Lack of acculturation does not explain excess COVID-19 mortality among immigrants. A population-based cohort study

Objective. To examine how excess mortality from COVID-19 among immigrants is associated with acculturation. Methods. A cohort study was conducted using Swedish register data. The study includes all Stockholm residents in co-residential unions who were 30 years of age or older and alive on March 4th, 2020 and living in Sweden in December 2019 (n=836,390). The follow-up period was March 4 until May 7, 2020. Cox regression models were conducted to assess the association between different constellations of immigrant-native couples (measure of acculturation) and COVID-19 mortality and all other causes of deaths. Models were adjusted for relevant confounders. Results. Compared to Swedish-Swedish couples, both immigrants partnered with another immigrant and a native showed excess mortality for COVID-19 (HR 1.45; 95%CI 1.12, 1.88 and HR 1.53; 95%CI 1.15, 2.05, respectively). Moreover, similar results are found for natives partnered with an immigrant (HR 1.39; 95%CI 1.03, 1.88). Conclusions. Immigrants experience excess mortality relative to Swedes from COVID-19 across levels of acculturation. Policy implications. Public health strategies based on cultural differences might not only be inefficient but also reinforce stereotypes and health inequalities.