Individual and neighborhood risk factors of hospital admission and death during the COVID-19 pandemic: a population-based cohort study

BMC Medicine

Research Article

Stefan Fors¹  Antonio Ponce de Leon²  Per Tynelius²  Anton Lager²  Maria-Pia Hergens³  Max Bell⁴ 

[1] Aging Research Center, Karolinska Institutet & Stockholm Universitet, Solna, Sweden;Center for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden;Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden;Center for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden;Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden;Department of Communicable Disease Control and Prevention, Region Stockholm, Stockholm, Sweden;Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden;Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden;

关键词: COVID-19;    Socioeconomics;    Population study;    Cohort study;    Stockholm;    Epidemiology;    Hospitalization;    Mortality;   

DOI  :  10.1186/s12916-022-02715-4

 received in 2022-07-08, accepted in 2022-12-15,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundThe 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.MethodsThis 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.ResultsAmong 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.ConclusionsSegregation 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.

【 授权许可】

CC BY   
© The Author(s) 2022

【 图 表 】

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