Did the vaccination campaign in Sweden narrow the gap in hospital-registered COVID-19 cases between foreign-born and Swedish-born individuals? A register-based cohort study of adults
4 affiliations
- 1Public Health and Caring Sciences, Uppsala Universitet, Uppsala, Sweden
- 2Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala Universitet, Uppsala, Sweden
- 3Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden
- 4Department of Occupational and Environmental Medicine, Uppsala University Hospital, Uppsala, Sweden
Abstract
Objectives: To examine differences between foreign-born and Swedish-born individuals regarding four interrelated research questions, 2021–2022: (1) risk factors for hospital-registered COVID-19, (2) vaccination rates for COVID-19, (3) the association between vaccination and COVID-19 and (4) 30-day mortality following COVID-19.
Design: A total-population, register-based cohort study of adults in Sweden.
Participants: All foreign-born (n=1 676 516) and Swedish-born (n=6 037 151) individuals aged 20–87 years, residing in Sweden on 31 December 2019.
Outcomes: Hospital-registered cases of COVID-19, vaccine rates of COVID-19 and the influence of vaccination on hospital-registered and 30-day mortality of COVID-19.
Methods: HRs with 95% CIs for estimating differences between foreign-born and Swedish-born individuals regarding hospital-registered COVID-19 and mortality with or without COVID-19 vaccinations were estimated. Effect estimates were adjusted for age, sex, educational level, household size and occupation.
Results: In working age (20–64 years), women had a higher risk of COVID-19 than men, both among foreign-born (adjusted HR: 1.13; 95% CI 1.10 to 1.16) and Swedish-born individuals (adjusted HR: 1.17; 95% CI 1.15 to 1.20). In crude models, increasing age was strongly associated with COVID-19 (HRs: 1.27–2.91); however, it diminished after adjustment (HRs: 1.07–1.48). Furthermore, elementary school only (adjusted HRs: 1.24–1.66), contact-intensive occupations (adjusted HRs: 1.11–1.97) and larger household size among foreign-born individuals (adjusted HR: 1.60; 95% CI 1.53 to 1.68) were associated with a higher risk of COVID-19 before taking vaccination into account. As of 31 December 2021, foreign-born individuals had substantially lower vaccination coverage (64.1%) than Swedish-born individuals (86.9%). After adjustment, vaccinated foreign-born individuals had a similar risk of hospital-registered COVID-19 as that of Swedish-born individuals. The 30-day mortality rate was generally low, with similar rates between foreign-born and Swedish-born individuals.
Conclusions: The difference in severe COVID-19 between foreign-born and Swedish-born individuals diminished after the vaccine rollout. Remaining risks were associated with low educational level, large household size and certain occupations, while 30-day mortality was similar between foreign-born and Swedish-born individuals.
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BibTeX
@article{helgesson2026vaccination,
title = {{Did the vaccination campaign in Sweden narrow the gap in hospital-registered COVID-19 cases between foreign-born and Swedish-born individuals? A register-based cohort study of adults}},
author = {Magnus Helgesson and Martin Tondel and Tobias Nordquist and Magnus Svartengren},
journal = {BMJ Open},
year = {2026},
month = oct,
doi = {10.1136/bmjopen-2026-118005},
url = {https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-118005},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Did the vaccination campaign in Sweden narrow the gap in hospital-registered COVID-19 cases between foreign-born and Swedish-born individuals? A register-based cohort study of adults
AU - Magnus Helgesson
AU - Martin Tondel
AU - Tobias Nordquist
AU - Magnus Svartengren
PY - 2026
DA - 2026/10/27
JO - BMJ Open
DO - 10.1136/bmjopen-2026-118005
UR - https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-118005
AB - Objectives: To examine differences between foreign-born and Swedish-born individuals regarding four interrelated research questions, 2021–2022: (1) risk factors for hospital-registered COVID-19, (2) vaccination rates for COVID-19, (3) the association between vaccination and COVID-19 and (4) 30-day mortality following COVID-19. Design: A total-population, register-based cohort study of adults in Sweden. Participants: All foreign-born (n=1 676 516) and Swedish-born (n=6 037 151) individuals aged 20–87 years, residing in Sweden on 31 December 2019. Outcomes: Hospital-registered cases of COVID-19, vaccine rates of COVID-19 and the influence of vaccination on hospital-registered and 30-day mortality of COVID-19. Methods: HRs with 95% CIs for estimating differences between foreign-born and Swedish-born individuals regarding hospital-registered COVID-19 and mortality with or without COVID-19 vaccinations were estimated. Effect estimates were adjusted for age, sex, educational level, household size and occupation. Results: In working age (20–64 years), women had a higher risk of COVID-19 than men, both among foreign-born (adjusted HR: 1.13; 95% CI 1.10 to 1.16) and Swedish-born individuals (adjusted HR: 1.17; 95% CI 1.15 to 1.20). In crude models, increasing age was strongly associated with COVID-19 (HRs: 1.27–2.91); however, it diminished after adjustment (HRs: 1.07–1.48). Furthermore, elementary school only (adjusted HRs: 1.24–1.66), contact-intensive occupations (adjusted HRs: 1.11–1.97) and larger household size among foreign-born individuals (adjusted HR: 1.60; 95% CI 1.53 to 1.68) were associated with a higher risk of COVID-19 before taking vaccination into account. As of 31 December 2021, foreign-born individuals had substantially lower vaccination coverage (64.1%) than Swedish-born individuals (86.9%). After adjustment, vaccinated foreign-born individuals had a similar risk of hospital-registered COVID-19 as that of Swedish-born individuals. The 30-day mortality rate was generally low, with similar rates between foreign-born and Swedish-born individuals. Conclusions: The difference in severe COVID-19 between foreign-born and Swedish-born individuals diminished after the vaccine rollout. Remaining risks were associated with low educational level, large household size and certain occupations, while 30-day mortality was similar between foreign-born and Swedish-born individuals.
SN - 2044-6055
SN - 2044-6055
ER -