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. 2021 Aug 31;11(9):e048952.
doi: 10.1136/bmjopen-2021-048952.

Intermarriage and COVID-19 mortality among immigrants. A population-based cohort study from Sweden

Siddartha Aradhya  1 , Maria Brandén  1   2 , Sven Drefahl  1 , Ognjen Obućina  3 , Gunnar Andersson  1 , Mikael Rostila  4 , Eleonora Mussino  1 , Sol Pía Juárez  5
Affiliations

Intermarriage and COVID-19 mortality among immigrants. A population-based cohort study from Sweden

Siddartha Aradhya et al. BMJ Open. .

Abstract

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.

Keywords: COVID-19; demography; epidemiology; public health.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Selection flow and final sample.
Figure 2
Figure 2
HRs for the risk of dying from COVID-19, other causes of death during the pandemic, and all-cause mortality in the year prior to the pandemic by couple dyad. Model A is adjusted for age and sex only and model B includes full adjustment (reference group: native-native couples).
Figure 3
Figure 3
HRs for the risk of dying from COVID-19, other causes of death during the pandemic and all-cause mortality in the year prior to the pandemic by couple dyad disaggregated by low-income and middle-income countries (LMIC) and high-income countries (HIC) immigrants. Model A is adjusted for age and sex only and model B includes full adjustment (reference group: native-native couples).
See this image and copyright information in PMC

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