Explaining COVID-19 mortality among immigrants in Sweden

Immigrants from low- to high-income countries have experienced excess COVID-19 mortality in Sweden to an extent that contrasts sharply with the immigrant mortality advantage observed for other causes before and during the pandemic. This finding is a major concern given its vast implications for increasing inequalities in a post-pandemic society.

The purpose of this project is to study the extent to which disproportionate COVID-19 mortality among immigrants in Sweden is explained by social determinants of health operating through differential exposure to the virus (e.g., by being more likely to work in high-exposure occupations) and differential effects of infection arising from socially-patterned, pre-existing health conditions or discrepancies in individual healthcare seeking and structural provision of healthcare.

Individual-level longitudinal information comprised of national social, migration, and health registers will be analyzed using a variety of advanced statistical modelling techniques.

The main contribution of this project lies in its empirical evaluation of how social conditions shape group risks in the context of a pandemic giving rise to native-immigrant inequalities in COVID-19 mortality. Furthermore, the project will offer a comprehensive understanding of native-immigrant inequalities across the COVID-19 disease pathway (i.e., positive test, hospitalization, intensive care unit admission and death). The identification of the social determinants leading to health inequalities between immigrants and natives (as well as across immigrant groups) is crucial to planning interventions that may help mitigate the unequal impacts of future pandemics on health and mortality.

• Sol P Juárez, Principal Investigator
• Siddartha Aradhya
• Srinivasa Vittal Katikireddi
• Anders Ledberg
• Yan Ma
• Eleonora Mussino
• Mikael Rostila

Publications

1. Honkaniemi, H., & Juárez, SP. (2026). Intersectional inequalities in COVID-19 morbidity and mortality in Sweden: a retrospective population-based cohort study. BMJ Public Health, e004719.
2. Ma, Y., Ledberg, A., Aradhya, S., & Juárez, S. P. (2026). The role of social determinants in COVID-19 hospitalization disparities by migration status in Stockholm, Sweden. A population-based cohort study. Communications Medicine.
3. Cederström, A., Rostila, M., Juárez, SP. (2025). COVID-19 outcomes by immigrant generation in Sweden: a national cohort population-based study. European Journal of Public Health, ckaf208.
4. Mussino, E., Juárez, S. P., Modig, K., Andersson, G., & Drefahl, S. (2025). Did migrants experience a COVID-19 mortality disadvantage in the Swedish care setting? An observational cohort study on type of care and mortality among older migrants in Sweden. European Journal of Public Health, ckaf155.
5. Juárez, S. P., Debiasi, E., Wallace, M., Drefahl, S., Mussino, E., Cederström, A., … & Aradhya, S. (2024). COVID-19 mortality among immigrants by duration of residence in Sweden: a population-based cohort study. Scandinavian Journal of Public Health, 52(3), 370-378.
6. Juarez, S. P., Cederström, A., Aradhya, S., & Rostila, M. (2023). Differences in hospitalizations associated with severe COVID-19 disease among foreign-and Swedish-born. European Journal of Public Health, 33(3), 522-527.
7. Rostila, M., Cederström, A., Wallace, M., Aradhya, S., Ahrne, M., & Juárez, S. P. (2023). Inequalities in COVID-19 severe morbidity and mortality by country of birth in Sweden. Nature Communications, 14(1), 4919.
8. Juárez, S. P., Honkaniemi, H., Aradhya, S., Debiasi, E., Katikireddi, S. V., Cederström, A. F., … & 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.
9. Kjøllesdal, M. K. R., Juarez, S. P., Aradhya, S., & Indseth, T. (2023). Understanding the excess COVID-19 burden among immigrants in Norway. Journal of Public Health, 45(2), 277-286.
10. Aradhya, S., Brandén, M., Drefahl, S., Obućina, O., Andersson, G., Rostila, M., … & Juárez, S. P. (2021). Intermarriage and COVID-19 mortality among immigrants. A population-based cohort study from Sweden. BMJ Open, 11(9), e048952.