COVID-19: incidence and mortality in Sweden comparing all foreign-born to all Swedish-born individuals in different occupations in an unvaccinated cohort of year 2020

Abstract

ObjectivesThe aim was to analyse the incidence and mortality of COVID-19 in immigrants compared with Swedish born in inpatients and outpatient registers, respectively.MethodsThe study population included all persons 20–88 years of age living in Sweden, 31 December 2019, including 1 676 516 foreign-born persons and 6 037 151 Swedish-born persons. The outcome was clinical cases of COVID-19 with a positive PCR test (ICD-10 U07.01) or without a positive PCR test (U07.2) from 1 January to 31 December 2020. Persons 20–64 years of age were classified with occupational titles according to the Swedish Standard Classification of Occupations. Residing municipality of each individual was coded according to the Swedish Association of Local Authorities. Relative risks (RR) were calculated by sex in 5 years age bands using Swedish born as reference. Age-adjusted RRs (adj RR) with 95% CIs were calculated in a Poisson regression model. Rural municipalities were used as the reference category.ResultsForeign born had consistently higher RRs in COVID-19, regardless of sex, with a peak in 50–69 years of age. Foreign born had a higher RR of death in COVID-19 above 50 years and 40 years of age in women and men, respectively. Among occupations, male drivers had the highest adj RR 4.37 (95% CI 3.45 to 5.54) and 5.09 (4.26 to 6.07) in outpatients and inpatients, respectively (U07.1). Persons living in commuting municipalities did not show any consistent increased risk for COVID-19.ConclusionForeign born have a higher risk of COVID-19 compared with Swedish-born individuals at any age and occupation before vaccination began in 2021.