Elderly migrants living in care settings experienced a COVID-19 mortality disadvantage

Migrants from low-income countries living in care settings in Sweden were more likely to die from Covid-19 than people born in the country during the first year of the pandemic, according to a new study by researchers from Stockholm University, published in the European Journal of Public Health. The finding stands out, since elderly migrants in daily care usually have higher life expectancy than Swedish-born individuals in similar circumstances.

Typically, migrants in care settings demonstrate what researchers call the migrant mortality advantage. The pre-pandemic data from 2019 confirms this pattern, showing that older migrants from low- and middle-income countries in institutional care had lower mortality rates than Swedish-born elderly in similar settings. This mortality advantage has been consistently observed across various migrant populations in high-income countries, particularly among immigrants from non-Western countries. During the Covid-19 pandemic there was a reversal of the mortality advantage.

I was very surprised by this result. This represents a significant departure from typical patterns and underscores the disproportionate impact the pandemic had on migrant populations, even within Sweden's well-regulated care system. Even after controlling for prior diseases, the migrant disadvantage still persisted."

Eleonora Mussino, researcher in demography, Stockholm University

It is known from previous studies that migrants in Sweden had a higher Covid-19 mortality rate than natives, especially during the first year of the pandemic. This is sometimes explained by differences in movement and socialising patterns. That is why Eleonora Mussino and her colleagues expected that living in care settings would have a large equalising effect on mortality.

Instead, the researchers found that care settings had a slight impact, and that the difference in mortality between migrants and natives was still significant.

"We believed that everyone living in a care setting would be exposed to the same type of routines. So, it is very strange to find that some people have a disadvantage despite living in the same context with the same people," says Eleonora Mussino.

The persistence of disparities between Swedish born individuals and migrants even in highly controlled institutional settings suggests, according to the researchers, that factors beyond facility-level differences - such as systemic barriers, communication challenges, or differential treatment within the same facilities - may contribute to these inequalities.

"These results highlight the urgent need for targeted public health strategies during future pandemics that address not only institutional protocols but also within-facility equity", says Eleonora Mussino.

While the study provides crucial evidence of persistent mortality disparities across care settings, fundamental questions remain about the underlying mechanisms driving these inequalities, Eleonora Mussino explains.

"Our findings point to complex systemic factors that require interdisciplinary investigation. Only by identifying these root causes can we develop targeted interventions to ensure truly equitable pandemic preparedness across all populations, regardless of country of origin," says Eleonora Mussino.

About the study

Methods
Using Swedish total population data (2019-2022), the researchers stratified participants aged 70+ by care setting and migration status. They analysed the first pandemic year (March 2020-February 2021) and the second year (March 2021-February 2022), alongside pre-pandemic mortality data for context. Outcome measures included all deaths from Covid-19 and other causes. Cox proportional hazards models were employed adjusting for sociodemographic and health variables.

Authors
The study "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" is written by Eleonora Mussino, Sol P. Juárez, Karin Modig, Gunnar Andersson and Sven Drefahl.