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Individual and neighborhood risk factors of hospital admission and death during the COVID-19 pandemic: a population-based cohort study
Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Center for Epidemiology and Community Medicine, Sweden.ORCID iD: 0000-0003-2656-8721
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Number of Authors: 62023 (English)In: BMC Medicine, E-ISSN 1741-7015, Vol. 21, no 1, article id 1Article in journal (Refereed) Published
Abstract [en]

Background: The coronavirus disease 2019 (COVID-19) disproportionately affects minority populations in the USA. Sweden — like other Nordic countries — have less income and wealth inequality but lacks data on the socioeconomic impact on the risk of adverse outcomes due to COVID-19.

Methods: This population-wide study from March 2020 to March 2022 included all adults in Stockholm, except those in nursing homes or receiving in-home care. Data sources include hospitals, primary care (individual diagnoses), the Swedish National Tax Agency (death dates), the Total Population Register “RTB” (sex, age, birth country), the Household Register (size of household), the Integrated Database For Labor Market Research “LISA” (educational level, income, and occupation), and SmiNet (COVID data). Individual exposures include education, income, type of work and ability to work from home, living area and living conditions as well as the individual country of origin and co-morbidities. Additionally, we have data on the risks associated with living areas. We used a Cox proportional hazards model and logistic regression to estimate associations. Area-level covariates were used in a principal component analysis to generate a measurement of neighborhood deprivation. As outcomes, we used hospitalization and death due to COVID-19.

Results: Among the 1,782,125 persons, male sex, comorbidities, higher age, and not being born in Sweden increase the risk of hospitalization and death. So does lower education and lower income, the lowest incomes doubled the risk of death from COVID-19. Area estimates, where the model includes individual risks, show that high population density and a high percentage of foreign-born inhabitants increased the risk of hospitalization.

Conclusions: Segregation and deprivation are public health issues elucidated by COVID-19. Neighborhood deprivation, prevalent in Stockholm, adds to individual risks and is associated with hospitalization and death. This finding is paramount for governments, agencies, and healthcare institutions interested in targeted interventions.

Place, publisher, year, edition, pages
2023. Vol. 21, no 1, article id 1
Keywords [en]
COVID-19, Socioeconomics, Population study, Cohort study, Stockholm, Epidemiology, Hospitalization, Mortality
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:su:diva-223981DOI: 10.1186/s12916-022-02715-4ISI: 001092330800001PubMedID: 36600273Scopus ID: 2-s2.0-85145541779OAI: oai:DiVA.org:su-223981DiVA, id: diva2:1814366
Available from: 2023-11-24 Created: 2023-11-24 Last updated: 2023-11-24Bibliographically approved

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Citation style
  • apa
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  • Other style
More styles
Language
  • de-DE
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  • en-US
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  • nn-NO
  • nn-NB
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  • Other locale
More languages
Output format
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  • asciidoc
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