Did migrants experience a COVID-19 mortality disadvantage in the Swedish care setting? Type of care and mortality among older migrants in Sweden

This study examines COVID-19 mortality across various care settings and living arrangements comparing migrants and native-Swedes during the first two years of the pandemic. Previous research shows that migrants faced higher risks of severe COVID-19 outcomes, contrasting with the observed Migrant Mortality Advantage. Using Swedish total population data (2019-2022), we stratified participants aged 70+ by care setting/living arrangements and migration status. We analyzed the first pandemic year (March 2020-February 2021) and the second year (March 2021-February 2022), alongside pre-pandemic mortality data for context. Outcome measures included all deaths from COVID-19 and other causes. Cox proportional hazards models were employed, adjusting for sociodemographic and health variables. Our findings highlight the significant impact of care settings on COVID-19 mortality in the first pandemic year, exceeding that for other causes of death. LMIC migrants in institutional care had higher mortality rates (HR=42.88, 95% CI=36.69–50.13) than native-born individuals (HR=25.83, 95% CI=24.12–27.65) relative to Swedish born with no care. This contrasts with mortality patterns for non-COVID causes before and during the pandemic, indicating a migrant disadvantage during the first year, regardless of care setting. In the second year, excess COVID-19 mortality in care settings decreased yet continued to be higher mortality than for native-born Swedes, likely due to the equalizing effect of vaccination. Despite mitigation efforts, a clear migrant mortality disadvantage persisted among those receiving home care or living in care homes.