An intersectional analysis of sociodemographic disparities in Covid-19 vaccination: A nationwide register-based study in Sweden

BACKGROUND

Studies on sociodemographic disparities in Covid-19 vaccination uptake in the general population are still limited and mostly focused on older adults. This study examined sociodemographic differences in Covid-19 vaccination uptake in the total Swedish population aged 18-64 years.

METHODS

National Swedish register data within the SCIFI-PEARL project were used to cross-sectionally investigate sociodemographic differences in Covid-19 vaccination among Swedish adults aged 18-64 years (n = 5,987,189) by 12 October 2021. Using logistic regression models, analyses were adjusted for sociodemographic factors, region of residence, history of Covid-19, and comorbidities. An intersectional analysis approach including several cross-classified subgroups was used to further address the complexity of sociodemographic disparities in vaccination uptake.

FINDINGS

By 12 October 2021, 76·0% of the Swedish population 18-64 years old had received at least two doses of Covid-19 vaccine, an additional 5·5% had received only one dose, and 18·5% were non-vaccinated. Non-vaccinated individuals were, compared to vaccinated, more often younger, male, had a lower income, were not gainfully employed, and/or were born outside Sweden. The social patterning for vaccine dose two was similar, but weaker, than for dose one. After multivariable adjustments, findings remained but were attenuated indicating the need to consider different sociodemographic factors simultaneously. The intersectional analysis showed a large variation in vaccine uptake ranging from 32% to 96% in cross-classified subgroups, reflecting considerable sociodemographic heterogeneity in vaccination coverage.

INTERPRETATION

Our study, addressing the entire Swedish population aged 18-64 years, showed broad sociodemographic disparities in Covid-19 vaccine uptake but also wide heterogeneities in coverage. The intersectional analysis approach indicates that focusing on specific sociodemographic factors in isolation and group average risks without considering the heterogeneity within such groups will risk missing the full variability of vaccine coverage.

FUNDING

SciLifeLab / Knut & Alice Wallenberg Foundation, Swedish Research Council, Swedish government ALF agreement, FORMAS.

Occupational role and Covid-19 among foreign-born healthcare workers: a registry-based study

Background

Studies have shown an elevated risk of Covid-19 among foreign-born healthcare workers (HCWs), but data on the distribution of the risk in different occupational roles are lacking. Such data are needed for the effective control of Covid-19 risk among HCWs. Here, we examined the risk of Covid-19 infection and hospitalization in foreign-born HCWs in different occupational roles in Sweden.

Methods

We prospectively linked occupational data (2018-2019) of 783950 employed foreign-born (20-65 years) workers to Covid-19 data registered between 1 January 2020 and 30 September 2021. We used Cox proportional hazards regression to estimate the risk of Covid-19 infection and hospitalization in foreign-born HCWs in eight different occupational groups compared to non-HCWs, and to assess whether the associations varied by region of birth. The analyses were adjusted for sociodemographic and socioeconomic factors, comorbidities, and Covid-19 vaccination.

Results

All HCWs had a higher risk of Covid-19 outcomes than non-HCWs, but the risk differed by occupational role. Assistant nurses had the highest risk both for Covid-19 infection (HR 1.80; 95%CI 1.74-1.87) and hospitalization (HR 1.85; 95%CI 1.57-2.18); other allied HCWs had the lowest risk (infection: HR 1.23; 95%CI 1.11-1.36; hospitalization: HR 1.02; 95%CI 0.63-1.67)). In some healthcare occupations, the relative risk of Covid-19 varied by region of birth. For example, physicians and dental nurses/hygienists of African and Asian origin had a higher risk of Covid-19 infection than European-born in the same occupation. In contrast, European-born assistant nurses had a greater risk of both outcomes than non-European-born in the same occupation.

Conclusions

The risk of Covid-19 among foreign-born HCWs varied by occupational role and region of birth. Public health efforts that target occupational exposures as well as incorporate culturally responsive measures may help to reduce Covid-19 risk among foreign-born HCWs.

Key messages

Occupational prestige and sickness absence inequality in Sweden: a registry-based study

Background

Socioeconomic position has been linked to sickness absence (SA). However, less is known about the role of occupational prestige, a measure of social status afforded by one's occupation, in SA. To expand knowledge on socioeconomic determinants of SA and on gender differences in SA, this study aimed to investigate the association between occupational prestige and SA and the distribution of the association in women and men. The study also aimed to analyze the effects of intersections of gender and occupational prestige on SA.

Methods

The study was based on data of 97 397 employed individuals aged 25-59 years selected from the 2004, 2007 and 2010 waves of the Swedish Labour Force Survey. Baseline occupational prestige was measured with the Standard International Occupational Prestige Scale. Information on SA was retrieved from the national register. Two measures of SA were defined: the number of SA days in any particular year during a 3-year follow-up and long-term (>120 days) SA based on data of participants with at least one sick leave spell during the follow-up.

Results

Working in lower prestige occupations was associated with increased SA among women and men. The association was independent of other socioeconomic indicators, such as income, education, and occupational class. In the intersectional analysis, women regardless of prestige level and men in lower prestige occupations had higher probability of SA compared with men in high prestige occupations. Women in high prestige occupations had the highest absenteeism rates (IRR, 2.25, 95%CI, 2.20-2.31), while men in medium prestige occupations had the lowest rates (IRR, 1.17, 95%CI, 1.13-1.20). Compared with the rest of the groups, men in low and medium prestige occupations had higher odds for long-term absence.

Conclusions

Women, regardless of occupational prestige level, and men in lower occupational prestige had an increased risk of sickness absence.

Key messages

Occupational prestige was associated with sickness absence in women and men. There is need to pay close attention to occupational prestige as a factor that may influence health and labor market participation.