Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden.
Department of Public Health Sciences, Stockholm University, Stockholm, Sweden.
Eur J Public Health. 2023 Jun 1;33(3):522-527. doi: 10.1093/eurpub/ckad009.
Differences in pre-existing health conditions are hypothesized to explain immigrants' excess COVID-19 mortality compared to natives. In this study, we evaluate whether immigrants residing in Sweden before the outbreak were more likely to be hospitalized for conditions associated with severe COVID-19 disease.
A cohort study using population-register data was conducted with follow-up between 1 January 1997 and 31 December 2017. Poisson regression was fitted to estimate incidence rate ratio (RR) and 95% confident intervals (95% CI) for 10 causes of hospitalization.
Compared to Swedish-born individuals, most immigrant groups showed a decreased risk of hospitalization for respiratory chronic conditions, CVD, cancer, chronic liver conditions and neurological problems. All immigrant groups had increased risk of hospitalization for tuberculosis [RR between 88.49 (95% CI 77.21; 101.40) for the Horn of Africa and 1.69 (95% CI 1.11; 2.58) for North America], HIV [RR between 33.23 (95% CI 25.17; 43.88) for the rest of Africa and 1.31 (95% CI 0.93; 1.83) for the Middle East] and, with a few exceptions, also for chronic kidney conditions, diabetes and thalassemia.
Foreign-born individuals-including origins with excess COVID-19 mortality in Sweden-did not show increased risk of hospitalizations for most causes associated with severe COVID-19 disease. However, all groups showed increased risks of hospitalization for tuberculosis and HIV and, with exceptions, for chronic kidney conditions, diabetes and thalassemia. Although studies should determine whether these health conditions explain the observed excess COVID-19 mortality, our study alerts to an increased risk of hospitalization that can be avoidable via treatment or preventive measures.
据推测，与本地人相比，先前存在的健康状况差异导致移民的 COVID-19 死亡率过高。在这项研究中，我们评估了在瑞典爆发之前居住在瑞典的移民是否更有可能因与严重 COVID-19 疾病相关的疾病住院。
使用人群登记数据进行了队列研究，随访时间为 1997 年 1 月 1 日至 2017 年 12 月 31 日。使用泊松回归来估计 10 种住院原因的发病率比（RR）和 95%置信区间（95%CI）。
与瑞典出生的人相比，大多数移民群体因呼吸道慢性疾病、心血管疾病、癌症、慢性肝脏疾病和神经系统问题住院的风险降低。所有移民群体因结核病住院的风险增加[RR 范围为非洲之角 88.49（95%CI 77.21; 101.40）至北美 1.69（95%CI 1.11; 2.58）]，艾滋病毒[RR 范围为非洲其他地区 33.23（95%CI 25.17; 43.88）至中东 1.31（95%CI 0.93; 1.83）]，除少数例外，还因慢性肾脏疾病、糖尿病和地中海贫血住院的风险增加。
外国出生的人，包括在瑞典 COVID-19 死亡率过高的原籍国的人，因大多数与严重 COVID-19 疾病相关的疾病住院的风险并未增加。然而，所有群体因结核病和艾滋病毒住院的风险增加，除了少数例外，还因慢性肾脏疾病、糖尿病和地中海贫血住院的风险增加。尽管研究应确定这些健康状况是否解释了观察到的 COVID-19 死亡率过高，但我们的研究提醒人们注意住院的风险增加，这种风险可以通过治疗或预防措施来避免。
