Journal Article

Did migrants experience a COVID-19 mortality disadvantage in the Swedish care setting? An observational cohort study on type of care and mortality among older migrants in Sweden

Andersson, Gunnar, Drefahl, Sven, Juárez, Sol P, Modig, Karin, Mussino, Eleonora

2025

Overview

Abstract This study examines COVID-19 mortality across long-term care settings comparing migrants and Swedish-born during the first 2 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 (2019–22), we stratified participants aged 70+ by care setting and migration status. We analysed 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. Migrants born in low- or middle-income countries in institutional care had higher mortality rates (HR = 42.88, 95% CI = 36.69–50.13) than Swedish-born individuals in institutional care (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 specific migrant disadvantage during the first year. In the second year, the excess COVID-19 mortality in care settings decreased yet continued to be higher for migrants than for Swedish-born, likely influenced by the equalizing effect of vaccinations. Despite mitigation efforts, a clear migrant mortality disadvantage persisted among those receiving home care or living in care homes.

• Publisher: Oxford University Press
• Subject: Aged / Aged, 80 and over / cause of death / Cohort analysis / Cohort Studies / COVID-19 / COVID-19 - ethnology / COVID-19 - mortality / Deaths / Female / First year / Health services / home care services / Home health care / Humans / Long term health care / Long-term care / Long-Term Care - statistics & numerical data / Low income groups / Male / Migrants / Migration / Mitigation / Mortality / Mortality patterns / Mortality rates / Observational studies / Older people / Pandemics / Residential care / SARS-CoV-2 / Sociodemographics / Statistical models / Sweden - epidemiology / Transients and Migrants - statistics & numerical data / Vaccination