Individual and neighborhood risk factors of hospital admission and death during the COVID-19 pandemic: a population-based cohort study
Abstract Background The coronavirus disease 2019 (COVID-19) disproportionately affects minority populations in the USA. Sweden — like other Nordic countries — have less income and wealth inequality but lacks data on the socioeconomic impact on the risk of adverse outcomes due to COVID-19. Methods Th...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-01-01
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| Series: | BMC Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12916-022-02715-4 |
| _version_ | 1797958672405495808 |
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| author | Max Bell Maria-Pia Hergens Stefan Fors Per Tynelius Antonio Ponce de Leon Anton Lager |
| author_facet | Max Bell Maria-Pia Hergens Stefan Fors Per Tynelius Antonio Ponce de Leon Anton Lager |
| author_sort | Max Bell |
| collection | DOAJ |
| description | Abstract Background The coronavirus disease 2019 (COVID-19) disproportionately affects minority populations in the USA. Sweden — like other Nordic countries — have less income and wealth inequality but lacks data on the socioeconomic impact on the risk of adverse outcomes due to COVID-19. Methods This population-wide study from March 2020 to March 2022 included all adults in Stockholm, except those in nursing homes or receiving in-home care. Data sources include hospitals, primary care (individual diagnoses), the Swedish National Tax Agency (death dates), the Total Population Register “RTB” (sex, age, birth country), the Household Register (size of household), the Integrated Database For Labor Market Research “LISA” (educational level, income, and occupation), and SmiNet (COVID data). Individual exposures include education, income, type of work and ability to work from home, living area and living conditions as well as the individual country of origin and co-morbidities. Additionally, we have data on the risks associated with living areas. We used a Cox proportional hazards model and logistic regression to estimate associations. Area-level covariates were used in a principal component analysis to generate a measurement of neighborhood deprivation. As outcomes, we used hospitalization and death due to COVID-19. Results Among the 1,782,125 persons, male sex, comorbidities, higher age, and not being born in Sweden increase the risk of hospitalization and death. So does lower education and lower income, the lowest incomes doubled the risk of death from COVID-19. Area estimates, where the model includes individual risks, show that high population density and a high percentage of foreign-born inhabitants increased the risk of hospitalization. Conclusions Segregation and deprivation are public health issues elucidated by COVID-19. Neighborhood deprivation, prevalent in Stockholm, adds to individual risks and is associated with hospitalization and death. This finding is paramount for governments, agencies, and healthcare institutions interested in targeted interventions. |
| first_indexed | 2024-04-11T00:22:18Z |
| format | Article |
| id | doaj.art-c85d3f3c3d1a4b37b5ffaf43c606e2a5 |
| institution | Directory Open Access Journal |
| issn | 1741-7015 |
| language | English |
| last_indexed | 2024-04-11T00:22:18Z |
| publishDate | 2023-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medicine |
| spelling | doaj.art-c85d3f3c3d1a4b37b5ffaf43c606e2a52023-01-08T12:13:57ZengBMCBMC Medicine1741-70152023-01-012111910.1186/s12916-022-02715-4Individual and neighborhood risk factors of hospital admission and death during the COVID-19 pandemic: a population-based cohort studyMax Bell0Maria-Pia Hergens1Stefan Fors2Per Tynelius3Antonio Ponce de Leon4Anton Lager5Department of Perioperative Medicine and Intensive Care, Karolinska University HospitalDepartment of Global Public Health, Karolinska InstitutetAging Research Center, Karolinska Institutet & Stockholm UniversitetDepartment of Global Public Health, Karolinska InstitutetDepartment of Global Public Health, Karolinska InstitutetDepartment of Global Public Health, Karolinska InstitutetAbstract Background The coronavirus disease 2019 (COVID-19) disproportionately affects minority populations in the USA. Sweden — like other Nordic countries — have less income and wealth inequality but lacks data on the socioeconomic impact on the risk of adverse outcomes due to COVID-19. Methods This population-wide study from March 2020 to March 2022 included all adults in Stockholm, except those in nursing homes or receiving in-home care. Data sources include hospitals, primary care (individual diagnoses), the Swedish National Tax Agency (death dates), the Total Population Register “RTB” (sex, age, birth country), the Household Register (size of household), the Integrated Database For Labor Market Research “LISA” (educational level, income, and occupation), and SmiNet (COVID data). Individual exposures include education, income, type of work and ability to work from home, living area and living conditions as well as the individual country of origin and co-morbidities. Additionally, we have data on the risks associated with living areas. We used a Cox proportional hazards model and logistic regression to estimate associations. Area-level covariates were used in a principal component analysis to generate a measurement of neighborhood deprivation. As outcomes, we used hospitalization and death due to COVID-19. Results Among the 1,782,125 persons, male sex, comorbidities, higher age, and not being born in Sweden increase the risk of hospitalization and death. So does lower education and lower income, the lowest incomes doubled the risk of death from COVID-19. Area estimates, where the model includes individual risks, show that high population density and a high percentage of foreign-born inhabitants increased the risk of hospitalization. Conclusions Segregation and deprivation are public health issues elucidated by COVID-19. Neighborhood deprivation, prevalent in Stockholm, adds to individual risks and is associated with hospitalization and death. This finding is paramount for governments, agencies, and healthcare institutions interested in targeted interventions.https://doi.org/10.1186/s12916-022-02715-4COVID-19SocioeconomicsPopulation studyCohort studyStockholmEpidemiology |
| spellingShingle | Max Bell Maria-Pia Hergens Stefan Fors Per Tynelius Antonio Ponce de Leon Anton Lager Individual and neighborhood risk factors of hospital admission and death during the COVID-19 pandemic: a population-based cohort study BMC Medicine COVID-19 Socioeconomics Population study Cohort study Stockholm Epidemiology |
| title | Individual and neighborhood risk factors of hospital admission and death during the COVID-19 pandemic: a population-based cohort study |
| title_full | Individual and neighborhood risk factors of hospital admission and death during the COVID-19 pandemic: a population-based cohort study |
| title_fullStr | Individual and neighborhood risk factors of hospital admission and death during the COVID-19 pandemic: a population-based cohort study |
| title_full_unstemmed | Individual and neighborhood risk factors of hospital admission and death during the COVID-19 pandemic: a population-based cohort study |
| title_short | Individual and neighborhood risk factors of hospital admission and death during the COVID-19 pandemic: a population-based cohort study |
| title_sort | individual and neighborhood risk factors of hospital admission and death during the covid 19 pandemic a population based cohort study |
| topic | COVID-19 Socioeconomics Population study Cohort study Stockholm Epidemiology |
| url | https://doi.org/10.1186/s12916-022-02715-4 |
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