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Spatial clustering and contextual factors associated with hospitalisation and deaths due to COVID-19 in Sweden: a geospatial nationwide ecological study.
Fonseca-Rodríguez, Osvaldo; Gustafsson, Per E; San Sebastián, Miguel; Connolly, Anne-Marie Fors.
  • Fonseca-Rodríguez O; Department of Clinical Microbiology, Umeå University, Umeå, Sweden osvaldo.fonseca@umu.se.
  • Gustafsson PE; Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
  • San Sebastián M; Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
  • Connolly AF; Department of Clinical Microbiology, Umeå University, Umeå, Sweden.
BMJ Glob Health ; 6(7)2021 07.
Article in English | MEDLINE | ID: covidwho-1331811
ABSTRACT

INTRODUCTION:

In Sweden, thousands of hospitalisations and deaths due to COVID-19 were reported since the pandemic started. Considering the uneven spatial distribution of those severe outcomes at the municipality level, the objective of this study was, first, to identify high-risk areas for COVID-19 hospitalisations and deaths, and second, to determine the associated contextual factors with the uneven spatial distribution of both study outcomes in Sweden.

METHODS:

The existences of spatial autocorrelation of the standardised incidence (hospitalisations) ratio and standardised mortality ratio were investigated using Global Moran's I test. Furthermore, we applied the retrospective Poisson spatial scan statistics to identify high-risk spatial clusters. The association between the contextual demographic and socioeconomic factors and the number of hospitalisations and deaths was estimated using a quasi-Poisson generalised additive regression model.

RESULTS:

Ten high-risk spatial clusters of hospitalisations and six high-risk clusters of mortality were identified in Sweden from February 2020 to October 2020. The hospitalisations and deaths were associated with three contextual variables in a multivariate model population density (inhabitants/km2) and the proportion of immigrants (%) showed a positive association with both outcomes, while the proportion of the population aged 65+ years (%) showed a negative association.

CONCLUSIONS:

Our study identified high-risk spatial clusters for hospitalisations and deaths due to COVID-19 and the association of population density, the proportion of immigrants and the proportion of people aged 65+ years with those severe outcomes. Results indicate where public health measures must be reinforced to improve sustained and future disease control and optimise the distribution of resources.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Observational study / Prognostic study Limits: Humans Country/Region as subject: Europa Language: English Year: 2021 Document Type: Article Affiliation country: Bmjgh-2021-006247

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Observational study / Prognostic study Limits: Humans Country/Region as subject: Europa Language: English Year: 2021 Document Type: Article Affiliation country: Bmjgh-2021-006247