RT Journal Article
SR Electronic
T1 Intermarriage and COVID-19 mortality among immigrants. A population-based cohort study from Sweden
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e048952
DO 10.1136/bmjopen-2021-048952
VO 11
IS 9
A1 Siddartha Aradhya
A1 Maria Brandén
A1 Sven Drefahl
A1 Ognjen Obućina
A1 Gunnar Andersson
A1 Mikael Rostila
A1 Eleonora Mussino
A1 Sol Pía Juárez
YR 2021
UL http://bmjopen.bmj.com/content/11/9/e048952.abstract
AB Objectives To evaluate the role of language proficiency and institutional awareness in explaining excess COVID-19 mortality among immigrants.Design Cohort study with follow-up between 12 March 2020 and 23 February 2021.Setting Swedish register-based study on all residents in Sweden.Participants 3 963 356 Swedish residents in co-residential unions who were 30 years of age or older and alive on 12 March 2020 and living in Sweden in December 2019.Outcome measures Cox regression models were conducted to assess the association between different constellations of immigrant-native couples (proxy for language proficiency and institutional awareness) and COVID-19 mortality and all other causes of deaths (2019 and 2020). Models were adjusted for relevant confounders.Results Compared with Swedish-Swedish couples (1.18 deaths per thousand person-years), both immigrants partnered with another immigrant and a native showed excess mortality for COVID-19 (HR 1.43; 95% CI 1.29 to 1.58 and HR 1.24; 95% CI 1.10 to 1.40, respectively), which translates to 1.37 and 1.28 deaths per thousand person-years. Moreover, similar results are found for natives partnered with an immigrant (HR 1.15; 95% CI 1.02 to 1.29), which translates to 1.29 deaths per thousand person-years. Further analysis shows that immigrants from both high-income and low-income and middle-income countries (LMIC) experience excess mortality also when partnered with a Swede. However, having a Swedish-born partner is only partially protective against COVID-19 mortality among immigrants from LMIC origins.Conclusions Language barriers and/or poor institutional awareness are not major drivers for the excess mortality from COVID-19 among immigrants. Rather, our study provides suggestive evidence that excess mortality among immigrants is explained by differential exposure to the virus.This study is produced under the Swedish Statistics Act, where privacy concerns restrict the availability of register data for research. Aggregated data can be made available by the authors, conditional on ethical vetting. The authors access the individual-level data through Statistics Sweden’s micro-online access system MONA.