# COVID-19 disease severity in language minorities in Finland: an observational population-based register study

## TL;DR

This study found no significant differences in disease severity between hospitalized language minorities and native speakers in Finland during the early stages of the COVID-19 pandemic.

## Contribution

The study provides population-based evidence that language minorities in Finland did not experience more severe in-hospital outcomes from COVID-19 after adjusting for age and sex.

## Key findings

- Language minorities were younger and had smaller CRP changes, but differences disappeared after adjusting for age and sex.
- CRP and leukocyte count were the strongest indicators of ICU admission and severe disease.
- No significant differences in ICU admission risk or biomarker trends were found between language groups.

## Abstract

Migrants and ethnic minority populations appear to have experienced a disproportionate burden of the coronavirus disease 2019 (COVID-19) pandemic. In Finland, a foreign first language is often considered an indicator of foreign ethnicity. We investigated whether hospitalized patients with a foreign first language presented with a more severe COVID-19 upon admission to specialized health care, and if they had a similar in-hospital course of disease compared with those with a domestic first language.

We conducted a retrospective observational population-based register study, including all patients with confirmed COVID-19 infection admitted to specialized health care and intensive care units (ICUs) in the capital province of Finland between 27 February and 3 August 2020. We examined first values, peak values, and changes in laboratory parameter elevation during hospitalization among different language groups. Studied biomarkers included creatinine, alanine aminotransferase (ALAT), fibrin D-dimer, leukocyte count, thrombocytes, C-reactive protein (CRP), and lactate dehydrogenase (LDH).

First language was registered for 614 (94.9%) patients admitted to specialist care, of whom 131 (21.3%) had a foreign first language. Those with a foreign first language were younger (median 49, IQR 36.5–57, versus 62, 50–75.5, years, p < 0.001) and exhibited smaller changes in CRP (22.5, IQR 0–104.75 versus 52, IQR 7.25–125, p = 0.031). After adjustment for age and sex, none of the differences remained significant. A foreign first language did not impact the risk of ICU admission (20.1% versus 21.4%, p = 0.81). Peak leukocyte count, change in leukocyte count, and all CRP variables were the most significant indicators of ICU admission (p < 0.001 for all) and behaved similarly across language groups.

CRP and leukocyte count were the most reliable indicators of more severe COVID-19 disease presentation and ICU admission. Although those with a foreign first language were overrepresented in COVID-19 related hospitalizations, we found no significant differences in laboratory findings based on first language, implying that disease severity among hospitalized patients did not differ between language minorities and the rest of the population.

The online version contains supplementary material available at 10.1186/s12889-025-23160-x.