# Associations between the spread of COVID-19 and end-of-life circumstances in the non-infected population of Sweden

## TL;DR

The study found that the spread of COVID-19 in Sweden led to more people dying alone and in non-hospital settings, affecting both infected and non-infected individuals.

## Contribution

The study reveals indirect effects of the pandemic on end-of-life circumstances, emphasizing the need for strategies to protect non-infected individuals.

## Key findings

- More individuals died without their next-of-kin present during the pandemic.
- A higher proportion of deaths occurred in nursing homes and at home.
- No significant associations were found with reported symptoms like anxiety or confusion.

## Abstract

Since its outbreak in 2020, the COVID-19 pandemic has directly caused the premature death of millions. However, indirect consequences, such as social restrictions, have affected a far greater number. We explored the association between the spread of COVID-19 and end-of-life circumstances in the infected and non-infected population in Sweden.

In this descriptive, population-based, observational study, we primarily used data from the Swedish National Registry of Palliative Care, which covers about 60% of all deaths in Sweden. We explored the association between the spread of COVID-19 and place of death, people present at death and end-of-life symptoms using regression analyses.

The study included 190,291 individuals who died in any region of Sweden from 1 January 2019 to 30 June 2022, of which 10,646 were COVID-19 cases. Correlated to the temporal and geographical spread of COVID-19, there was a greater proportion of individuals dying without the presence of their next-of-kin, and consequently more people dying alone, both in those with and without COVID-19. There was a similar pattern of a greater proportion of deaths taking place in nursing homes and in the individual’s own home. However, we did not find substantial associations to reported symptoms, such as anxiety or confusion.

This study shows the profound effects of the COVID-19 pandemic on end-of-life circumstances in both the infected and non-infected population in Sweden. As we prepare for future pandemics, there is a need to develop strategies to minimise the impact on non-infected individuals.