Intermarriage and COVID-19 mortality among immigrants. A population-based cohort study from Sweden

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.

Differences by region of birth in SARS-CoV-2 vaccine coverage and positive SARS-CoV-2 test among 400 000 healthcare workers and the general population in Sweden.

BACKGROUND: Globally SARS-CoV-2 vaccine coverage varies among healthcare workers. METHODS: Based on Swedish registers, data on vaccination status as of 31 October 2021 were analysed for all adults aged 35-64 years, 3 861 565 individuals, in Sweden by healthcare worker occupation group and region of birth. RESULTS: For both men and women vaccination coverage decreased in a graded manner by healthcare worker group with physicians having the highest coverage (96%), followed by registered nurses, licensed practical nurses, and nurse aides. Coverage also differed by region of birth for all groups of healthcare workers and non-healthcare workers with those born in Sweden with Sweden born parents having the highest coverage, and those born outside Sweden but within EU the lowest. CONCLUSION: The difference in vaccine coverage by region of birth among healthcare workers, regardless of whether it results from socioeconomic inequalities or sociocultural beliefs, puts them at a great occupational hazard and increased risk of nosocomial transmission.

Immigration, skills and changing urban income inequality in New Zealand

Policies have been implemented in New Zealand since the early 1990s that encourage long-term immigration of skilled workers and greater temporary immigration of unskilled workers. This paper investigates the contribution of immigration to change in income inequality of New Zealand's urban population and compares that with the contribution of the changing skill composition of the population. We apply sub-group and Shapley-value-regression decompositions of inequality to calculate contributions of eight population groups, defined by skill level and migration status, to inequality. We use microdata from six consecutive population censuses between 1986 and 2013. We find with both methodologies that: (1) more than 90 per cent of income inequality in each census can be attributed to within-group inequality;(2) the growth in the share of the population that is highly skilled and the growth in the share of foreign born in the population both had inequality-increasing effects;(3) the skill effect exceeded the migration effect. The findings suggest that changes to the level and skill composition of future immigration - triggered by the anticipated 'reset' of New Zealand immigration policies when the border re-opens after the subsiding of the COVID-19 pandemic - will impact on future income inequality. Hence our decomposition approaches ought to be revisited after the 2023 census data become available to measure early effects of any new policies.

Impact of COVID-19 Among Immigrant and Communities of Color Living with HIV in Oregon, 2020: Two Pandemics Rooted in Racism.

Over 8100 people living with HIV (PLWH) in Oregon are at risk of acquiring COVID-19, and communities of color are disproportionately impacted by both COVID-19 and HIV. This study identifies factors associated with a positive COVID-19 test among PLWH in Oregon, with the goal of promoting health equity. We probabilistically linked COVID-19 laboratory results with laboratory-confirmed HIV cases. Crude and adjusted risk ratios of having a COVID-19 diagnosis were calculated for each covariate. Almost 6% of the 2390 PLWH tested for COVID-19 had a positive COVID-19 result. PLWH with positive results tended to identify as American Indian/Alaska Native or Hispanic/Latinx. Younger (age < 50) immigrant PLWH were more than twice as likely to have a positive COVID-19 result than did older (age ≥ 50) US-born PLWH. The pandemic has magnified disparities among American Indian/Alaska Native, Latinx, and younger immigrant PLWH. Dismantling institutional racism and redistributing power are strategies that could be considered to help reduce health disparities.

Disparities in Coronavirus Disease 2019 Mortality by Country of Birth in Stockholm, Sweden: A Total-Population-Based Cohort Study.

Preliminary evidence points to higher morbidity and mortality from coronavirus disease 2019 (COVID-19) in certain racial and ethnic groups, but population-based studies using microlevel data are lacking so far. We used register-based cohort data including all adults living in Stockholm, Sweden, between January 31, 2020 (the date of the first confirmed case of COVID-19) and May 4, 2020 (n = 1,778,670) to conduct Poisson regression analyses with region/country of birth as the exposure and underlying cause of COVID-19 death as the outcome, estimating relative risks and 95% confidence intervals. Migrants from Middle Eastern countries (relative risk (RR) = 3.2, 95% confidence interval (CI): 2.6, 3.8), Africa (RR = 3.0, 95% CI: 2.2, 4.3), and non-Sweden Nordic countries (RR = 1.5, 95% CI: 1.2, 1.8) had higher mortality from COVID-19 than persons born in Sweden. Especially high mortality risks from COVID-19 were found among persons 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 the foreign-born. Disadvantaged socioeconomic and living conditions may increase infection rates in migrants and contribute to their higher risk of COVID-19 mortality.