Social inequality in COVID-19-related morbidity and mortality during the first three waves of the pandemic in Denmark: a nationwide register-based cohort study, 2020–22
- 1National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
Abstract
This nationwide cohort study aimed to examine social inequality in coronavirus disease 2019 (COVID-19)-related morbidity and mortality in Denmark during the first three pandemic waves using different individual-level measures of socioeconomic position. Additionally, the study aimed to investigate potential changes in social inequality in COVID-19-related morbidity and mortality throughout the pandemic. The cohort comprised the total Danish population. Individual-level, linkable register data were extracted and analysed for all residents of Denmark across the first three pandemic waves (26 February 2020-15 April 2022). Poisson regression of incidence rates (IR) was performed to compare COVID-19-related morbidity and mortality rates between individuals grouped according to length of educational, household income, and employment status. Social inequality in COVID-19-related hospitalization, ICU admission, and mortality was observed across the three measures of socioeconomic position. The social inequality in COVID-19-related hospitalization and ICU admission increased throughout the pandemic. The incidence rate ratio (IRR) for COVID-19-related hospitalization for individuals with elementary vs. long education increased from 0.93 [95% confidence interval (CI): 0.83-1.05] in wave 1 to 1.75 (1.67-1.84) in wave 3. The corresponding changes in IRRs for low vs. high household income and unemployed vs. employed individuals were 0.87 (0.75-1.01) to 1.83 (1.71-1.95) and 1.04 (0.86-1.25) to 3.23 (3.02-3.45), respectively. Social inequality in COVID-19-related morbidity changed during the pandemic. Interventions that reduce differential vulnerability to and consequences of COVID-19 between groups defined by socioeconomic position seem to be increasingly important as pandemics evolve.
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BibTeX
@article{kjærulff2026social,
title = {{Social inequality in COVID-19-related morbidity and mortality during the first three waves of the pandemic in Denmark: a nationwide register-based cohort study, 2020–22}},
author = {Thora M Kjærulff and Mikkel B Nielsen and Michelle T Pedersen and Kristine Bihrmann and Janne S Tolstrup and Annette K Ersbøll},
journal = {European journal of public health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag196},
url = {https://europepmc.org/article/PMC/PMC13722283},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Social inequality in COVID-19-related morbidity and mortality during the first three waves of the pandemic in Denmark: a nationwide register-based cohort study, 2020–22
AU - Thora M Kjærulff
AU - Mikkel B Nielsen
AU - Michelle T Pedersen
AU - Kristine Bihrmann
AU - Janne S Tolstrup
AU - Annette K Ersbøll
PY - 2026
DA - 2026/10/01
JO - European journal of public health
DO - 10.1093/eurpub/ckag196
UR - https://europepmc.org/article/PMC/PMC13722283
AB - This nationwide cohort study aimed to examine social inequality in coronavirus disease 2019 (COVID-19)-related morbidity and mortality in Denmark during the first three pandemic waves using different individual-level measures of socioeconomic position. Additionally, the study aimed to investigate potential changes in social inequality in COVID-19-related morbidity and mortality throughout the pandemic. The cohort comprised the total Danish population. Individual-level, linkable register data were extracted and analysed for all residents of Denmark across the first three pandemic waves (26 February 2020-15 April 2022). Poisson regression of incidence rates (IR) was performed to compare COVID-19-related morbidity and mortality rates between individuals grouped according to length of educational, household income, and employment status. Social inequality in COVID-19-related hospitalization, ICU admission, and mortality was observed across the three measures of socioeconomic position. The social inequality in COVID-19-related hospitalization and ICU admission increased throughout the pandemic. The incidence rate ratio (IRR) for COVID-19-related hospitalization for individuals with elementary vs. long education increased from 0.93 [95% confidence interval (CI): 0.83-1.05] in wave 1 to 1.75 (1.67-1.84) in wave 3. The corresponding changes in IRRs for low vs. high household income and unemployed vs. employed individuals were 0.87 (0.75-1.01) to 1.83 (1.71-1.95) and 1.04 (0.86-1.25) to 3.23 (3.02-3.45), respectively. Social inequality in COVID-19-related morbidity changed during the pandemic. Interventions that reduce differential vulnerability to and consequences of COVID-19 between groups defined by socioeconomic position seem to be increasingly important as pandemics evolve.
SN - 1101-1262
SN - 1464-360X
ER -