poisson regressions with region/country of birth as exposure and underlying cause of death by COVID-19 as outcome was performed, estimating relative risks (RR) and confidence intervals (CI). Migrants from Middle-Eastern countries (RR 3.2, 95% CI: 2.6-3.8), Africa (RR 3.0, 95% CI: 2.2-4.3) and the Nordic countries (RR 1.5, 95% CI: 1.2-1.8) had higher mortality in COVID-19 when compared to Swedish born. Especially high mortality risks from COVID-19 was found among individuals born in Somalia, Lebanon, Syria, Turkey, Iran and Iraq. Socioeconomic status, number of working age household members and neighborhood population density attenuated up to half of the increased COVID-19 mortality risks among foreign born. Disadvantaged socioeconomic and living conditions may increase infection rates in migrants and contribute to their higher COVID-19 mortality risk.