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This population-based study was conducted with adults living in Sweden between March 1, 2020 and June 1, 2022. The study shows that, compared to the Swedish-born population, migrants from, among other places, Africa, the Middle East and Asia and a few other countries had higher risk of Covid-19 mortality. In addition, these migrant groups had a significantly higher risk of being admitted to intensive care units. The study also investigated whether the differences increased or decreased during the pandemic as a whole. For most of the migrant groups, the risk of Covid-19-related mortality and admission to intensive care was highest during the first wave, and these differences persisted throughout much of the pandemic. However, during the fourth wave ("Omicron"), the differences were significantly smaller.

Mikael Rostila, professor at the Department of Public Health Sciences, Stockholm University. Photo: Stockholm University.

“Already early on in the pandemic we saw that migrants were hit harder than the native-born, and these differences were also found during the second and third waves of the pandemic,” says Mikael Rostila, professor at the Department of Public Health Sciences, Stockholm University and the first author of the research article.

The vaccine contributed to reduced inequality

The study further investigated the reason for these differences. Socioeconomic conditions and living conditions partly explained the elevated risk of COVID-19-related mortality and intensive care among migrants in the absence of a vaccine. Factors such as low education, lower income, overcrowding and the population density of the residential area could pose an increased risk of contracting COVID-19 among foreign-born, which contributes to the differences. However, the results show that vaccine access during the final fourth wave resulted in a dramatic reduction in the differences in mortality and admission to intensive care linked to country of birth.

“The vaccine resulted in the serious complications of COVID-19 being reduced in Sweden and the world. But it also erased much of the large disparity in mortality and intensive care between migrants and the native-born that we saw during the pandemic. The vaccine thus had a decisive importance in reducing inequality,” says Mikael Rostila.

“Deficient socio-economic conditions and living conditions mean an increased risk of suffering serious complications from a Covid-19 infection. When a vaccine became available, equal vaccination coverage by country of birth was essential. Unfortunately, the percentage of those vaccinated was also significantly lower in many migrant groups, which meant that some differences remained after all.”

The article "Inequalities in COVID-19 severe morbidity and mortality by country of birth in Sweden" was published in mid-August in Nature Communications.

Håkan Soold