COVID-19 in The Neighbourhood: The Socio-Spatial Selectivity of Severe COVID-19 Cases in Sweden, March 2020-June 2021

In this paper we analyse spatial and temporal inequalities in the risk of intensive care unit (ICU) admission for COVID-19 in Sweden between March 2020 and June 2021. The analysis is based on geocoded and time-stamped data from the Swedish Intensive Care Registry. We merge this data with a classification of Swedish neighbourhoods developed with multi-scalar measures of education, income, poverty rates, employment, social allowances, and migration. We examine 1) if residence in more socio-economically deprived or diverse types of neighbourhoods was associated with higher risk of ICU admission for COVID-19, net of known individual and neighbourhood level epidemiological factors 2) if residence in more affluent neighbourhoods was associated with lower risk of ICU admission for COVID-19 3) how have these patterns changed overtime during the three waves of the pandemic. The highest risk was associated with living in neighbourhoods characterised by rural town disadvantage coupled with diversity under wave 3. In the third wave residence in such neighbourhood types was associated with four times higher risk of ICU admission, compared to the reference category of living in homogenous rural neighbourhoods with average levels of deprivation under wave 1. Looking at disparities within each wave we found that residence in most affluent urban areas was at first associated with higher risk and then with lower risk of ICU admission for COVID-19. In contrast to earlier studies, we find that the largest inequalities between different neighbourhood types could be seen in the first wave and not the second. Overtime, the risks converged between different types of neighbourhoods.