Disparities in covid-19 deaths by country of birth in Stockholm, Sweden: A total population based cohort study

Preliminary evidence points to higher morbidity and mortality of covid-19 in certain racial and ethnic groups but population-based studies using micro-level data are so far lacking. We examined disparities in covid-19 deaths by region/country of birth and studied whether migrants’ socioeconomic and living conditions attenuated such disparities. A register-based cohort including all adults living in Stockholm, Sweden (n=2,365,434) between January 31st (date of first confirmed case) and May 4th 2020 was utilized. Poisson regressions with region/country of birth as exposure and underlying cause of death by Covid-19 was performed. Migrants from Middle-Eastern countries (RR 3.2, 95% CI: 2.6-3.8), Africa (RR 3.0, 95% CI: 2.2-4.3) and the Nordic countries (RR 1.5, 95% CI: 1.2-1.8) had higher mortality in covid-19 when compared to Swedish born. Especially high mortality risks from covid-19 was found among individuals born in Somalia (RR 8.9, 95% CI: 5.6-14.0), Lebanon (RR 5.9, 95% CI: 3.4-10.3), Syria (RR 4.7, 95% CI: 3.3-6.6), Turkey (RR 3.1, 95% CI: 2.1-4.4), Iran (RR 2.6, 95% CI: 1.7-3.8) and Iraq (RR 2.4, 95% CI: 1.7-3.5). Socioeconomic status, number of working age household members and neighborhood population density attenuated up to half of the increased covid-19 mortality risks among foreign born, although a sizable amount of excess mortality remained in all groups. We found large disparities in covid-19 mortality by country of birth in Stockholm, one of the most affected regions in the world. Disadvantaged socioeconomic and living conditions may increase infection rates in migrants and contribute to their higher covid-19 mortality risk.