Background:Explanations for the disproportional COVID-19 burden among immigrants relative to host-country natives include differential exposure to the virus and susceptibility due to poor health conditions. Prior to the pandemic, immigrants displayed deteriorating health with duration of residence that may be associated with increased susceptibility over time. The aim of this study was to compare immigrant–native COVID-19 mortality by immigrants’ duration of residence to examine the role of differential susceptibility.Methods:A population-based cohort study was conducted with individuals between 18 and 100 years old registered in Sweden between 1 January 2015 and 15 June 2022. Cox regression models were run to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).Results:Inequalities in COVID-19 mortality between immigrants and the Swedish-born population in the working-age group were concentrated among those of non-Western origins and from Finland with more than 15 years in Sweden, while for those of retirement age, these groups showed higher COVID-19 mortality HRs regardless of duration of residence. Both age groups of immigrants from Africa and the Middle East showed consistently higher COVID-19 mortality HRs. For the working-age population: Africa: HR<15: 2.46, 95%CI: 1.78, 3.38; HR≥15: 1.49, 95%CI: 1.01, 2.19; and from the Middle East: HR<15: 1.20, 95%CI: 0.90, 1.60; HR≥15: 1.65, 95%CI: 1.32, 2.05. For the retirement-age population: Africa: HR<15: 3.94, 95%CI: 2.85, 5.44; HR≥15: 1.66, 95%CI: 1.32, 2.09; Middle East: HR<15: 3.27, 95%CI: 2.70, 3.97; HR≥15: 2.12, 95%CI: 1.91, 2.34.Conclusions:Differential exposure, as opposed to differential susceptibility, likely accounted for the higher COVID-19 mortality observed among those origins who were disproportionately affected by the pandemic in Sweden.

中文翻译：

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按在瑞典居住时间划分的移民中的 COVID-19 死亡率：一项基于人群的队列研究

背景：移民相对于东道国本地人所承受的 COVID-19 负担不成比例的解释包括，由于健康状况不佳而对病毒的暴露程度不同以及易感性不同。在大流行之前，随着居住时间的延长，移民的健康状况不断恶化，这可能与随着时间的推移易感性的增加有关。本研究的目的是根据移民的居住时间比较移民与本地人的 COVID-19 死亡率，以检验差异易感性的作用。方法：对瑞典登记的 18 岁至 100 岁的个人进行了一项基于人群的队列研究2015 年 1 月 1 日至 2022 年 6 月 15 日之间。运行 Cox 回归模型来估计风险比 (HR) 和 95% 置信区间 (CI)。结果：工作中移民与瑞典出生人口之间的 COVID-19 死亡率不平等年龄组集中在非西方血统和来自芬兰、在瑞典居住超过 15 年的人群，而对于退休年龄的人群，无论居住时间长短，这些群体都表现出较高的 COVID-19 死亡率 HR。来自非洲和中东的两个年龄段的移民均表现出持续较高的 COVID-19 死亡率 HR。对于工作年龄人口：非洲：HR<15：2.46，95%CI：1.78，3.38； HR≥15：1.49，95%CI：1.01，2.19；来自中东：HR<15：1.20，95%CI：0.90，1.60； HR≥15：1.65，95%CI：1.32，2.05。对于退休年龄人口：非洲：HR<15：3.94，95%CI：2.85，5.44； HR≥15：1.66，95%CI：1.32，2.09；中东：HR<15：3.27，95%CI：2.70，3.97； HR≥15：2.12，95%CI：1.91，2.34。结论：不同的暴露（而不是不同的易感性）可能是在瑞典受大流行影响不成比例的来源中观察到的较高的 COVID-19 死亡率的原因。