# Neighbourhood immigrant density and COVID-19 infection and hospitalisation among healthcare workers in Sweden: a register-based observational study

## TL;DR

This study found that healthcare workers in Sweden living in immigrant-dominated neighborhoods had a higher risk of hospitalization from COVID-19, but not infection.

## Contribution

The study identifies a link between neighborhood immigrant density and hospitalization risk for healthcare workers during the pandemic.

## Key findings

- Living in immigrant-dominated neighborhoods was not associated with increased risk of infection but with higher hospitalization risk.
- Immigrant healthcare workers had about twice the risk of hospitalization compared to non-immigrant workers in Swedish-dominated areas.
- The association between immigrant-dominated neighborhoods and hospitalization risk was consistent throughout the study period.

## Abstract

We investigated whether living in immigrant-dominated neighbourhoods constituted a risk factor for COVID-19 infection and hospitalisation among healthcare workers (HCWs) in Sweden, and if so, whether such exposure exacerbated the risk of COVID-19 among immigrant HCWs.

We used population-based register data from HCWs aged 20–62 years (N=86 187) resident in 14 Swedish municipalities (3 of which are Sweden’s largest metropolitan cities) on 1 January 2020. Residential neighbourhoods of the HCWs were categorised into three groups: Swedish-dominated, mixed and immigrant-dominated. Multilevel mixed-effects survival regression was used for the association analyses, with control for relevant confounding variables. The results are reported as HRs, with 95% CIs.

From 1 January 2020 to 30 September 2022, we recorded 39 746 COVID-19 infections and 860 COVID-19-related hospitalisations. Except during the first wave of the pandemic, living in immigrant-dominated (adjusted HR 0.98; 95% CI 0.94 to 1.01) or mixed (adjusted HR 1.02; 95% CI 0.99 to 1.05) neighbourhoods was not associated with COVID-19 infection, but living in these areas was associated with an increased risk of having COVID-19-related hospitalisation throughout the study period. Immigrant HCWs, regardless of their neighbourhood of residence, had approximately 2-fold higher risk of being hospitalised for COVID-19 than non-immigrant HCWs living in Swedish-dominated neighbourhoods.

Among HCWs in Sweden, neighbourhood immigrant density constituted a risk factor for COVID-19-related hospitalisation. However, immigrant HCWs had an elevated risk of COVID-19-related hospitalisation regardless of where they lived.