Juárez, S. P., Honkaniemi, H., Aradhya, S., Debiasi, E., Katikireddi, S. V. , Cederström, A. F., Mussino, E. and Rostila, M. (2023) Explaining COVID-19 mortality among immigrants in Sweden from a social determinants of health perspective (COVIS): protocol for a national register-based observational study. BMJ Open, 13(4), e070670. (doi: 10.1136/bmjopen-2022-070670) (PMID:37094903) (PMCID:PMC10151235)
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Abstract
Introduction: Adopting a social determinants of health perspective, this project aims to study how disproportionate COVID-19 mortality among immigrants in Sweden is associated with social factors operating through differential exposure to the virus (eg, by being more likely to work in high-exposure occupations) and differential effects of infection arising from socially patterned, pre-existing health conditions, differential healthcare seeking and inequitable healthcare provision. Methods and analysis: This observational study will use health (eg, hospitalisations, deaths) and sociodemographic information (eg, occupation, income, social benefits) from Swedish national registers linked using unique identity numbers. The study population includes all adults registered in Sweden in the year before the start of the pandemic (2019), as well as individuals who immigrated to Sweden or turned 18 years of age after the start of the pandemic (2020). Our analyses will primarily cover the period from 31 January 2020 to 31 December 2022, with updates depending on the progression of the pandemic. We will evaluate COVID-19 mortality differences between foreign-born and Swedish-born individuals by examining each mechanism (differential exposure and effects) separately, while considering potential effect modification by country of birth and socioeconomic factors. Planned statistical modelling techniques include mediation analyses, multilevel models, Poisson regression and event history analyses. Ethics and dissemination: This project has been granted all necessary ethical permissions from the Swedish Ethical Review Authority (Dnr 2022-0048-01) for accessing and analysing deidentified data. The final outputs will primarily be disseminated as scientific articles published in open-access peer-reviewed international journals, as well as press releases and policy briefs.
| Item Type: | Articles |
|---|---|
| Additional Information: | This work was supported by the Swedish Council for Health, Working Life and Social welfare (FORTE), grant number 2021-00271. In addition, SPJ acknowledges funding from the Swedish Council for Health, Working Life and Social welfare (FORTE), grant number 2016-07128 and the Swedish Research Council (VR), gran number 2018-01825. SVK acknowledges funding from a NRS Senior Clinical Fellowship (SCAF/15/02), the Medical Research Council (MC_UU_00022/2) and the Scottish Government Chief Scientist Office (SPHSU17). |
| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | Katikireddi, Professor Vittal |
| Authors: | Juárez, S. P., Honkaniemi, H., Aradhya, S., Debiasi, E., Katikireddi, S. V., Cederström, A. F., Mussino, E., and Rostila, M. |
| College/School: | College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU |
| Journal Name: | BMJ Open |
| Publisher: | BMJ Publishing Group |
| ISSN: | 2044-6055 |
| ISSN (Online): | 2044-6055 |
| Published Online: | 24 April 2023 |
| Copyright Holders: | Copyright © 2023 The Authors |
| First Published: | First published in BMJ Open 13(4): e070670 |
| Publisher Policy: | Reproduced under a Creative Commons License |
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