1
|
Juárez SP, Debiasi E, Wallace M, Drefahl S, Mussino E, Cederström A, Rostila M, Aradhya S. COVID-19 mortality among immigrants by duration of residence in Sweden: a population-based cohort study. Scand J Public Health 2024; 52:370-378. [PMID: 38600446 PMCID: PMC11067384 DOI: 10.1177/14034948241244560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 01/18/2024] [Accepted: 03/15/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Explanations for the disproportional COVID-19 burden among immigrants relative to host-country natives include differential exposure to the virus and susceptibility due to poor health conditions. Prior to the pandemic, immigrants displayed deteriorating health with duration of residence that may be associated with increased susceptibility over time. The aim of this study was to compare immigrant-native COVID-19 mortality by immigrants' duration of residence to examine the role of differential susceptibility. METHODS A population-based cohort study was conducted with individuals between 18 and 100 years old registered in Sweden between 1 January 2015 and 15 June 2022. Cox regression models were run to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS Inequalities in COVID-19 mortality between immigrants and the Swedish-born population in the working-age group were concentrated among those of non-Western origins and from Finland with more than 15 years in Sweden, while for those of retirement age, these groups showed higher COVID-19 mortality HRs regardless of duration of residence. Both age groups of immigrants from Africa and the Middle East showed consistently higher COVID-19 mortality HRs. For the working-age population: Africa: HR<15: 2.46, 95%CI: 1.78, 3.38; HR≥15: 1.49, 95%CI: 1.01, 2.19; and from the Middle East: HR<15: 1.20, 95%CI: 0.90, 1.60; HR≥15: 1.65, 95%CI: 1.32, 2.05. For the retirement-age population: Africa: HR<15: 3.94, 95%CI: 2.85, 5.44; HR≥15: 1.66, 95%CI: 1.32, 2.09; Middle East: HR<15: 3.27, 95%CI: 2.70, 3.97; HR≥15: 2.12, 95%CI: 1.91, 2.34. CONCLUSIONS Differential exposure, as opposed to differential susceptibility, likely accounted for the higher COVID-19 mortality observed among those origins who were disproportionately affected by the pandemic in Sweden.
Collapse
Affiliation(s)
- Sol P. Juárez
- Department of Public Health Sciences, Stockholm University, Sweden
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
| | - Enrico Debiasi
- Department of Public Health Sciences, Stockholm University, Sweden
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
| | - Matthew Wallace
- Stockholm University Demography Unit (SUDA), Department of Sociology, Stockholm University, Sweden
| | - Sven Drefahl
- Stockholm University Demography Unit (SUDA), Department of Sociology, Stockholm University, Sweden
| | - Eleonora Mussino
- Stockholm University Demography Unit (SUDA), Department of Sociology, Stockholm University, Sweden
| | - Agneta Cederström
- Department of Public Health Sciences, Stockholm University, Sweden
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
| | - Mikael Rostila
- Department of Public Health Sciences, Stockholm University, Sweden
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
- Aging Research Center (ARC), Karolinska Institutet, Stockholm, Sweden
| | - Siddartha Aradhya
- Stockholm University Demography Unit (SUDA), Department of Sociology, Stockholm University, Sweden
| |
Collapse
|
2
|
Herrero-Arias R, Halbostad IV, Diaz E. Norwegian "dugnad" as a rhetorical device in public health communication during the COVID-19 pandemic. A qualitative study from immigrant's perspectives. Arch Public Health 2024; 82:11. [PMID: 38238794 PMCID: PMC10797926 DOI: 10.1186/s13690-024-01237-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 01/02/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND During the COVID-19 pandemic, the Norwegian government appealed to the term "national dugnad" in the communication of containment measures as a call for collective action to fight the spread of infection. "Dugnad" is traditionally associated with solidarity, social responsibility, and a communal spirit in the form of volunteer work carried out by a local community. Although the word "dugnad" is difficult to translate to other languages, it was used as a rhetorical device by the government to communicate health-related information during the pandemic. This study aims to explore how immigrants understood and related to the term "dugnad" as used in the context of the COVID-19 pandemic in Norway. METHODS We conducted 55 semi-structured interviews in 2020 with immigrants from Poland (10), Syria (15), Somalia (10), Sri Lanka (10), and Chile (10). Interviews were conducted in participants' mother-tongues. We used systematic text condensation following Malterud's four steps to analyze the data. RESULTS The results are organized into three themes corresponding to: (1) meaning making of the term "dugnad"; (2) attitudes towards the term "dugnad"; and (3) reactions to the use of "dugnad" in a public health context. Overall, participants were familiar with the term "dugnad" and positively associated it with volunteering, unity, and a sense of community. However, we found a variety of reactions towards using this term in a public health context, ranging from agreement to disagreement and irritation. CONCLUSION Health communication during pandemics is crucial for maximizing compliance and gaining control of disease spread. In multicultural societies, governments and authorities should be aware of the linguistic and cultural barriers to public health communication if they are to effectively reach the entire population. The use of culturally specific concepts in this context, specially as rhetorical devices, may hinder effective health communication and increase health inequalities.
Collapse
Affiliation(s)
- Raquel Herrero-Arias
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
| | | | - Esperanza Diaz
- Pandemic Center, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| |
Collapse
|
3
|
Pérez-Muto V, Bertran MJ, Barón-Miras L, Torá-Rocamora I, Gualda-Gea JJ, Vilella A. Inequalities in health outcomes of SARS-CoV-2 infection by migration status in Barcelona, Spain. Front Public Health 2024; 11:1297025. [PMID: 38259790 PMCID: PMC10800692 DOI: 10.3389/fpubh.2023.1297025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/29/2023] [Indexed: 01/24/2024] Open
Abstract
Background Migrants are a vulnerable population at risk of worse health outcomes due to legal status, language barriers, and socioeconomic and cultural factors. Considering the conflicting literature on the subject, it is important to further explore the extent and nature of these inequalities. Objective The aim of this study is to compare health outcomes associated with SARS-CoV-2 infection between Spanish native and migrant population living in Barcelona. Methods Observational retrospective cohort study including all adult cases of SARS-CoV-2 infection who visited a tertiary hospital in Barcelona between the 1st March 2020 and the 31st March 2022. We established the following five health outcomes: the presence of symptomatology, hospitalisation, intensive care unit admission, use of mechanical ventilation, and in-hospital 30-day mortality (IHM). Using Spanish natives as a reference, Odds Ratios (OR) with 95% confidence interval (95%CI) were calculated for migrants by multivariate logistic regression and adjusted by sociodemographic and clinical factors. Results Of 11,589 patients (46.8% females), 3,914 were born outside of Spain, although 34.8% of them had legal citizenship. Most migrants were born in the Americas Region (20.3%), followed by other countries in Europe (17.2%). Migrants were younger than natives (median 43 [IQR 33-55] years vs. 65 [49-78] years) and had a higher socioeconomic privation index, less comorbidities, and fewer vaccine doses. Adjusted models showed migrants were more likely to report SARS-CoV-2 symptomatology with an adjusted OR of 1.36 (95%CI 1.20-1.54), and more likely to be hospitalised (OR 1.11 [IC95% 1.00-1.23], p < 0.05), but less likely to experience IHM (OR 0.67 [IC95% 0.47-0.93], p < 0.05). Conclusion Characteristics of migrant and native population differ greatly, which could be translated into different needs and health priorities. Native population had higher odds of IHM, but migrants were more likely to present to care symptomatic and to be hospitalised. This could suggest disparities in healthcare access for migrant population. More research on health disparities beyond SARS-CoV-2 in migrant populations is necessary to identify gaps in healthcare access and health literacy.
Collapse
Affiliation(s)
- Valeria Pérez-Muto
- Department of Preventive Medicine and Epidemiology, Clinical Institute of Medicine and Dermatology (ICMiD), Hospital Clínic, Barcelona, Spain
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Maria Jesús Bertran
- Department of Preventive Medicine and Epidemiology, Clinical Institute of Medicine and Dermatology (ICMiD), Hospital Clínic, Barcelona, Spain
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Lourdes Barón-Miras
- Department of Preventive Medicine and Epidemiology, Clinical Institute of Medicine and Dermatology (ICMiD), Hospital Clínic, Barcelona, Spain
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Isabel Torá-Rocamora
- Department of Preventive Medicine and Epidemiology, Clinical Institute of Medicine and Dermatology (ICMiD), Hospital Clínic, Barcelona, Spain
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Juan José Gualda-Gea
- Department of Preventive Medicine and Epidemiology, Clinical Institute of Medicine and Dermatology (ICMiD), Hospital Clínic, Barcelona, Spain
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Anna Vilella
- Department of Preventive Medicine and Epidemiology, Clinical Institute of Medicine and Dermatology (ICMiD), Hospital Clínic, Barcelona, Spain
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| |
Collapse
|