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1.
Eur J Public Health ; 33(5): 916-922, 2023 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-37263601

RESUMO

BACKGROUND: Estimating excess mortality and years of life lost (YLL) attributed to coronavirus disease 19 (COVID-19) infection provides a comprehensive picture of the mortality burden on society. We aimed to estimate the impact of the COVID-19 pandemic on age- and sex-specific excess mortality and YLL in Sweden during the first 17 months of the pandemic. METHODS: In this population-based observational study, we calculated age- and sex-specific excess all-cause mortality and excess YLL during 2020 and the first 5 months of 2021 and cause-specific death [deaths from cardiovascular disease (CVD), cancer, other causes and deaths excluding COVID-19] in 2020 compared with an average baseline for 2017-19 in the whole Swedish population. RESULTS: COVID-19 deaths contributed 9.9% of total deaths (98 441 deaths, 960 305 YLL) in 2020, accounting for 75 151 YLL (7.7 YLL/death). There were 2672 (5.7%) and 1408 (3.0%) excess deaths, and 19 141 (3.8%) and 3596 (0.8%) excess YLL in men and women, respectively. Men aged 65-110 years and women aged 75-110 years were the greatest contributors. Fewer deaths and YLL from CVD, cancer and other causes were observed in 2020 compared with the baseline adjusted to the population size in 2020. CONCLUSIONS: Compared with the baseline, excess mortality and YLL from all causes were experienced in Sweden during 2020, with a higher excess observed in men than in women, indicating that more men died at a younger age while more women died at older ages than expected. A notable reduction in deaths and YLL due to CVD suggests a displacement effect from CVD to COVID-19.

2.
Glob Epidemiol ; 4: 100095, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36447481

RESUMO

Background: Studies on risk factors for severe COVID-19 in people of working age have generally not included non-working persons or established population attributable fractions (PAFs) for occupational and other factors. Objectives: We describe the effect of job-related, sociodemographic, and other exposures on the incidence, relative risks and PAFs of severe COVID-19 in individuals aged 18-64. Methods: We conducted a registry-based study in Swedish citizens aged 18-64 from 1 January 2020 to 1 February 2021 with respect to COVID-19-related hospitalizations and death. Results: Of 6,205,459 persons, 272,043 (7.5%) were registered as infected, 3399 (0.05%) needed intensive care, and 620 (0.01%) died, with an estimated case fatality rate of 0.06% over the last 4-month period when testing was adequate. Non-Nordic origin was associated with a RR for need of intensive care of 3·13, 95%CI 2·91-3·36, and a PAF of 32·2% after adjustment for age, sex, work, region and comorbidities. In a second model with occupation as main exposure, and adjusted for age, sex, region, comorbidities and origin, essential workers had an RR of 1·51, 95%CI, 1·35-1·6, blue-collar workers 1·18, 95%CI 1·06-1·31, school staff 1·21, 95%CI 1·01-1·46, and health and social care workers 1·89, 95%CI 1·67-2·135) compared with people able to work from home, with altogether about 13% of the PAF associated with these occupations. Essential workers and blue-collar workers, but no other job categories had higher risk of death, adjusted RRs of 1·79, 95%CI 1·34-2·38 and 1·37, 95%CI 1·04-1·81, with adjusted PAFs of altogether 9%. Conclusion: Among people of working age in Sweden, overall mortality and case fatality were low. Occupations that require physical presence at work were associated with elevated risk of needing intensive care for COVID-19, with 14% cases attributable to this factor, and 9% of deaths.

3.
J Intern Med ; 292(4): 641-653, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35612518

RESUMO

BACKGROUND: Exposure to many contacts is the main risk factor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, while risk of serious disease and death is chiefly determined by old age and comorbidities. Relative and population-attributable fractions (PAFs) of multiple medical and social exposures for COVID-19 outcomes have not been evaluated among older adults. OBJECTIVES: We describe the effect of multiple exposures on the odds of testing positive for the virus and of severe disease (hospital care or death) and PAFs in Swedish citizens aged 55 years and above. METHODS: We used national registers to follow all citizens aged 55 years and above with respect to (1) testing positive, (2) hospitalization, and (3) death between 31 January 2020 and 1 February 2021. RESULTS: Of 3,410,241 persons, 156,017 (4.6%, mean age 68.3 years) tested positive for SARS-CoV-2, while 35,999 (1.1%, mean age 76.7 years) were hospitalized or died (12,384 deaths, 0.4%, mean age 84.0 years). Among the total cohort, the proportion living without home care or long-term care was 98.8% among persons aged 55-64 and 22.1% of those aged 95 and above. After multiple adjustment, home care and long-term care were associated with odds ratios of 7.9 (95% confidence interval [CI] 6.8-9.1) and 22.5 (95% CI 19.6-25.7) for mortality, with PAFs of 21.9% (95% CI 20.9-22.9) and 33.3% (95% CI 32.4-34.3), respectively. CONCLUSION: Among Swedish residents aged 55 years and above, those with home care or long-term care had markedly increased risk for COVID-19 death during the first year of the pandemic, with over 50% of deaths attributable to these factors.


Assuntos
COVID-19 , Pandemias , Idoso , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , Comorbidade , Hospitalização , Humanos , Fatores de Risco , SARS-CoV-2 , Suécia/epidemiologia
4.
Scand J Work Environ Health ; 48(1): 52-60, 2022 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34665872

RESUMO

OBJECTIVES: This is the first population-level study to examine inequalities in COVID-19 mortality according to working-age individuals' occupations and the indirect occupational effects on COVID-19 mortality of older individuals who live with them. METHODS: We used early-release data for the entire population of Sweden of all recorded COVID-19 deaths from 12 March 2020 to 23 February 2021, which we linked to administrative registers and occupational measures. Cox proportional hazard models assessed relative risks of COVID-19 mortality for the working-aged population registered in an occupation in December 2018 and the older population who lived with them. RESULTS: Among working aged-adults, taxi/bus drivers had the highest relative risk of COVID-19 mortality: over four times that of skilled workers in IT, economics, or administration when adjusted only for basic demographic characteristics. After adjusting for socioeconomic factors (education, income and country of birth), there are no occupational groups with clearly elevated (statistically significant) COVID-19 mortality. Neither a measure of exposure within occupations nor the share that generally can work from home were related to working-aged adults' risk of COVID-19 mortality. Instead of occupational factors, traditional socioeconomic risk factors best explained variation in COVID-19 mortality. Elderly individuals, however, faced higher COVID-19 mortality risk both when living with a delivery or postal worker or worker(s) in occupations that generally work from home less, even when their socioeconomic factors are taken into account. CONCLUSIONS: Inequalities in COVID-19 mortality of working-aged adults were mostly based on traditional risk factors and not on occupational divisions or characteristics in Sweden. However, older individuals living with those who likely cannot work from home or work in delivery or postal services were a vulnerable group.


Assuntos
COVID-19 , Adulto , Idoso , Humanos , Pessoa de Meia-Idade , Ocupações , Sistema de Registros , SARS-CoV-2 , Fatores Socioeconômicos
5.
BMJ Open ; 11(9): e048952, 2021 08 31.
Artigo em Inglês | MEDLINE | ID: mdl-34465581

RESUMO

OBJECTIVES: To evaluate the role of language proficiency and institutional awareness in explaining excess COVID-19 mortality among immigrants. DESIGN: Cohort study with follow-up between 12 March 2020 and 23 February 2021. SETTING: Swedish register-based study on all residents in Sweden. PARTICIPANTS: 3 963 356 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 MEASURES: Cox 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. RESULTS: Compared 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. CONCLUSIONS: Language 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.


Assuntos
COVID-19 , Emigrantes e Imigrantes , Estudos de Coortes , Humanos , Casamento , Sistema de Registros , SARS-CoV-2 , Suécia/epidemiologia
6.
Am J Epidemiol ; 190(8): 1510-1518, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-33710317

RESUMO

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.


Assuntos
COVID-19/etnologia , COVID-19/mortalidade , Etnicidade/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Migrantes/estatística & dados numéricos , Adulto , Estudos de Coortes , Emprego/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oriente Médio/etnologia , Sistema de Registros , Características de Residência/estatística & dados numéricos , Fatores de Risco , SARS-CoV-2 , Classe Social , Suécia/epidemiologia
7.
Nat Commun ; 11(1): 5097, 2020 10 09.
Artigo em Inglês | MEDLINE | ID: mdl-33037218

RESUMO

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.


Assuntos
Infecções por Coronavirus/mortalidade , Pneumonia Viral/mortalidade , Betacoronavirus , COVID-19 , Causas de Morte , Estudos de Coortes , Feminino , Humanos , Masculino , Pandemias , Fatores de Risco , SARS-CoV-2 , Fatores Socioeconômicos , Suécia/epidemiologia
8.
Adv Life Course Res ; 43: 100286, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36726251

RESUMO

This study investigates how the childbearing intentions of women and men in couples affect actual childbearing over the following years with the aim to explore whether women's or men's intentions may be more important. The study is set in Sweden, a country known for ranking high in terms of gender equality and a country with relatively high fertility. We use the Young Adult Panel Study (YAPS), which gives information about both partners' long-term childbearing intentions in 2009, and follow these couples for five years with register data on childbearing. In 30 percent of the couples, both partners intended to have a child, and out of these about three quarters have a child. The results show that, in general, both partners need to intend to have a child for the couple to do so but that women's intentions tend to have more influence over the decision to have a second or third child. This phenomenon is interpreted as decision-making in relation to the cost and utility of children for women and men.

9.
Lancet Healthy Longev ; 1(2): e80-e88, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33521770

RESUMO

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 (m2) 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 km2) 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 km2). 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.


Assuntos
COVID-19 , Idoso , Idoso de 80 Anos ou mais , Humanos , Renda , Modelos de Riscos Proporcionais , Características de Residência , Fatores de Risco
10.
Popul Space Place ; 26(8): e2371, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33935604

RESUMO

This research examines the relationship between older parents' health issues and (i) their relocations closer to their faraway adult children, (ii) their relocations into institutionalised care facilities, or (iii) having distant children move closer. Additionally, we investigate how these relocations are structured by children's gender and location. We focused on parents aged 80 years and older and their distant children. Multinomial logistic regression models were employed for older men and women based on data from administrative registers of Sweden. Whereas severe health problems were associated with an increased likelihood of parent relocations closer to their children or into institutions, they were not associated with the likelihood of children's moves towards parents. Mothers were more likely to move towards daughters or towards distant children who had at least one sibling living nearby. Children moved closer to their parents when there was at least one sibling living near the parent or in response to their own life circumstances.

11.
Eur J Popul ; 35(3): 435-458, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31372100

RESUMO

Although the migration of couples and families is well examined, the migration that occurs at the start of co-residence has only been minimally studied. This study examines (1) whether women move more often and move over longer distances at the start of co-residence and (2) whether gender differences (if any) stem from compositional differences between women and men, such as gender differences in ties, or if they are the consequence of the within-couple distribution of bargaining power. The analyses are performed on Swedish population register data from 1991 to 2008, including longitudinal information on the residence of all couples who either married or had a child as cohabitants in 2008, backtracking them to the year of union formation. The results indicate that women are more prone to move for the sake of their male partner in the process of union formation than vice versa. If partners lived in close proximity prior to co-residence, the woman's increased likelihood of moving and longer distance moved is nearly completely explained by power imbalances in the couple. Gender differences in ties only have minor importance in explaining gender differences in these types of migration patterns. If partners lived far apart prior to co-residence, gender differences are particularly pronounced. These differences remain after adjusting for the two partners' relative resources. We contribute to the family migration literature by suggesting that women's higher propensity to move and their longer distance moved are indications that even couples' decisions at the start of co-residence are made in favour of the man's career.

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